Management of Frozen Shoulder Conditions

Frozen shoulder, or adhesive capsulitis, is a self-limiting but often protracted condition characterised by pain, progressive stiffness and eventual spontaneous resolution over months to years. It arises from an inflammatory-fibrotic process within the glenohumeral joint capsule, leading to thickening of the coracohumeral ligament, contraction of the rotator interval and obliteration of the subcoracoid fat triangle. Clinically, it progresses through a painful “freezing” phase, a stiff “frozen” phase and a gradual “thawing” phase as fibrosis resolves. Management strategies seek to control inflammation, prevent or reverse capsular fibrosis and restore range of motion. First-line therapy typically combines non-steroidal anti-inflammatory drugs with physiotherapy, comprising stretching, mobilisation and strengthening exercises. Intra-articular corticosteroid injections offer more rapid pain relief and improved function in the early phase, while hydrodilatation may mechanically expand the capsule. More invasive interventions—manipulation under anaesthesia and arthroscopic capsular release—are reserved for cases refractory to conservative measures after six to nine months. Emerging approaches aim to target key cellular mediators of inflammation and fibrosis in order to accelerate resolution and reduce chronicity.

Research from Nature Portfolio

Single-cell transcriptomic and spatial analyses of frozen shoulder capsule tissue have revealed distinct subpopulations of macrophages and fibroblasts that govern the balance between inflammation and fibrotic resolution. A pro-inflammatory MERTKlowCD48+ macrophage subset coexists with a pro-resolving MERTK+LYVE1+MRC1+ phenotype, the latter interacting via integrin-mediated bonds with specific fibroblast populations expressing DKK3 and POSTN. These findings suggest that reactivating or augmenting pro-resolving macrophages can promote matrix remodelling and fibrosis resolution. Cross-tissue comparisons implicate analogous macrophage–fibroblast circuits in other resolving joint diseases, pointing to a conserved developmental programme established during fetal shoulder formation. This work identifies cellular and molecular targets for novel therapies designed to hasten the natural thawing phase of frozen shoulder.

Management of Frozen Shoulder Conditions publication trend

The graph below shows the total number of articles in management of frozen shoulder conditions across all publications each year (not limited to Nature Index journals).

Technical terms

Adhesive capsulitis: A condition of the shoulder capsule characterised by inflammation, fibrosis and progressive restriction of passive and active motion.

Fibroblast: A connective-tissue cell responsible for collagen production and extracellular matrix remodelling during inflammation and repair.

Macrophage: An immune cell involved in phagocytosis and cytokine secretion, exhibiting pro-inflammatory or pro-resolving phenotypes within fibrotic tissue.

Hydrodilatation: A procedure in which fluid (often saline with corticosteroid) is injected under pressure to distend and stretch the contracted joint capsule.

Intra-articular corticosteroid injection: Direct delivery of steroid medication into the joint space to reduce inflammation and pain in the early phase of frozen shoulder.

References

1. A single cell atlas of frozen shoulder capsule identifies features associated with inflammatory fibrosis resolution. Nature Communications (2024).
2. Agomir-122-loaded nanoparticles coated with cell membrane of activated fibroblasts to treat frozen shoulder based on homologous targeting. Journal of Nanobiotechnology (2024).
3. Comparison of Treatments for Frozen Shoulder. JAMA Network Open (2020).
4. Clinical Guidelines in the Management of Frozen Shoulder: An Update!. Indian Journal of Orthopaedics (2021).
5. Multi-modal imaging of adhesive capsulitis of the shoulder. Insights into Imaging (2016).
6. The pathophysiology associated with primary (idiopathic) frozen shoulder: A systematic review. BMC Musculoskeletal Disorders (2016).