Shoulder adhesive capsulitis; Clinical aspects and practical algorithmic approach

Shoulder adhesive capsulitis is a relatively common shoulder problem, characterized by severe pain, progressive limitation of the active and passive movements, and significant disability. It may be primary (idiopathic) or secondary (known disorders such as diabetes, thyroid disease, cardiopulmonary diseases, stroke, cervical discopathy, after surgeries, rotator cuff tendinopathy or tears, calcific tendinitis, proximal humerus fractures, shoulder surgery, or prolonged shoulder immobilization). Adhesive capsulitis may be present in four stages, i.e. painful, freezing, frozen, and thawing. The diagnosis of adhesive capsulitis is often clinical and usually, there is no need for further imaging. There is no consensus in the management of adhesive capsulitis and the most effective treatment remains unclear. However, interventions such as patient education, analgesics, injection therapies (corticosteroids, hyaluronic acid, platelet-rich plasma, ….), exercise therapy, physiotherapy modalities, acupuncture, manual therapy and mobilization techniques, nerve blocks, hydrodilation, and surgery may help the patient to shorten the course of the longstanding disease. In this review, we aimed to provide an evidence-based algorithmic approach to this problem and an illustrated exercise protocol for proper rehabilitation of the affected patients.