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Frozen Shoulder Stages-Diagnosis-Symptoms-capsular pattern

In this article we will discuss about the frozen shoulder stages, symptoms and diagnosis. To make diagnosis of frozen shoulder it is important to know about the causes of adhesive capsulitis..

Symptoms of frozen shoulder

Here are the some general symptoms of frozen shoulder.

  • Frozen shoulder symptoms include pain in the shoulder joint, which can be severe and constant, especially at night.
  • As the condition progresses, the shoulder joint becomes increasingly stiff, making it difficult to move the arm.
  • Decrease in range of motion of shoulder joint.
  • This stiffness can also cause weakness in the shoulder muscles and may lead to muscle atrophy.
  • In severe cases, frozen shoulder can cause a frozen joint, where the joint becomes completely immobilized.
  • Difficulty sleeping due to pain.

Stages of frozen shoulder

The symptoms progress through three frozen shoulder stages, which are described below:

Freezing (painful) stage:

  • The first stage, last from 2-9 months,
  • The shoulder joint becomes increasingly painful, particularly at night.
  • The pain may be sharp or dull and may worsen with movement.
  • As the pain intensifies, the shoulder joint also becomes increasingly stiff, making it difficult to move the arm.
  • Limited range of motion in the shoulder joint.
  • Difficulty sleeping due to pain.
  • Difficulty with activities of daily living, such as dressing or reaching for objects.
  • Muscle weakness and atrophy due to disuse.

Frozen (adhesive) stage:

  • Second stage, which can last from 4-12 moths.
  • The pain may begin to subside, but the shoulder joint becomes increasingly stiff and difficult to move.
  • Simple tasks like reaching for objects or dressing may become nearly impossible due to the restricted range of motion.
  • Severely restricted range of motion in the shoulder joint.
  • Pain that occurs mainly with movement or stretching of the joint
  • Difficulty performing activities of daily living
  • Muscle weakness and atrophy due to disuse

Thawing (recovery) stage

  • The third and final stage, which can last from 12-42 months.
  • Gradual improvement in range of motion in the shoulder joint.
  • Reduction in pain and stiffness.
  • Gradual return of strength and function in the shoulder muscles.
  • Improved ability to perform activities of daily living.

Frozen Shoulder Diagnosis

The diagnosis of frozen shoulder typically involves a physical examination and a review of the individual’s medical history. Here are some common steps in the diagnostic process:

Medical history

A healthcare provider will ask about the individual’s symptoms, onset and progression of the disease. They may also ask about any previous injuries or medical history that may be contributing to the shoulder pain.

Physical examination

The healthcare provider will examine the individual’s shoulder, checking for range of motion, strength, and any signs of inflammation or swelling. They may also perform specific tests, such as the “passive external rotation test,” to help diagnose frozen shoulder.

Imaging tests

In some cases, imaging tests such as X-rays, magnetic resonance imaging (MRI), or ultrasound may be ordered to help rule out other conditions, such as arthritis or rotator cuff tears, and to confirm the diagnosis of frozen shoulder.

Evaluation of response to treatment

If the healthcare provider suspects frozen shoulder, they may recommend a trial of conservative treatment, such as physical therapy or pain medication. If the individual experiences improvement in their symptoms, this can help confirm the diagnosis of frozen shoulder.

Capsular pattern

The capsular pattern of frozen shoulder typically involves restriction of active and passive movement of the shoulder joint in a specific pattern, with external rotation being the most limited, followed by abduction, and finally internal rotation being the least limited. This means that the shoulder joint has the most limited range of motion when attempting to rotate the arm away from the body (external rotation), followed by lifting the arm up to the side (abduction), and finally rotating the arm towards the body (internal rotation).

The presence of this capsular pattern helps to distinguish frozen shoulder from other shoulder conditions that can cause similar symptoms.


It’s important to seek medical attention if you are experiencing shoulder pain or stiffness, as early diagnosis and treatment can help prevent complications and improve outcomes. A healthcare provider can help determine the underlying cause of the shoulder pain and recommend an appropriate treatment plan.

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