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.
Key red flags
Severe pain with tiny passive movements plus fever, warmth, immune compromise, bacteraemia or recent injection requires emergency evaluation for septic arthritis.
Investigation priorities
Demonstrate true glenohumeral capsular restriction and separate it from pain-limited active weakness.
Management branches
Gradual pain and progressive stiffness occur without trauma, fever, deformity or neurological deficit.
- Compare active and passive external rotation, elevation and internal rotation while stabilising or observing the scapula.
- Obtain radiographs when arthritis, previous injury, calcification or another structural diagnosis remains plausible.
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.
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.