Adhesive Capsulitis (Frozen Shoulder)

Types

1. Primary Adhesive Capsulitis

• No clear external cause

• Occurs from inflammation in the body that leads to fibrosis (scarring) of the shoulder joint capsule

• Often occurs alongside with other systemic conditions such as diabetes or thyroid disorders

• Is thought to occur due to systemic inflammation or autoimmune responses

2. Secondary Adhesive Capsulitis

• Occurs from distinct external causes such as:

  • Trauma, surgery, or prolonged immobilization of the shoulder

• These events lead to stiffening of the joint capsule

Can also be classified as:

High irritability

• High pain level

• Frequent pain at night and/or at rest

• Pain throughout shoulder movement (at start and beginning of range)

• AROM is smaller than PROM

• Unable to determine end feel during PROM due to pain

Moderate irritability

• Moderate pain level

• Occasional pain at night and/or at rest

• Pain at end of AROM and PROM

• AROM and PROM are almost equal

Low irritability

• Lower pain level

• No pain at night and at rest

• Pain at end of PROM

• AROM and PROM are equal

Treatment Ideas Based on High/Moderate/Low Irritability

High irritability

• AAROM w/ dowel in pain-free range

• AROM exercises in all planes

• Proprioceptive Neuromuscular Facilitation (PNF)

  • Therapist performs PROM to end range

  • Patient then gently contracts in opposite direction of PROM for around 5 seconds and then relaxes

  • Therapist then gently performs PROM to the slightly increased range

  • Repeat 3-5 times

• Encourage use functional use as tolerated

Moderate irritability

• Gentle joint mobilizations with an increased hold at end range

• AROM exercises in all planes - increase difficulty as patient gains strength overtime

• PNF

• Neuromuscular re-education activities such as mirror therapy, wall push-ups, serratus punches, scapular retraction

• Encourage use functional use as tolerated

Low irritability

• Joint mobilizations with an increased hold at end range

• PNF

• Frequent self-stretching

• AROM exercises in all planes - increase difficulty as patient gains strength overtime

• Neuromuscular re-education activities

• Encourage use functional use as tolerated

References

Li, D., St Angelo, J. M., & Taqi, M. (2025). Adhesive capsulitis (Frozen shoulder). In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK532955/

Mertens, M. G., Meeus, M., Verborgt, O., Vermeulen, E. H. M., Schuitemaker, R., Hekman, K. M. C., Van Der Burg, D. H., & Struyf, F. (2022). An overview of effective and potential new conservative interventions in patients with frozen shoulder. Rheumatology International, 42(6), 925–936. https://doi.org/10.1007/s00296-021-04979-0