Adhesive Capsulitis or Frozen Shoulder: What It Is and How We Help at KINEO Benidorm

Your shoulder hurts when you lean on it at night, buttoning a bra or reaching the top shelf becomes a struggle, and over time the shoulder seems to get “stuck” no matter which way you move it. That's how many patients describe the start of adhesive capsulitis, better known as frozen shoulder. It's one of the shoulder conditions we see most often at KINEO Benidorm, and precisely because of its long course and how easily it's confused with other injuries, it's one we follow up on most closely and manage with the clearest protocol.

What is adhesive capsulitis?

Adhesive capsulitis is an inflammation followed by fibrosis (thickening and loss of elasticity) of the capsule surrounding the glenohumeral joint, especially the coracohumeral ligament and the rotator interval. That thickening reduces the space available for the humeral head to move normally and produces its hallmark feature: loss of range of motion, both active (movement the patient makes) and passive (movement the physiotherapist produces by moving the arm). That overall loss of mobility, in every direction, is what sets frozen shoulder apart from other causes of shoulder pain, where passive range is usually well preserved.

It usually appears between the ages of 40 and 60, is somewhat more common in women, and is particularly associated with diabetes, thyroid disorders, and periods of prolonged immobilisation after surgery, a fracture, or an injury. In many cases, however, no clear cause is found, and it's described as “primary” or idiopathic capsulitis.

The three phases of frozen shoulder

Understanding which phase the shoulder is in is the basis of any approach, because the goal changes depending on the stage of the process:

• Freezing phase (painful). Pain takes centre stage, especially at night, and stiffness keeps increasing. It can last two to nine months.

• Frozen phase (stiff). Pain decreases, but stiffness reaches its peak and significantly limits everyday activities. It usually lasts four to twelve months.

• Thawing phase (recovery). Range of motion gradually returns, a process that can take many months, sometimes more than a year.

Altogether, the full process can last between one and three years, and some patients retain a degree of residual stiffness even afterwards. That's why we stress that patience and medium-term follow-up are part of the treatment, not a side effect of it.

Frozen shoulder or impingement? Why the diagnosis matters

Not every shoulder pain with difficulty raising the arm is adhesive capsulitis. Shoulder impingement, for example, usually hurts more when raising the arm overhead, but preserves most of the passive mobility. Confusing the two conditions can lead to poorly targeted treatment, since what helps one doesn't always suit the other. That's why the first step at KINEO Benidorm is always a detailed clinical assessment, which in many cases we supplement with real-time musculoskeletal ultrasound.

The role of ultrasound in diagnosis

Adhesive capsulitis is mainly diagnosed clinically: the pattern of overall movement loss is very characteristic. Even so, real-time musculoskeletal ultrasound is a very useful tool in our assessment, because it lets us:

• Rule out other causes of pain and stiffness, such as a rotator cuff tear, calcific tendinopathy, or subacromial bursitis.

• Observe indirect signs associated with the painful phase, such as thickening of the rotator interval or changes in local vascularisation.

• Precisely guide certain invasive physiotherapy techniques when they're indicated.

This imaging-based assessment, carried out in the same consultation, is one of KINEO Benidorm's hallmarks, and it lets us tailor the treatment pathway to what is actually happening in the shoulder, not only to the symptoms the patient reports.

The Itinerario KINEO for adhesive capsulitis

At KINEO Benidorm we don't apply a single, identical protocol to every frozen shoulder: we design an Itinerario KINEO — your personalised KINEO care pathway — adapted to the phase each patient is in and to their individual situation. In general terms, this pathway combines:

• Initial clinical and ultrasound assessment, to confirm the diagnosis and rule out other causes.

• Education about the natural course of the condition, to set realistic expectations and reduce the anxiety that comes with pain and stiffness.

• Pain control and load management, especially during the most painful phase, prioritising a shoulder that tolerates movement without being overloaded.

• Manual therapy and progressive mobilisation of the shoulder, adapting intensity to each phase of the process.

• Ultrasound-guided invasive physiotherapy (EPTE), in selected cases, as part of the approach to the periarticular tissues involved.

• Tecar therapy or diathermy, as a complementary technique within the pathway.

• Functional recovery during the thawing phase, so the shoulder not only regains range but also responds well again in everyday life.

You can find out more about how we treat the shoulder at KINEO Benidorm on our shoulder physiotherapy page (in Spanish). We also treat international patients in English — read more about our English-speaking physiotherapy service in Benidorm.

When should you ask for help?

The sooner frozen shoulder is identified, the sooner we can start working on it and the better we can support each phase. If you're finding it increasingly hard to move your shoulder in every direction, if night-time pain keeps you from sleeping on that side, or if you've had weeks of stiffness that isn't improving, it's a good time to book an assessment at KINEO Benidorm.

Frequently asked questions

How long does adhesive capsulitis last?

The full process usually lasts between one and three years, spread across the pain, stiffness and recovery phases. Physiotherapy doesn't suddenly speed up the biological clock, but it helps control pain and maintain the best possible range of motion at each stage.

Is it the same as a rotator cuff tear?

No. In frozen shoulder, mobility is lost in every direction, both active and passive, while with a rotator cuff tear most passive movement is usually preserved. Ultrasound helps tell the two conditions apart precisely.

Is surgery necessary?

Most cases of adhesive capsulitis improve well with conservative treatment. Surgery is reserved for specific cases that don't respond after a reasonable period of treatment, and should always be assessed by a specialist doctor.

Can I carry on with normal life during treatment?

Yes, although some activities should be adapted depending on the phase. During your assessment we'll explain which movements to prioritise and which to temporarily avoid, always on an individual basis.

Why does KINEO Benidorm use ultrasound for frozen shoulder?

Because it lets us confirm the diagnosis, rule out other causes of shoulder pain and, when indicated, precisely guide certain invasive physiotherapy techniques within the treatment pathway.

Article written by Chema, physiotherapist at KINEO Benidorm specialising in shoulder conditions, musculoskeletal ultrasound and invasive physiotherapy (EPTE).