Capsulitis: Appearance, Symptoms, Stages, and Differentiation

What Does Capsulitis Look Like?

Capsulitis, most commonly observed as adhesive capsulitis or "frozen shoulder," manifests primarily as a progressive and significant loss of joint range of motion, accompanied by pain that often worsens with movement and at night. Its appearance is characterized by distinct, evolving stages of increasing stiffness and discomfort that severely limit functional capacity.

Understanding Capsulitis: A Brief Overview

Capsulitis refers to inflammation and thickening of the joint capsule, the fibrous sac that encloses the joint and helps stabilize it. While it can theoretically affect any joint, it is most famously associated with the shoulder, where it's known as adhesive capsulitis or frozen shoulder. This condition is characterized by the formation of adhesions (scar tissue) within the capsule, causing it to contract and restrict movement. Though less common, similar processes can affect other joints like the hip, ankle, or even the small joints of the fingers.

The Hallmarks of Capsulitis: Signs and Symptoms

The "look" of capsulitis is less about a visible deformity and more about the observable limitations and discomfort it imposes.

• Progressive Loss of Range of Motion (ROM): This is the most defining characteristic. Both active (movement performed by the individual) and passive (movement performed by an examiner) range of motion are significantly restricted. This global stiffness is a key differentiator from other shoulder conditions.
  • Specific Movements Affected: Typically, external rotation is the most limited, followed by abduction (lifting arm out to the side) and internal rotation (reaching behind the back).
• Pain: Initially, pain is often the dominant symptom. It's typically a dull, aching pain, insidious in onset, and can be felt deep within the joint.
  • Exacerbating Factors: Pain often worsens with movement, especially at the end ranges of motion, and can be particularly troublesome at night, disrupting sleep.
• Functional Limitations: The restricted movement directly impacts daily activities. Individuals may struggle with:
  • Reaching overhead or behind their back (e.g., washing hair, dressing, fastening a bra).
  • Sleeping comfortably on the affected side.
  • Performing tasks that require arm elevation or rotation.
• Muscle Atrophy (Later Stages): Due to disuse and guarding, muscles surrounding the affected joint, particularly the deltoid and rotator cuff muscles, may appear visibly smaller or wasted over time.
• Guarding and Compensation: Individuals may adopt compensatory movements, such as shrugging the shoulder or leaning the trunk, to achieve desired arm positions, further indicating the underlying stiffness.

The Stages of Capsulitis Progression

Adhesive capsulitis typically progresses through three distinct, overlapping stages, each with its own characteristic presentation:

• Stage 1: The Freezing (Painful) Stage
  • Duration: Typically lasts from 2 to 9 months.
  • Appearance: This stage is primarily defined by the gradual onset of pain, which steadily worsens. The pain can be diffuse and aching, often more severe at night. While stiffness begins to develop, pain is the predominant symptom, and the loss of motion is subtle at first but progressively increases. Patients often experience sharp pain at the end range of motion.
• Stage 2: The Frozen (Stiffening) Stage
  • Duration: Can last from 4 to 12 months.
  • Appearance: During this stage, the pain may start to subside, but the stiffness becomes profound and very noticeable. The loss of both active and passive range of motion is severe, making even simple daily tasks challenging. The joint capsule has significantly thickened and contracted, limiting virtually all movements.
• Stage 3: The Thawing (Recovery) Stage
  • Duration: This stage can be prolonged, lasting anywhere from 5 to 24 months, or even longer.
  • Appearance: This is the recovery phase, where the range of motion gradually begins to return. The pain continues to decrease, and the shoulder slowly regains its mobility. While significant improvement is typical, some individuals may not fully recover their pre-condition range of motion.

Differentiating Capsulitis from Other Conditions

It's crucial for healthcare professionals to differentiate capsulitis from other conditions that cause shoulder pain and stiffness. While symptoms can overlap, key distinctions include:

• Rotator Cuff Tears: Often present with pain and weakness, particularly with active movement, but passive range of motion is frequently preserved or less restricted than in capsulitis.
• Osteoarthritis: Typically has a more gradual onset, often accompanied by crepitus (grinding sensation) and pain that improves with rest. While it causes stiffness, the global and capsular pattern of restriction seen in adhesive capsulitis is usually less pronounced.
• Tendinitis/Bursitis: Characterized by localized pain and tenderness, often exacerbated by specific movements, but rarely causes the profound, global loss of both active and passive range of motion seen in capsulitis.

The hallmark of adhesive capsulitis remains the significant restriction of both active and passive range of motion in a capsular pattern (external rotation > abduction > internal rotation restriction), which helps distinguish its "look" from other musculoskeletal issues.

When to Seek Professional Evaluation

If you experience persistent shoulder pain, progressive stiffness that limits your ability to perform daily activities, or a noticeable reduction in your shoulder's range of motion, it is important to seek evaluation from a healthcare professional. Early diagnosis can help manage symptoms and guide appropriate interventions, such as physical therapy, to optimize recovery and prevent prolonged disability.