Retractile capsulitis affects approximately 2 to 5% of the general population. This figure rises to 10-38% among people with diabetes. Here's the good news: in more than 90% of cases, capsulitis can be treated without surgery. Your shoulder is not permanently "frozen." It is going through a difficult phase that will eventually resolve itself. You will learn why this condition occurs, how it progresses, and how to regain your mobility.

What is adhesive capsulitis, and why is it called frozen shoulder?

Adhesive capsulitis is an inflammation of the shoulder joint capsule that causes progressive fibrosis, resulting in severe pain and significant loss of mobility. It is called "frozen shoulder" because the joint gradually becomes stiff.

The joint capsule is a layer of tissue that surrounds the joint and holds the arm bone in place. In capsulitis, it becomes inflamed, then thickens and contracts, losing its elasticity.

Between 2 and 5% of adults will develop capsulitis, with a peak between the ages of 40 and 60. Women are 1.4 to 4 times more likely to be affected, possibly due to menopause.

Now that you understand how the capsule becomes rigid, let's see how this condition progresses.

What are the three phases of capsulitis and how long do they last?

Capsulitis progresses in three distinct phases: the painful phase (2-9 months) where pain dominates, the stiffness phase (4-12 months) where mobility is greatly reduced, and the recovery phase (6-24 months) where the shoulder gradually regains its function. The total duration varies from 12 to 36 months depending on the individual.

Phase 1: Painful (freezing) - Intense pain that gradually worsens, especially at night. Inflammation makes the capsule hypersensitive. Phase 2: Stiffness (frozen) - Pain decreases, but stiffness reaches its maximum. Passive movements are as limited as active movements. Phase 3: Thawing - Mobility is gradually returning. People with diabetes generally take longer to recover.

Research suggests that some limitations are "neurological": patients under anesthesia regained greater range of motion, suggesting that the nervous system sometimes protects the shoulder excessively.

Now that you understand how capsulitis develops, let's look at how to recognize it.

What are the symptoms of capsulitis and how can it be recognized?

The main symptoms of capsulitis are intense shoulder pain that worsens at night, followed by a gradual loss of mobility. The movements most affected are external rotation and arm elevation, making everyday tasks such as putting on a coat or fastening a bra difficult.

The pain appears gradually, without trauma. It is localized in the shoulder and is particularly intense at night. Stiffness sets in gradually, affecting first external rotation, then elevation and internal rotation.

Daily activities become difficult: putting on a coat, fastening a bra, washing your back, combing your hair, or fastening your seatbelt.

One reassuring factor is that capsulitis follows a predictable pattern. This predictability leads us to explore why it occurs.

[CTA_NEWSLETTER]

What causes capsulitis and who is at risk?

The exact cause of capsulitis often remains unknown (idiopathic). The main risk factors are diabetes (3 times higher risk), prolonged immobilization of the shoulder, recent surgery, and certain conditions such as hypothyroidism. Women aged 40-60 are most affected.

In 50% of cases, capsulitis develops without any triggering factor ("primary" capsulitis). In the other 50%, it occurs after immobilization, minor trauma, or in the context of medical conditions ("secondary" capsulitis).

Diabetes is the most significant risk factor, with a threefold increase in risk. Between 10 and 38 percent of people with diabetes will develop frozen shoulder, compared to 2–5 percent of the general population. If you develop capsulitis without any apparent cause, your doctor should check your blood sugar levels.

Other risk factors: hypothyroidism, immobilization (fracture, surgery), age 40-60, female gender (1.4 to 4 times higher risk). Approximately 15% will develop the condition in the other shoulder within the next five years.

Now let's see how your healthcare provider confirms the diagnosis.

How is shoulder capsulitis diagnosed?

The diagnosis of capsulitis is based primarily on symptom history and clinical examination. The professional assesses active and passive mobility in all directions. Significant limitation in passive external rotation distinguishes capsulitis from other conditions. Imaging is generally not necessary, except to rule out other causes.

The pattern of gradual onset, intense nighttime pain, and loss of mobility points to capsulitis. The key examination: in capsulitis, both active AND passive mobility are limited, which distinguishes it from tendinopathy (where passive mobility remains normal).

X-rays can rule out other causes, but do not show capsulitis. MRI is usually not necessary.

Once the diagnosis has been confirmed, let's look at how to treat this condition.

How does physical therapy treat shoulder capsulitis?

Physical therapy treats capsulitis through progressive joint mobilization, exercises tailored to each phase, and coordination with medical treatments such as cortisone injections. The treatment aims to reduce pain, maintain mobility, and speed up recovery. The combined approach of physical therapy and injections yields the best results, with a success rate of 90%.

Phase 1 (painful) Pain management. Exercises within a comfortable range of motion. Aggressive stretching aggravates inflammation. Cortisone injections are particularly effective. Phase 2 (stiffness) : Progressive stretching becomes essential. Mild pain during exercises is acceptable. Mobilization becomes more vigorous. Distension arthrography (fluid injection) is an option for refractory cases. Phase 3 (recovery) : Strengthening and gradual return to activities.

The best evidence supports a combined approach: physical therapy AND injections. Approximately 90% of patients improve with conservative treatment. Surgery is only considered in rare cases that remain refractory after 6-12 months.

For more information, see our comprehensive guide to physical therapy for shoulder pain.

Now let's see how long it takes to heal.

[CTA_Appointment]

How long does it take to recover from capsulitis, and what are the chances of a full recovery?

Complete recovery from capsulitis takes an average of 18 to 24 months, sometimes up to 30 months. Approximately 70% of patients regain full mobility. With a combination of physical therapy and injections, significant improvement often occurs within 3 to 6 months. People with diabetes generally have a longer recovery time.

This duration may seem discouraging. Capsulitis tests your patience. Without treatment, it follows its natural course over 18 to 24 months, sometimes up to 3 years. With appropriate treatment, you will notice a significant improvement between 3 and 6 months.

Approximately 70% regain full mobility. Approximately 30% retain minor limitations that do not interfere with daily activities.

Factors influencing recovery: diabetes (longer recovery), early treatment, and adherence to exercises.

Capsulitis almost always resolves itself. It's a matter of time, not "if." Your shoulder is not permanently damaged.

To better understand the causes of shoulder pain, check out our comprehensive guide to shoulder pain.

What can you do at home to help yourself?

What can be done at home to relieve capsulitis?

At home, gentle mobility exercises tailored to your phase are essential. During the painful phase, move without straining. During the stiffness phase, stretch gradually. Also adopt suitable sleeping positions and support your arm with pillows to reduce nighttime pain.

Phase 1 (painful) Move within a comfortable range of motion. Pendulum exercises: lean forward, let your arm hang down, and make small circles. Avoid aggressive stretching at all costs. Phase 2 (stiffness) : Progressive stretching becomes important. "Wall walk": facing the wall, walk your fingers upward, hold for 20-30 seconds, repeat several times a day. External rotation stretches with a stick. Phase 3 (recovery) Continue stretching and add strengthening exercises using elastic bands. Managing nighttime pain Avoid sleeping on the affected shoulder. Place a pillow under your elbow if you sleep on your back, or place a pillow in front of you to rest your arm on if you sleep on the opposite side. Support your arm with a pillow under your armpit when sitting.

If there is no improvement after 10 days, consult a physical therapist. These strategies complement professional treatment, but do not replace it.

When should you consult a professional?

When should you see a professional for your capsulitis?

You should consult a physical therapist as soon as you experience shoulder pain accompanied by progressive stiffness, especially if the pain is disrupting your sleep. You do not need a medical referral to consult a physical therapist in Quebec. Early intervention can speed up your recovery.

In Quebec, direct access to physical therapy means that you can consult a physical therapist without first seeing a doctor.

Seek medical attention immediately if: pain worsens over several weeks, progressive stiffness, nighttime pain that disrupts sleep, difficulty with daily activities, or limitation in all directions.

The sooner you consult a professional, the sooner you can begin appropriate treatment. Your physical therapist may refer you to a doctor for an injection or to check your blood sugar levels.

Capsulitis tests your patience. Here is the evidence-based truth: your shoulder will improve. The vast majority of people regain function. With the right treatment and your active participation, you can speed up this process.

References

• Zreik NH, Malik RA, Charalambous CP. Adhesive capsulitis of the shoulder and diabetes: a meta-analysis of prevalence. Muscles Ligaments Tendons J. 2016;6(1):26-34.

• Tighe CB, Oakley WS Jr. The prevalence of diabetes and adhesive capsulitis of the shoulder. South Med J. 2008;101(6):591-595.

• Le HV, Lee SJ, Nazarian A, Rodriguez EK. Adhesive capsulitis of the shoulder: review of pathophysiology and current clinical treatments. Shoulder Elbow. 2017;9(2):75-84.

• 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.

• Dias R, Cutts S, Massoud S. Frozen shoulder. BMJ. 2005;331(7530):1453-1456.

• Ingraham P. The Complete Guide to Frozen Shoulder. Pain Science. 2024. Updated 2025.

• Neviaser AS, Neviaser RJ. Adhesive capsulitis of the shoulder. J Am Acad Orthop Surg. 2011;19(9):536-542.

• Hand C, Clipsham K, Rees JL, Carr AJ. Long-term outcome of frozen shoulder. J Shoulder Elbow Surg. 2008;17(2):231-236.

• Ramchurn N, Mashamba C, Leitch E, et al. Upper limb musculoskeletal abnormalities and poor metabolic control in diabetes. Eur J Intern Med. 2009;20(7):718-721.

• Walmsley S, Osmotherly PG, Walker CJ, Rivett DA. Passive mechanical properties in adhesive capsulitis. J Orthop Res. 2015;33(3):359-364.

• Codman EA. The Shoulder: Rupture of the Supraspinatus Tendon and Other Lesions in or About the Subacromial Bursa. Boston: Thomas Todd Co; 1934.

• Arkkila PE, Kantola IM, Viikari JS, Rönnemaa T. Shoulder capsulitis in type I and II diabetic patients: association with diabetic complications and related diseases. Ann Rheum Dis. 1996;55(12):907-914.

• Yian EH, Contreras R, Sodl JF. Effects of glycemic control on prevalence of diabetic frozen shoulder. J Bone Joint Surg Am. 2012;94(10):919-923.

• Cho CH, Song KS, Kim BS, Kim DH, Lho YM. Biological Aspect of Pathophysiology for Frozen Shoulder. Biomed Res Int. 2018;2018:7274517.

• Bunker TD. Frozen shoulder: unraveling the enigma. Annals of the Royal College of Surgeons of England. 1997;79(3):210-213.

• Buchbinder R, Green S, Youd JM, Johnston RV. Oral steroids for adhesive capsulitis. Cochrane Database Syst Rev. 2006;(4):CD006189.

• Jacobs LG, Barton MA, Wallace WA, et al. Intra-articular distension and steroids in the management of capsulitis of the shoulder. BMJ. 1991;302(6791):1498-1501.

• Carette S, Moffet H, Tardif J, et al. Intraarticular corticosteroids, supervised physical therapy, or a combination of the two in the treatment of adhesive capsulitis of the shoulder: a placebo-controlled trial. Arthritis Rheum. 2003;48(3):829-838.

• Shaffer B, Tibone JE, Kerlan RK. Frozen shoulder. A long-term follow-up. J Bone Joint Surg Am. 1992;74(5):738-746.

• Miller MD, Wirth MA, Rockwood CA Jr. Thawing the frozen shoulder: the "patient" patient. Orthopedics. 1996;19(10):849-853.

• Uppal HS, Evans JP, Smith C. Frozen shoulder: A systematic review of therapeutic options. World J Orthop. 2015;6(2):263-268.

• 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 with 125 patients. J Shoulder Elbow Surg. 2007;16(6):722-726.

• Tanaka K, Saura R, Takahashi N, et al. Joint mobilization versus self-exercises for limited glenohumeral joint mobility: randomized controlled study of management of rehabilitation. Clin Rheumatol. 2010;29(12):1439-1444.

• Quebec Professional Order of Physiotherapy (OPPQ). Direct access to physiotherapy. 2025. Available at: https://oppq.qc.ca/