Frozen shoulder, medically known as adhesive capsulitis, is a debilitating condition characterized by progressive pain and global restriction of both active and passive shoulder movement. The disorder results from inflammation, thickening, and fibrosis of the glenohumeral joint capsule, leading to reduced joint volume and severe motion limitation. Frozen shoulder may arise spontaneously (primary adhesive capsulitis) or secondary to trauma, surgery, or prolonged immobilization.

The condition most commonly affects individuals between 40 and 60 years of age and is more prevalent in patients with metabolic disorders, particularly diabetes. The natural history of frozen shoulder is classically divided into three overlapping stages: the painful freezing stage, the stiff frozen stage, and the recovery thawing stage. Each stage may last several months, and the overall course can extend over one to two years.

Patients initially present with gradually increasing shoulder pain that is often poorly localized and worse at night. As pain progresses, patients experience increasing difficulty with overhead activities, reaching behind the back, dressing, and grooming. Unlike other shoulder conditions, both active and passive range of motion are restricted, which is a key diagnostic feature.

Orthopaedic evaluation includes careful clinical examination to document global motion loss in all planes. External rotation is typically the most severely affected movement. Strength testing may appear reduced due to pain and stiffness rather than true muscle weakness. Imaging is primarily used to exclude alternative diagnoses such as rotator cuff tears or arthritis.

Management of frozen shoulder is primarily non-operative and focuses on pain control and gradual restoration of motion. Treatment must be individualized based on disease stage. Aggressive stretching during the painful stage may worsen symptoms, whereas controlled mobilization becomes more important as pain subsides. Patient education regarding the prolonged but self-limiting nature of the condition is essential.

Adjunctive treatments may be used to facilitate pain relief and improve participation in rehabilitation. Most patients improve with structured conservative care, although recovery is often slow and requires patience and adherence to therapy.

Surgical intervention is reserved for refractory cases where stiffness and pain persist despite prolonged conservative treatment. Surgical objectives include capsular release to restore joint mobility. Postoperative rehabilitation is critical to maintain gains in motion.

Frozen shoulder requires careful orthopaedic management, staged treatment, and realistic expectation setting to restore shoulder function and minimize long-term disability.