Written by: Editorial Team of Dr Ayyappan V Nair
Medically Reviewed by: Dr. Ayyappan V. Nair
Senior Consultant – Shoulder Surgery, Arthroscopy and Sports Trauma
Manipal Hospitals, Bangalore
Last Reviewed: 8th August 2026
Frozen shoulder, medically known as adhesive capsulitis, is a painful condition characterized by progressive stiffness and restriction of shoulder movement. The condition affects the shoulder joint capsule, which becomes inflamed, thickened, and contracted. Fibrotic changes and adhesions within the capsule contribute to pain and loss of movement [1].
Frozen shoulder commonly affects adults between 40 and 60 years of age and is more frequently seen in women. Diabetes mellitus and thyroid disorders are important associated risk factors. The condition may also develop after shoulder injury, surgery, or prolonged immobilization [1].
Symptoms
The most common symptoms are gradually increasing shoulder pain, progressive stiffness, difficulty with overhead activities, and reduced ability to perform everyday tasks such as dressing, bathing, grooming, and reaching behind the back. Night pain may significantly affect sleep [1].
A characteristic clinical feature is restriction of both active and passive range of motion. External rotation is often affected early and may become markedly restricted as the condition progresses [1].
Diagnosis
The diagnosis of adhesive capsulitis is primarily clinical and is based on the patient’s history and physical examination. Imaging is generally used to exclude other causes of shoulder pain and stiffness rather than to confirm every case of frozen shoulder [1].
Plain X-rays may be used to rule out arthritis, fracture, calcific tendinopathy, or other bony abnormalities. MRI is not routinely required when the clinical presentation is typical, but it may be useful when an associated rotator cuff tear, labral injury, or another shoulder disorder is suspected [1].
Treatment
Dr Ayyappan V Nair, considered the best shoulder surgeon in India says that the treatment is individualized according to the stage of the condition, severity of pain, degree of stiffness, functional limitation, and associated medical conditions.
Physiotherapy
Physiotherapy and a structured home-exercise program are important components of treatment. The intensity of rehabilitation should be adjusted according to the patient’s symptoms and stage of disease. During the painful phase, aggressive stretching may increase discomfort, whereas gentle, pain-limited exercises may be more appropriate [1,2].
Corticosteroid Injection
Intra-articular corticosteroid injection may provide short-term improvement in pain and shoulder function, particularly during the early painful stage. Pain relief may also help patients participate more effectively in physiotherapy [2,3].
Evidence suggests that corticosteroid injection and physiotherapy should not necessarily be viewed as competing treatments. In appropriately selected patients, combining pain-relieving interventions with rehabilitation may provide additional benefits in pain, range of motion, and shoulder function [2].
Surgical Treatment
Most patients are initially treated without surgery. Manipulation under anaesthesia or arthroscopic capsular release may be considered when significant pain and stiffness persist despite an adequate course of appropriate conservative treatment [1].
Arthroscopic capsular release involves the controlled division of the contracted shoulder capsule using minimally invasive techniques. It may improve pain, shoulder movement, and function in carefully selected patients with persistent or refractory stiffness [5].
References
[1] Vita F, Pederiva D, Tedeschi R, et al. Adhesive capsulitis: the importance of early diagnosis and treatment. Journal of Ultrasound. 2024;27(3):579–587. doi:10.1007/s40477-024-00891-y.
[2] Hill JL. Evidence for Combining Conservative Treatments for Adhesive Capsulitis. Ochsner Journal. 2024;24(1):47–52. doi:10.31486/toj.23.0128.
[3] Sun Y, et al. Steroid Injection Versus Physiotherapy for Patients With Adhesive Capsulitis of the Shoulder: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Medicine. 2016.
[4] Lin CL, Chuang TY, Lin PH, et al. The comparative effectiveness of combined hydrodilatation/corticosteroid procedure with two different quantities for adhesive capsulitis. Clinical Rehabilitation. 2024;38(5):600–611. doi:10.1177/02692155241227607.
[5] Pasqualini I, et al. Establishing the Minimal Clinically Important Difference and Patient Acceptable Symptom State Thresholds Following Arthroscopic Capsular Release for the Treatment of Idiopathic Shoulder Adhesive Capsulitis. Arthroscopy. 2024;40(4):1081–1088. doi:10.1016/j.arthro.2023.08.083.
OUR FINDINGS:
Dr Ayyappan V Nair et al.Outcomes of Clinico-radiologically Predetermined Patient-specific Multi-site Steroid Injection in Primary Frozen Shoulder: A Prospective Study
94 patients with primary FS, confirmed via ultrasound and X-ray, received intra-articular and multisite betamethasone injections. Statistically significant improvements were observed: mean abduction increased from 124° to 173° (P = 0.001), forward flexion from 123° to 174° (P = 0.040), and external rotation from 26° to 55° (P = 0.009). The mean ASES score improved from 28.8 to 92.5 (P = 0.001), VAS decreased from 6.7 to 0.4, and internal rotation improved by 4 vertebral levels
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