Capsulitis, also known as “frozen shoulder” or adhesive capsulitis, affects the glenohumeral joint, the main ball-and-socket joint of the shoulder. It is characterized by pain and a progressive loss of both active and passive range of motion. This stiffness arises because the connective tissue capsule surrounding the joint becomes inflamed, thickens, and tightens around the head of the humerus, restricting movement. The condition is self-limiting, meaning it eventually resolves on its own, though the process is lengthy.
The Three Phases of Recovery
Adhesive capsulitis progresses sequentially through distinct stages. The first stage is the “freezing” or painful stage, marking the onset of the condition. This initial phase, lasting from six weeks up to nine months, involves increasing pain with movement and a gradual decrease in range of motion. Discomfort often worsens at night, making sleep difficult.
Following this is the “frozen” or stiff stage, where pain may subside, but shoulder stiffness reaches its maximum. This phase, typically lasting four to 12 months, significantly restricts motion, making daily tasks challenging. The final phase, known as “thawing” or resolution, involves a gradual return of motion as the joint capsule slowly loosens and function improves. This resolution phase can last anywhere from five months up to two years, with the total duration of the entire process ranging from one to three years.
Essential Non-Surgical Management Strategies
While capsulitis resolves naturally, active interventions manage symptoms and potentially shorten recovery time. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are commonly used to reduce pain and inflammation, especially during the initial “freezing” phase. Managing pain allows the patient to better tolerate physical activities that maintain motion.
Physical therapy is a core component of management, with goals shifting based on the stage. In the early, painful stages, the focus is on gentle, passive range-of-motion exercises to control pain and maintain existing mobility. As the patient transitions into the “frozen” and “thawing” phases, therapy progresses to include more aggressive stretching and mobilization techniques to restore functional movement.
Corticosteroid injections deliver powerful anti-inflammatory medicine directly into the joint. These injections are most effective when administered early during the highly inflamed “freezing” phase, targeting the synovitis that causes intense pain. They provide rapid pain relief lasting several weeks, facilitating participation in physical therapy. Procedures like hydrodilatation, which involves injecting fluid into the joint to stretch the capsule, are sometimes utilized when symptoms do not respond to conservative methods.
Predicting Recovery Timelines and Long-Term Outlook
The total recovery timeline is highly variable, ranging from six months to three years, depending on individual and clinical factors. A significant factor influencing the duration and severity of the condition is the presence of underlying health issues.
Individuals with diabetes, for example, have an increased risk of developing capsulitis and often experience a prolonged or more severe course. Poorly controlled blood sugar levels are thought to impair tissue repair, potentially extending the time spent in the “frozen” stage. Other factors affecting recovery include the patient’s age, the severity of the initial stiffness, and consistent adherence to the prescribed physical therapy regimen.
The long-term outlook is positive for the majority of patients, with research indicating most people regain 90 to 95 percent of their shoulder function. Recurrence in the same shoulder is uncommon. However, the condition may develop later in the opposite shoulder, a risk that is slightly higher for people with pre-existing conditions like diabetes.