Physiotherapeutic Management of Adhesive Capsulitis of the Shoulder: A Narrative Review
DOI:
https://doi.org/10.12775/JEHS.2026.95.74629Keywords
physiotherapy, frozen shoulder syndrome, adhesive capsulitisAbstract
Adhesive capsulitis, also known as frozen shoulder, is a common musculoskeletal disorder characterized by progressive pain and significant limitation of both active and passive glenohumeral range of motion. The condition results from chronic inflammation, fibrosis, and contracture of the joint capsule, leading to impaired upper limb function and reduced quality of life. The prevalence in the general population is estimated at 2–5%, with a markedly higher incidence among patients with diabetes mellitus and thyroid disorders. The aim of this narrative review was to summarize current evidence regarding the pathophysiology, clinical presentation, diagnosis, and physiotherapeutic management of adhesive capsulitis. The review was based on scientific literature indexed in the PubMed and Scopus databases, with particular emphasis on recent systematic reviews, clinical guidelines, and randomized controlled trials. Current evidence indicates that physiotherapy is the cornerstone of conservative treatment. Rehabilitation should be individualized according to the stage of the disease and tissue irritability and should combine patient education, therapeutic exercise, manual therapy, and, when indicated, pharmacological interventions. During the painful stage, treatment should focus on pain reduction, preservation of shoulder mobility, and prevention of secondary functional impairments. During the stiffness stage, rehabilitation should emphasize progressive restoration of joint mobility, stretching, strengthening exercises, and neuromuscular control. Surgical treatment should be considered only in patients who do not respond to comprehensive conservative management. An evidence-based, multimodal rehabilitation approach integrating the best available scientific evidence, clinical expertise, and patient preferences appears to provide the most favorable outcomes.
References
1. Achilova F, Daher M, Nassar JE, Daniels AH, Abboud JA. Frozen shoulder: Diagnosis and treatment of adhesive capsulitis. Am J Med. 2026 May;139(5):598-605. DOI: https://doi.org/10.1016/j.amjmed.2026.01.021. Epub 2026 Jan 23. PMID: 41581632.
2. Akhtar A, Richards J, Monga P. The biomechanics of the rotator cuff in health and disease – A narrative review. Journal of Clinical Orthopaedics and Trauma. 2021;18:150–156. DOI: https://doi.org/10.1016/j.jcot.2021.04.019.
3. Bialosky JE, Bishop MD, Price DD, Robinson ME, George SZ. The mechanisms of manual therapy in the treatment of musculoskeletal pain: a comprehensive model. Man Ther. 2009 Oct;14(5):531-8. DOI: https://doi.org/10.1016/j.math.2008.09.001. Epub 2008 Nov 21. PMID: 19027342; PMCID: PMC2775050.
4. Bunker T, Anthony P. The pathology of frozen shoulder. A Dupuytren-like disease. J Bone Joint Surg Br. 1995;77-B(5):677-683. DOI: https://doi.org/10.1302/0301-620X.77B5.7559688
5. Canadian Orthopaedic Association. Position statement: Management of adhesive capsulitis. 2022.
6. Challoumas D, Biddle M, McLean M, Millar NL. Comparison of Treatments for Frozen Shoulder: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020 Dec 1;3(12):e2029581. DOI: https://doi.org/10.1001/jamanetworkopen.2020.29581. PMID: 33326025; PMCID: PMC7745103.
7. Chan HBY, Pua PY, How CH. Physical therapy in the management of frozen shoulder. Singapore Med J. 2017;58(12):685–689. DOI: https://doi.org/10.11622/smedj.2017107.
8. Crosbie J, Kilbreath SL, Hollmann L, York S. Scapulohumeral rhythm and associated spinal motion. Clin Biomech. 2008;23(2):184–192. DOI: https://doi.org/10.1016/j.clinbiomech.2007.09.012.
9. Cyriax, J.H. (1982). Textbook of Orthopaedic Medicine. Vol. 1: Diagnosis of Soft Tissue Lesions. 8th ed. London: Baillière Tindall. ISBN: 978-0702009358.
10. Doner G, Guven Z, Atalay A, Celiker R. Evaluation of Mulligan's technique for adhesive capsulitis of the shoulder: a randomized controlled trial. J Rehabil Med. 2013;45(1):87–91. DOI: https://doi.org/10.2340/16501977-1077.
11. Edmond SL. Joint Mobilization/Manipulation: Extremity and Spinal Techniques. 2nd ed. St. Louis: Mosby; 2006. DOI: https://doi.org/10.1016/B978-0-323-02726-7.X5001-0
12. Georgiannos D, Markopoulos G, Devetzi E, Bisbinas I. Adhesive Capsulitis of the Shoulder. Is there Consensus Regarding the Treatment? A Comprehensive Review. Open Orthopaedics Journal. 2017;11:65–76. DOI: https://doi.org/10.2174/1874325001711010065.
13. Grant JA, Schroeder N, Miller BS, Carpenter JE. Comparison of manipulation and arthroscopic capsular release for adhesive capsulitis. Journal of Shoulder and Elbow Surgery. 2013;29(6):1135–1145. DOI: https://doi.org/10.1016/j.jse.2013.01.010
14. Halder AM, Itoi E, An KN. Anatomy and biomechanics of the shoulder. Orthop Clin North Am. 2000 Apr;31(2):159-76. DOI: https://doi.org/10.1016/s0030-5898(05)70138-3. PMID: 10736387.
15. Hand GCR, Athanasou NA, Matthews T, Carr AJ. The pathology of frozen shoulder. J Bone Joint Surg Br. 2007;89-B(7):928-932. DOI: https://doi.org/10.1302/0301-620X.89B7.19097.
16. Herbert RD, Jamtvedt G, Mead J, Hagen KB. Practical Evidence-Based Physiotherapy. 3rd ed. Elsevier; 2022.
17. Hsu JE, Anakwenze OA, Warrender WJ, Abboud JA. Current review of adhesive capsulitis. J Shoulder Elbow Surg. 2011;20(3):502–514. DOI: https://doi.org/10.1016/j.jse.2010.08.023.
18. Hunt SA, Kwon YW, Zuckerman JD. The rotator interval: anatomy, pathology, and strategies for treatment. J Am Acad Orthop Surg. 2007 Apr;15(4):218-27. DOI: https://doi.org/10.5435/00124635-200704000-00005. PMID: 17426293.
19. Itoi E, Arce G. Shoulder stiffness: current concepts and concerns. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2015;31(7):1402–1414. DOI: https://doi.org/10.1016/j.arthro.2014.12.024.
20. Joel E. Bialosky, Jason M. Beneciuk, Mark D. Bishop, Rogelio A. Coronado, Charles W. Penza, Corey B. Simon, and Steven Z. George. Journal of Orthopaedic & Sports Physical Therapy 2018 48:1, 8-18 10.2519/jospt.2018.7476
21. Kaltenborn FM. Manual Mobilization of the Joints. Vol. I. 6th ed. Oslo: Olaf Norlis Bokhandel; 2003.
22. Kelley MJ, McClure PW, Leggin BG. (2009). Frozen shoulder: evidence and a proposed model guiding rehabilitation. Journal of Orthopaedic & Sports Physical Therapy, 39(2), 135–148. https://doi.org/10.2519/jospt.2009.2916.
23. Kelley MJ, Shaffer MA, Kuhn JE, et al. Shoulder Pain and Mobility Deficits: Adhesive Capsulitis. J Orthop Sports Phys Ther. 2013;43(5):A1–A31. DOI: https://doi.org/10.2519/jospt.2013.0302.
24. Kibler WB, Ludewig PM, McClure PW, et al. Clinical implications of scapular dyskinesis in shoulder injury. Br J Sports Med. 2013;47(14):877–885. DOI: https://doi.org/10.1136/bjsports-2013-092425.
25. Kingston K, Curry EJ, Galvin JW, Li X. Shoulder adhesive capsulitis: epidemiology and predictors of surgery. J Shoulder Elbow Surg. 2018 Aug;27(8):1437-1443. DOI: https://doi.org/10.1016/j.jse.2018.04.004. Epub 2018 May 25. PMID: 29807717.
26. Kivimäki J, Pohjolainen T, Malmivaara A, et al. Manipulation under anesthesia with home exercises versus home exercises alone in the treatment of frozen shoulder: a randomized controlled trial. J Shoulder Elbow Surg. 2007;16(6):722–726. DOI: https://doi.org/10.1016/j.jse.2007.02.125.
27. Le HV, Lee SJ, Nazarian A, Rodriguez EK. Adhesive capsulitis of the shoulder: review of pathophysiology and current clinical treatments. Shoulder Elbow. 2017 Apr;9(2):75-84. DOI: https://doi.org/10.1177/1758573216676786. Epub 2016 Nov 7. PMID: 28405218; PMCID: PMC5384535.
28. Lewis J. Frozen shoulder contracture syndrome – Aetiology, diagnosis and management. Man Ther. 2015;20(1):2–9. DOI: https://doi.org/10.1016/j.math.2014.07.006.
29. Lho YM, Ha E, Cho CH, et al. Inflammatory cytokines are overexpressed in the subacromial bursa and capsule of patients with frozen shoulder. Journal of Shoulder and Elbow Surgery. 2013;22(5):666–672. DOI: https://doi.org/10.1016/j.jse.2012.06.014.
30. Ludewig PM, Reynolds JF. The association of scapular kinematics and glenohumeral joint pathologies. J Orthop Sports Phys Ther. 2009;39(2):90–104. DOI: https://doi.org/10.2519/jospt.2009.2808.
31. Maitland GD, Hengeveld E, Banks K, English K. Maitland's Vertebral Manipulation. 7th ed. Oxford: Elsevier; 2005.
32. Michener LA, McClure PW, Sennett BJ. American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: reliability, validity, and responsiveness. J Shoulder Elbow Surg. 2002;11(6):587–594. DOI: https://doi.org/10.1067/mse.2002.127096.
33. Mulligan BR. Manual Therapy: NAGS, SNAGS, MWMS. 6th ed. Wellington: Plane View Services; 2010.
34. Myers JB, Lephart SM. The role of the sensorimotor system in the athletic shoulder. J Athl Train. 2000 Jul;35(3):351-63. PMID: 16558648; PMCID: PMC1323397.
35. Nicholas, M., Vlaeyen, J. W. S., Rief, W., Barke, A., Aziz, Q., Benoliel, R., Cohen, M., Evers, S., Giamberardino, M. A., Goebel, A., Korwisi, B., Perrot, S., Svensson, P., Wang, S.-J., Treede, R.-D., & IASP Taskforce for the Classification of Chronic Pain (2019). The IASP classification of chronic pain for ICD-11: chronic primary pain. Pain, 160(1), 28-37. https://doi.org/10.1097/j.pain.0000000000001390
36. Page MJ, Green S, Kramer S, et al. Manual therapy and exercise for adhesive capsulitis (frozen shoulder). Cochrane Database Syst Rev. 2014;(8). DOI: https://doi.org/10.1002/14651858.CD011275.
37. Petchprapa CN, Beltran LS, Jazrawi LM, i wsp. The rotator interval: a review of anatomy, function, and normal and abnormal MRI appearance. American Journal of Roentgenology. 2010;195(3):567–576. DOI: https://doi.org/10.2214/AJR.10.4406.
38. Reeves B. The natural history of the frozen shoulder syndrome. Scand J Rheumatol. 1975;4(4):193–196. DOI: https://doi.org/10.3109/03009747509165255.
39. Rodeo SA, Hannafin JA, Tom J, Warren RF, Wickiewicz TL. Immunolocalization of cytokines and their receptors in adhesive capsulitis of the shoulder. J Orthop Res. 1997;15(3):427–436. DOI: https://doi.org/10.1002/jor.1100150316.
40. Sarasua SM, Floyd S, Bridges WC, Pill SG. The epidemiology and etiology of adhesive capsulitis in the U.S. Medicare population. BMC Musculoskelet Disord. 2021;22:828. DOI: https://doi.org/10.1186/s12891-021-04704-9.
41. Snow M, Boutros I, Funk L. Posterior arthroscopic capsular release in frozen shoulder. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2009;25(1):19–23. DOI: https://doi.org/10.1016/j.arthro.2008.08.010.
42. Stausholm MB, Naterstad IF, Joensen J, et al. Efficacy of low-level laser therapy on pain and disability in knee osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials. BMJ Open 2019;9:e031142. DOI: https://doi.org/10.1136/ bmjopen-2019-031142
43. Sugamoto K, Harada T, Machida A, i wsp. Scapulohumeral rhythm: relationship between motion velocity and rhythm. Clinical Orthopaedics and Related Research. 2002;(401):119–124. DOI: https://doi.org/10.1097/00003086-200208000-00014.
44. Sun Y, Lu S, Zhang P, Wang Z, Chen J. Steroid injection versus physiotherapy for adhesive capsulitis: systematic review and meta-analysis. Medicine 95(20):p e3469, May 2016. | DOI: https://doi.org/10.1097/MD.0000000000003469
45. Vermeulen HM, et al. End-Range Mobilization Techniques in Adhesive Capsulitis of the Shoulder Joint: A Multiple-Subject Case Report, Physical Therapy. 2000;80(12):1204-1213. doi.org/10.1093/ptj/80.12.1204.
46. Wong CK, Levine WN, Deo K, et al. Natural history of frozen shoulder: fact or fiction? A systematic review. Physiotherapy. 2017;103(1):40–47. DOI: https://doi.org/10.1016/j.physio.2016.05.009.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Wojciech Garczyński, Oliwer Andrysiak
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
Stats
Number of views and downloads: 14
Number of citations: 0
