Adhesive capsulitis

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 3 Aug 2025

Last updated: 24 Feb 2023

Adhesive capsulitis affects 2% to 5% of the population. It is slightly more common in women than in men, and is most common in people between 40 and 70 years of age.

Recent history of traumatic shoulder injury, prior surgery to affected shoulder, diabetes mellitus, thyroid disease, and previous history of adhesive capsulitis are all risk factors for developing adhesive capsulitis.

Mainstay of treatment is physical therapy and observation. Evidence shows that nonsteroidal anti-inflammatory drugs and injected corticosteroids may also be beneficial.

Refractory cases may require a surgical capsular release. This can be performed reliably and satisfactorily with arthroscopic techniques.

Definition

Adhesive capsulitis is a chronic fibrosing condition characterized by insidious and progressive severe restriction of both active and passive shoulder range of motion, in the absence of a known intrinsic disorder of the shoulder. It is generally regarded as a self-limited condition that usually resolves within 18 to 24 months. However, some reports have indicated that many patients can have residual pain and limited range of motion lasting several years.[1][2][3]

A poor understanding of the pathogenesis of adhesive capsulitis underpins the continued debate regarding the best treatment strategies.[3] There is a paucity of good-quality randomized controlled trials that help guide clinicians by providing a stepwise and systematic treatment algorithm.[4] However, one critical review of available evidence found that most interventions, including nonoperative treatments, are designed to mitigate or alleviate symptoms, speed up recovery, and reduce the duration of painful symptoms and limited range of motion.[5]

History and exam

Key diagnostic factors

shoulder stiffness
decreased shoulder active range of motion
decreased shoulder passive range of motion
positive coracoid pain test
positive shoulder shrug test

Full details

Other diagnostic factors

shoulder pain
alternative diagnosis not suggested by provocative maneuvers
negative Spurling maneuver (to exclude cervical spine radiculopathy)
negative Hawkins test (to exclude rotator cuff impingement)
negative Neer test (to exclude shoulder impingement)
negative Speed test (to exclude superior labrum from anterior to posterior [SLAP] tear)
negative O'Brien test (to exclude superior labrum from anterior to posterior [SLAP] lesion)
negative Yergason test (to exclude proximal biceps tendon pathology)
negative apprehension test (to exclude anterior shoulder instability)
negative relocation test (to further exclude anterior shoulder instability)
negative Kim test (to exclude posteroinferior labral lesion of the shoulder)

Full details

Risk factors

age 40 to 70 years
diabetes mellitus
prior history of adhesive capsulitis
shoulder pain and immobilization
previous shoulder surgery
female sex
thyroid disease

Full details

Diagnostic tests

1st tests to order

plain film radiographs
ultrasound

Full details

Tests to consider

MRI/MR arthrogram shoulder
CT arthrogram

Full details

Treatment algorithm

ACUTE

all patients

Contributors

Authors

Matthew T. Provencher, MD, CAPT MC USNR

Complex Shoulder Knee and Sports Surgery

The Steadman Clinic

Steadman Philippon Research Institute

Vail

Disclosures

MTP is a consultant for Arthrex and Joint Restoration Foundation. MTP receives royalties from Arthrex and has received an honorarium from Arthrosurface. He receives research funding from Vail Health and Steadman Philippon Research Institute.

Lance LeClere, MD, LCDR MC USN

Staff Surgeon

Team Physician

Orthopaedic Sports Medicine and Shoulder Surgery

Naval Health Clinic

US Naval Academy

Annapolis

Disclosures

LL declares that he has no competing interests.

Jennifer Smith, MD, LCDR MC USN

Staff Surgeon

Orthopaedic Sports Surgery

Naval Medical Center San Diego

San Diego

Disclosures

JS declares that she has no competing interests.

Peer reviewers

Matthew Busam, MD

Orthopedic Surgeon

Cincinnati Sports Medicine Research and Education Foundation

Cincinnati

Disclosures

MB declares that he has no competing interests.

Daniel Solomon, MD

Co-Director of Orthopedic Sports and Shoulder Service

Department of Orthopedic Surgery

Naval Medical Center San Diego

San Diego

Disclosures

DS declares that he has no competing interests.

Steven Corbett, BSc, PhD, FRCS (Tr & Orth)

Consultant Orthopaedic Surgeon

Guy's and St Thomas’ Hospital NHS Foundation Trust

London

Disclosures

SC declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Griggs SM, Ahn A, Green A. Idiopathic adhesive capsulitis: a prospective functional outcome study of nonoperative treatment. J Bone Joint Surg Am. 2000 Oct;82(10):1398-407. Abstract

Shaffer B, Tibone JE, Kerlan RK. Frozen shoulder: a long-term follow-up. J Bone Joint Surg Am. 1992 Jun;74(5):738-46. Abstract

Hannafin JA, Chiaia TA. Adhesive capsulitis: a treatment approach. Clin Orthop Relat Res. 2000 Mar;(372):95-109. Abstract

Tighe CB, Oakley WS Jr. The prevalence of a diabetic condition and adhesive capsulitis of the shoulder. South Med J. 2008 Jun;101(6):591-5. Abstract

Page MJ, Green S, Kramer S, et al. Manual therapy and exercise for adhesive capsulitis (frozen shoulder). Cochrane Database Syst Rev. 2014 Aug 26;(8):CD011275.Full text Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Posterior glenohumeral dislocation
- Rotator cuff injury
- Subacromial rotator cuff impingement
More Differentials
Guidelines
- ACR appropriateness criteria: chronic shoulder pain
More Guidelines
Patient information
Rotator cuff injury
More Patient information
Log in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer

Adhesive capsulitis

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Treatment algorithm

all patients

Contributors

Authors

Matthew T. Provencher, MD, CAPT MC USNR

Disclosures

Lance LeClere, MD, LCDR MC USN

Disclosures

Jennifer Smith, MD, LCDR MC USN

Disclosures

Peer reviewers

Matthew Busam, MD

Disclosures

Daniel Solomon, MD

Disclosures

Steven Corbett, BSc, PhD, FRCS (Tr & Orth)

Disclosures

Peer reviewer acknowledgements

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice