Adhesive Capsulitis of the Shoulder. Is there Consensus Regarding the Treatment? A Comprehensive Review

Dimitrios Georgiannos1, George Markopoulos1, Eirini Devetzi2, Ilias Bisbinas1, *
1 Orthopaedics and Trauma Surgery 424 Military General Hospital, Thessaloniki, Greece
2 Rheumatology 424 Military General Hospital, Thessaloniki, Greece

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© 2017 Georgiannos et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Orthopaedics and Trauma Surgery, 424 Military General Hospital, Thessaloniki, Greece; Tel: 0030 2310 381000; ext 2610; E-mail:



Adhesive capsulitis of the shoulder (ACS) is a common self-limiting condition characterized by disabling pain and restricted movements. Its pathophysiology is poorly understood, clinically it is characterized by stages of pain and stiffness, and finally often patients never recover fully. However, there is no consensus about available methods of treatment for ACS. The aims of this paper are to discuss and develop issues regarding approaches to management in ACS in the stages of it.


A review of the literature was performed and guidelines for the treatment of that clinical entity for doctors and health care professionals are provided.


Anti-inflammatory medications, steroid and/or hyaluronate injections and physiotherapy is the mainstay of conservative management either alone in the first stages or in combination with other treatment modalities in the later stages. Next line of treatment, involving minor to moderate intervention, includes suprascapular nerve block, distension arthrography and manipulation under anaesthesia. In order to avoid complications of “blind intervention”, arthroscopic capsular release is gradually more commonly applied, and in recalcitrant severe cases open release is a useful option.


Various modalities of conservative management and gradually more surgical release are applied. However, often clinicians choose on personal experience and training rather than on published evidence.

Keywords: Adhesive capsulitis, Shoulder, Treatment.