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Capsulitis / Frozen Shoulder

Capsulitis / Frozen Shoulder


The shoulder, as outlined previously, is a ball-and-socket joint which enables a great deal of mobility but also suffers from great instability. As in other joints in the human body, there is a layer which surrounds the joint as a whole forming the joint capsule and which stabilises the joint among other features.

Adhesive capsulitis, more commonly known as frozen shoulder, is a process which is characterised by the swelling and retraction of this joint capsule, causing pain and above all restricted shoulder movement.


Primary or idiopathic capsulitis:

Currently the aetiology of this complaint is not known. However, it is known that it affects women more than men and that the disorder rarely occurs in the under-40s or the over-60s. Adhesive capsulitis tends to occur alone and to be a long process evolving over between 12 and 24 months depending on the treatment provided. Very rarely and after some time it may occur in the counter-lateral joint and never on the same side.

There are certain factors which influence the onset of adhesive capsulitis:

Metabolic and endocrinal diseases: Bridgman (1972) identified a significant increase in adhesive capsulitis in patients with diabetes, especially in insulin-dependent patients.

Prolonged immobilisation of the shoulder: following shoulder surgery or other operations such as breast surgery.

High level of triglycerides.

Secondary capsulitis:

This is a complication of other processes: calcifying tendinopathy, surgery, trauma injuries with or without fractures, etc.


The onset of the disease is insidious and there is no known trigger factor. First there is increasing pain, due to a swollen capsule, and then increasingly constrained movement which compromises regular everyday actions.

The disease tends to spread in phases and when it is not treated it may even be two years before spontaneous restitution takes place.

Phase I (1-4 months): this phase is characterised by progressive pain which spreads and gradually constrains mobility.

Phase II (5-8 months): relative persistence of the complaint with pain at night and at rest and general constrained mobility.

Phase III (9-12 months): in this phase the pain eases but movement is still limited.


In the first phase the treatment will only involve pain relief with pharmaceutical resources, and physiotherapy, using pain relief techniques such as TENS (Transcutaneous Electrical Nerve Stimulation), ultrasound scans, acupuncture, myofascial release therapy, etc. Later on there will be mobilization and hydrotherapy. It is very important that nothing that is undertaken in general or by the physiotherapist increases the pain as this would result in a greater spasm in the joint capsule. In this pathology the concept “no pain no gain” is not the case.

In rare cases, surgical treatment may be used yet only in cases where patients suffer limited mobility despite having undergone a long period of conservative treatment (12 months). The surgery, known as "arthrolysis", involves a series of therapeutic actions such as capsulotomy, debridement and surgical removal of adhesions under arthroscopic control, ending with forced mobility under anaesthetics and followed up with a specific prolonged rehabilitation programme. The application of platelet-rich plasma in these surgical operations seeks to improve the healing process and the anti-inflammatory and anti-fibrosis effect as in other surgery.