This review by the Neviasers defines adhesive capsulitis as a specific pathologic entity — not a synonym for any stiff shoulder — and outlines its four arthroscopic stages. It addresses diagnosis, natural history controversy, and the evidence base for nonsurgical and surgical management. The central argument is that treatment must target the specific underlying pathology, and the term 'frozen shoulder' should be abandoned.
The stiff, painful shoulder is one of the most common referral patterns in orthopedics, and the most important diagnostic step is recognizing that not every stiff shoulder is adhesive capsulitis.
Rotator cuff tears, calcific tendinitis, glenohumeral arthritis, and cervical radiculopathy all produce similar pictures — and their treatment is entirely different. The term 'frozen shoulder' is nonspecific and should not appear in your assessment.
When you do confirm true adhesive capsulitis, the steroid injection question comes up at almost every visit. The evidence is clear: injections blunt early pain for a few weeks but do not change motion or long-term outcomes. Use them to make therapy tolerable, not as a primary treatment.
For boards and clinical practice, know the four arthroscopic stages cold. Stage 1 is the trap: the patient has full motion and nonspecific pain, and if you scope the shoulder for another reason and see a fibrinous synovitic reaction in the rotator interval, reconsider your planned procedure.
The 6-month threshold for surgery is the key decision point. Arthroscopic release is now preferred over manipulation because it allows diagnosis confirmation, controlled capsulotomy, and avoids the fracture and subscapularis rupture risks of blind manipulation.
Adhesive Capsulitis of the Shoulder
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This review by the Neviasers defines adhesive capsulitis as a specific pathologic entity — not a synonym for any stiff shoulder — and outlines its four arthroscopic stages. It addresses diagnosis, natural history controversy, and the evidence base for nonsurgical and surgical management. The central argument is that treatment must target the specific underlying pathology, and the term 'frozen shoulder' should be abandoned.
The stiff, painful shoulder is one of the most common referral patterns in orthopedics, and the most important diagnostic step is recognizing that not every stiff shoulder is adhesive capsulitis.
Rotator cuff tears, calcific tendinitis, glenohumeral arthritis, and cervical radiculopathy all produce similar pictures — and their treatment is entirely different. The term 'frozen shoulder' is nonspecific and should not appear in your assessment.
When you do confirm true adhesive capsulitis, the steroid injection question comes up at almost every visit. The evidence is clear: injections blunt early pain for a few weeks but do not change motion or long-term outcomes. Use them to make therapy tolerable, not as a primary treatment.
For boards and clinical practice, know the four arthroscopic stages cold. Stage 1 is the trap: the patient has full motion and nonspecific pain, and if you scope the shoulder for another reason and see a fibrinous synovitic reaction in the rotator interval, reconsider your planned procedure.
The 6-month threshold for surgery is the key decision point. Arthroscopic release is now preferred over manipulation because it allows diagnosis confirmation, controlled capsulotomy, and avoids the fracture and subscapularis rupture risks of blind manipulation.