Unlocking the Truth: Evidence-Based Management of Frozen Shoulder

Adhesive Capsulitis, more commonly known as Frozen Shoulder, is as frustrating as it is painful. Characterised by a progressive loss of both active and passive shoulder motion, it typically strikes those between 40 and 60 years old. For years, the advice was to "wait it out," with some suggesting it could take up to three years to resolve. However, modern research offers a more proactive, evidence-based roadmap to recovery.

The Three Phases of "The Freeze"

Clinical evidence categorises the condition into three distinct stages:

1. Freezing (Painful): Intense pain, often worse at night.

2. Frozen (Adhesive): Pain may plateau, but stiffness becomes profound.

3. Thawing (Recovery): Gradual return of range of motion (ROM).

What the Research Actually Supports

The British Elbow & Shoulder Society and recent meta-analyses have clarified which interventions actually work:

• Corticosteroid Injections (CSI): High-level evidence suggests that a guided CSI is most effective during the early "freezing" phase. It significantly reduces inflammation and pain, providing a "window of opportunity" to begin movement.

• Supervised Physiotherapy: Research indicates that aggressive stretching during the painful phase can actually worsen symptoms. Instead, "pain-contingent" stretching—moving within a comfortable limit—is the gold standard.

• Hydrodilatation: This involves injecting saline into the joint capsule to stretch it from the inside. Trials show it can offer faster ROM improvements compared to physiotherapy alone in the "frozen" stage.

• Patient Education: Evidence shows that patients who understand the natural history of the condition (that it will eventually improve) report lower levels of distress and better functional outcomes.

The Verdict on Surgery

The UK FROST trial, one of the largest clinical studies on the topic, compared manipulation under anaesthesia (MUA), arthroscopic capsular release, and structured physiotherapy. The result? No single surgical intervention was significantly superior to another, suggesting that non-operative management remains the primary recommendation for most patients.