Shoulder Adhesive Capsulitis
The shoulder is one of the most mobile joints in the body, allowing a wide range of motion. It is made up of three bones—the upper arm bone (humerus), shoulder blade (scapula), and collarbone (clavicle)—held together by tendons, ligaments, and the joint capsule. The capsule is a soft tissue envelope that surrounds the shoulder joint, keeping it stable while allowing smooth, fluid movement. In adhesive capsulitis, this capsule becomes tight and inflamed, forming scar tissue that limits movement and causes pain.
Shoulder adhesive capsulitis, more commonly known as frozen shoulder, is a condition that causes pain, stiffness, and limited movement in the shoulder joint. It occurs when the connective tissue that surrounds the shoulder joint, called the joint capsule, becomes inflamed and thickened, restricting motion making daily life activities difficult. This condition typically develops gradually and often resolves slowly, sometimes taking months or even years to fully recover without appropriate care.
When the shoulder capsule becomes inflamed, scar tissue begins to form. As this thickened tissue builds up, the capsule tightens, reducing the space within the joint. This restricts movement and causes pain with even small motions. Over time, the shoulder muscles may weaken due to disuse, further contributing to stiffness and functional limitation.
Frozen shoulder usually develops in three stages, each with its own characteristics and duration:
- Freezing stage: This is the initial phase when shoulder movement becomes painful. Over time, the range of motion starts to decrease. This stage can last anywhere from six weeks to nine months.
- Frozen stage: During this period, pain may lessen, but stiffness and loss of motion become more pronounced. Everyday tasks such as reaching overhead, dressing, or sleeping on the affected side may be extremely difficult. This stage can last from four to six months.
- Thawing stage: The shoulder gradually regains its range of motion. This stage can take several months to over a year, depending on the individual and the treatment approach.
The primary symptoms include:
- Persistent pain in the shoulder, often worsening at night or with movement
- Stiffness that makes it difficult to move the shoulder in any direction
- Loss of both active and passive range of motion (meaning even when someone else tries to move your arm, it remains restricted)
- Difficulty performing everyday tasks such as reaching for objects, lifting the arm, or fastening a seatbelt
Pain often begins gradually and worsens over time before eventually improving. The stiffness may make simple motions like combing your hair or tucking in a shirt nearly impossible without discomfort.
The exact cause of adhesive capsulitis is not always clear, but certain factors increase the likelihood of developing it.
- Injury or surgery: Shoulder injuries such as fractures, rotator cuff tears, or surgeries that require immobilization can trigger frozen shoulder. Limited movement during the healing period can cause the capsule to stiffen and form adhesions.
- Medical conditions: People with diabetes are at significantly higher risk—up to five times more likely—to develop frozen shoulder. Other conditions such as thyroid disorders, heart disease, and Parkinson’s disease are also associated with increased risk.
- Age and gender: Adhesive capsulitis most commonly affects individuals between the ages of 40 and 60, and it occurs more frequently in women.
- Prolonged immobility: Extended periods of shoulder inactivity, whether due to an injury, surgery, or illness, can lead to stiffness and contribute to the development of frozen shoulder.
Dr. Kevin Collon, fellowship-trained in sports medicine at Keck Medicine of USC in Los Angeles, can diagnose adhesive capsulitis through a detailed physical examination and imaging studies. During the evaluation, he assesses shoulder mobility, strength, and pain patterns. X-rays are often used to rule out other possible causes such as arthritis or fractures. In some cases, an MRI may be recommended to assess the capsule and surrounding soft tissues.
If you are experiencing ongoing shoulder stiffness or pain that limits your movement, it’s important to seek evaluation from an orthopedic specialist. Early diagnosis allows for faster recovery and helps prevent long-term complications.
Without treatment, adhesive capsulitis can persist for several years, significantly affecting quality of life. Stiffness and pain can interfere with sleep, work, and daily tasks. While most people eventually regain mobility, untreated cases may lead to permanent restriction of motion or chronic discomfort. Early recognition and intervention can shorten recovery time and prevent further loss of movement.
Commitment to physical therapy and consistent stretching are key to preventing recurrence. Once healed, maintaining an active lifestyle and avoiding prolonged immobilization can help preserve shoulder health.
If you’re struggling with shoulder pain or stiffness that is affecting your daily life, Dr. Kevin Collon, fellowship-trained orthopedic sports medicine surgeon at Keck Medicine of USC in Los Angeles, California, can help. Dr. Collon specializes in diagnosing and treating shoulder conditions, including frozen shoulder, using advanced, evidence-based techniques designed to restore movement and relieve pain. Schedule your consultation today to take the first step toward regaining your mobility and returning to the activities you enjoy.
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Dr. Kevin Collon
- Fellowship-Trained Sports Medicine Surgeon
- Team Physician – LA Kings, USC Athletics
- Cutting-edge, Evidence-based Treatment
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