Frozen Hip (Adhesive Capsulitis)

Understanding Frozen Hip

Adhesive capsulitis of the hip occurs when the normally flexible joint capsule — the fibrous envelope surrounding the hip — becomes inflamed and subsequently contracts, forming scar tissue (adhesions) that restrict movement. The result is a progressive reduction in all planes of hip motion accompanied by pain that is often worse at night or at rest.

While far less common than the shoulder equivalent, frozen hip can significantly affect walking, dressing, and daily function. It is more frequently seen in middle-aged adults and is associated with a number of underlying conditions.

Causes & Risk Factors

In many cases frozen hip is idiopathic — meaning no clear underlying cause is identified. However, several associated factors have been recognised.

• Previous hip surgery or prolonged immobilisation
• Inflammatory arthritis (rheumatoid arthritis, ankylosing spondylitis)
• Diabetes mellitus, which is a well-established risk factor for adhesive capsulitis at multiple joints
• Hypothyroidism and other metabolic conditions
• Avascular necrosis of the femoral head in early stages
• Idiopathic — occurring without identifiable cause

Treatment Options

Treatment is largely guided by the stage of the condition and the degree of functional impairment. The natural history is one of eventual recovery, but this may take one to three years without intervention. Active treatment aims to relieve pain and restore movement more quickly.

• Physiotherapy — the cornerstone of management, focusing on gentle range-of-motion exercises, stretching, and activity modification
• Anti-inflammatory medication — oral NSAIDs to manage pain and inflammation, particularly in the early stages
• Intra-articular corticosteroid injection — ultrasound or fluoroscopy-guided injection into the hip joint can provide significant short-term pain relief and facilitate physiotherapy
• Hydrodilatation — injection of fluid under pressure to distend and stretch the contracted capsule
• Arthroscopic capsular release — a surgical option for cases that have failed conservative management over an extended period, releasing the thickened capsule to restore movement