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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Adhesive capsulitis

Musculoskeletal medicine and orthopaedics · UK scope · Sources checked 27 Aug 2026 · Clinical review pending

RapidFull
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A hot or traumatically locked shoulder is not frozen shoulder

Fever, systemic illness, a warm effusion, recent surgery or injection, acute deformity, neurological deficit or sudden inability to move after trauma suggests infection, fracture-dislocation or nerve injury rather than primary capsular fibrosis.

Action: Assess observations and neurovascular status, obtain urgent trauma imaging where relevant, and arrange same-day orthopaedic assessment and aspiration for suspected sepsis; do not inject or prescribe forceful stretching until the urgent diagnosis is excluded.

Synopsis

Diagnose adhesive capsulitis from its characteristic passive movement loss, exclude arthritis and dangerous mimics, explain its prolonged phased course, and combine stage-appropriate rehabilitation, analgesia, injection and referral without harmful forcing.

  • The defining examination feature is loss of both active and passive glenohumeral movement, with passive external rotation at the side disproportionately restricted.
  • Pain commonly precedes dominant stiffness: a painful phase may progress to a stiff phase and then slow recovery, although individual trajectories overlap rather than follow a perfect timetable.
  • Diabetes is the strongest common association; ask about thyroid disease, previous shoulder immobilisation, trauma and surgery, but do not order broad screening without clinical reason.
  • First-line investigation is a careful movement examination; obtain plain radiographs when needed to exclude glenohumeral arthritis, fracture, dislocation, calcification or destructive disease.
  • MRI is not the gold-standard confirmation for a typical case because adhesive capsulitis is a clinical diagnosis and scanning may reveal distracting age-related cuff abnormalities.
  • First-line management combines explanation, analgesia and physiotherapy matched to irritability: gentle tolerated movement during severe pain, then progressive range and strengthening as pain recedes.
  • An image-guided or anatomically accurate intra-articular corticosteroid injection can improve short-term pain and function, particularly early, and should be linked to a rehabilitation goal.
  • Escalate persistent major restriction after adequate non-operative care for specialist consideration of hydrodilatation, manipulation under anaesthesia or arthroscopic capsular release.

Key red flags

Severe pain with tiny passive movements plus fever, warmth, immune compromise, bacteraemia or recent injection requires emergency evaluation for septic arthritis.

Sudden restriction after trauma, a seizure or electrical injury requires orthogonal radiographs because fracture and posterior dislocation can be missed clinically.

Progressive night pain with weight loss, swelling, previous cancer or neurological deficit requires tumour and cervical or plexus assessment.

True motor loss, dermatomal sensory change, altered reflexes or hand clumsiness is not explained by uncomplicated adhesive capsulitis.

Bilateral girdle pain with prolonged morning stiffness, headache or visual symptoms in an older adult raises polymyalgia rheumatica and possible giant-cell arteritis.

Investigation priorities

01
First-line active and passive range examinationFirst stepFirst line

Demonstrate true glenohumeral capsular restriction and separate it from pain-limited active weakness.

Management branches

First-lineConfirm the capsular pattern

Gradual pain and progressive stiffness occur without trauma, fever, deformity or neurological deficit.

  1. Compare active and passive external rotation, elevation and internal rotation while stabilising or observing the scapula.
  2. Obtain radiographs when arthritis, previous injury, calcification or another structural diagnosis remains plausible.
  3. Explain the uncertain duration and generally improving course using individual functional goals rather than a promised recovery date.
  4. Start compatible analgesia and stage-appropriate physiotherapy with explicit advice against forceful pain-provoking manipulation at home.

Key medicines

Paracetamol for short rescue useTake paracetamol 500–1000 mg orally when required, leaving at least 4 hours between administrations and keeping the total at or below 4 g each 24 hours; reduce the ceiling for low weight, frailty, malnutrition or liver risk.Check all combination products to prevent overdose, reduce dose for relevant hepatic risk, and review continued use because benefit in musculoskeletal pain is often modest.
Short-course oral NSAID with protection when indicatedIf suitable, use naproxen 250–500 mg orally twice daily with food for the shortest effective course and add omeprazole 20 mg orally once daily during treatment when gastroprotection is needed.Avoid or modify for ulcer disease, kidney impairment, heart failure, uncontrolled hypertension, cardiovascular risk, anticoagulants and antiplatelets; follow pregnancy restrictions from 20 weeks and avoid in the third trimester.
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Sources and review status4 sources · checked 27 Aug 2026 · clinical review pending+
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

  • British Orthopaedic Association Frozen ShoulderUK orthopaedic diagnostic and treatment pathway resource.
  • British Elbow and Shoulder Society Frozen ShoulderClinical course, exercises and procedural context.
  • NHS Frozen shoulderSymptoms, recovery expectations and treatment options.
  • NICE CKS Shoulder painPrimary-care assessment, red flags and referral framework.

Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom