Thawing the Ice: The Clinical Diagnosis and Effective Management of Adhesive Capsulitis.
Erin Sullivan, Solomon Bhandari-Young, Aimee Kamat and 1 others
PMID 40986875WHAT IT FOUND
Physical therapy, steroid or hyaluronic acid injections, and hydrodilation can improve frozen shoulder pain and motion early, but long-term differences often disappear.
Newer biologics remain investigational.
Key findings
01Physical therapy is considered a cornerstone treatment, and the review says early diagnosis may be critical because frozen shoulder seems more responsive in stages 1 and 2.
02Corticosteroid injection improved pain versus placebo, and improved pain and function versus oral NSAIDs at 6 and 8 weeks, but not at 12 weeks; hyaluronic acid improved pain and external rotation versus control, and combined injection was best up to 3 months but not at 3 or 6 months.
03A randomized trial comparing physical therapy, manipulation under anesthesia, and arthroscopic capsular release found no long-term statistical difference at 12 months, while arthroscopic release showed greater internal and external rotation gains if symptoms lasted less than 10 months.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for RNs
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What it does not show
This is a narrative review, not a systematic review or original trial, so it does not state how sources were selected or how conflicting evidence was weighted. The paper has no single primary outcome or participant group, so treatment conclusions are summaries of prior studies. Diagnostic criteria are vague, and MRI is not a diagnostic standard, so clinical judgment remains central. Many treatment benefits are short-term, and long-term differences often disappear. Orthobiologics lack standardized dosing, preparation, and long-term safety data.
The easy way to misread this
Do not conclude that injections, hydrodilation, or surgery are clearly better long-term. The review reports early gains that often disappear by 12 weeks to 12 months, and it says orthobiologics remain investigational.