Frozen Shoulder (Adhesive Capsulitis)

«Understanding the condition (definition, symptoms, epidemiology, stages, absolute surgical indications)» slot — content in preparation.

«How surgery and SART complement each other» slot — content in preparation.

These are the evidence candidates assigned to this topic. The citations to be used are finalised by the author when the page is published.

• EV-010★★★★★L1 · Systematic review / meta-analysis

  Frozen shoulder is a systemic and metabolic condition, not merely a local one

  Prevalence of frozen shoulder is 2–5% in the general population and 10–30% among people with diabetes, making diabetes the strongest and most consistent risk factor (roughly a fivefold increase). It follows a three-stage course and usually improves over one to two years, though some cases persist for several years. True recurrence in the same shoulder is rare, but there is a risk of sequential onset in the opposite shoulder.

  2019 · AFP 2019 meta-analysis; American Journal of Medicine 2026 review

  Limitation — Bibliographic details still need to be verified.

• EV-008★★★L3 · Retrospective cohort / case-control / cross-sectional

  The thorax and posture sit upstream of shoulder pathology

  Patients with subacromial impingement syndrome show restricted thoracic extension and a scapula positioned in greater anterior tilt, protraction and downward rotation (case–control study, 108 participants).

  PMC9875974 · PMC9875974

  Limitation — Bibliographic details still need to be verified.

• EV-009★★★L3 · Retrospective cohort / case-control / cross-sectionalfoundational

  Scapular dyskinesis is associated with a broad range of shoulder disorders

  Abnormal scapular position and movement (scapular dyskinesis) is associated with impingement, rotator cuff disease, instability and adhesive capsulitis, and accompanies most shoulder injuries.

  Ludewig PM; Kibler WB (2009) · Ludewig PM & Reinold(JOSPT 2009); Kibler WB(2012)

  Limitation — Bibliographic details still need to be verified.

• EV-027★★L4 · Cadaveric / biomechanical model / basic experimentfoundational

  The scapula is the foundation of shoulder function, and scapular dyskinesis accompanies shoulder pathology broadly

  Established the concept of scapular dyskinesis, with the scapula as the stable base for humeral movement. Abnormal scapular position and rhythm accompany impingement, rotator cuff disease and instability, pointing to restoration of scapulo-thoracic alignment rather than local strengthening.

  Kibler WB · The role of the scapula in athletic shoulder function

• EV-086★★L4 · Cadaveric / biomechanical model / basic experimentfoundational

  Function (movement) can fail even when imaging is normal

  Functional diagnosis established that segmental dysfunction — restricted or excessive movement — can exist even when structural imaging such as radiographs is normal.

  Dvorak J & Dvorak V · Manual Medicine: Diagnostics

• EV-017★L5 · Expert opinion / classical theory / mechanistic hypothesisfoundational

  The thorax is not a rigid cage but a stack of mobile rings, and when one ring twists the structures above and below are affected

  The thorax is modelled as a stack of individual rings (rib segments); when a particular ring rotates or translates, the structures above it — shoulder and cervical spine — compensate.

  Lee D (2015) · The Thoracic Ring Approach

• EV-039★L5 · Expert opinion / classical theory / mechanistic hypothesisfoundational

  Selective tissue tension testing differentiates the painful tissue

  Combining active, passive and resisted testing differentiates contractile tissue (muscle and tendon) from non-contractile tissue (ligament and capsule).

  Cyriax J (1954) · Textbook of Orthopaedic Medicine

• EV-045★L5 · Expert opinion / classical theory / mechanistic hypothesisfoundational

  Placing a segment in a position of ease switches off muscle spindle hyper-excitability and tension releases

  An indirect technique that places the tender point in its most comfortable position to reset abnormal muscle spindle signalling.

  Jones LH (1981) · Strain-Counterstrain