Ombro congelado

Sinônimo: capsulite adesiva do ombro

O que é ombro congelado?

Capsulite adesiva é uma das causas mais comuns de dor intrínseca no ombro. É uma disfunção da articulação glenoumeral e pode ocorrer em um ombro ou em ambos simultaneamente. O espessamento e a contração da cápsula da articulação glenoumeral, juntamente com a formação de aderências, causam dor e perda de movimento.¹

A ombro congelado pode ocorrer:

• De forma espontânea.

• Seguindo lesões/lesões do manguito rotador.

• In conditions causing immobility - eg, after a cerebrovascular accident or plaster immobilisation.

Veja o separado Dor no ombro e Exame do ombro artigos.

Qual a frequência de ombro congelado? (Epidemiologia)¹²

• Capsulite adesiva ocorre em aproximadamente 2-5% da população, com pico de incidência entre 40 e 70 anos de idade.

• It is more common in females and bilateral in 20-30% of cases. When unilateral, the non-dominant hand is more commonly affected.

• The incidence of adhesive capsulitis is more common in those with diabetes and thyroid disorders - outcomes are worse in those with a longer duration of diabetes.

O que causa o ombro congelado?¹²

Os principais sintomas são dor e rigidez, causados pela formação de tecido adesivo ou cicatricial na articulação glenoumeral.

• There is usually a gradual onset of severe pain in the shoulder, which is then followed by stiffness.

• Restrição de todos os movimentos do ombro, tanto ativos quanto passivos.

• Incapacidade de dormir do lado afetado.

• Restriction of activities of daily living due to impaired external rotation - eg, driving and dressing.

• Costuma haver três fases:

  • Fase 1 - severe generalised pain associated with stiffness. Daily activities are limited (eg, putting on a jacket). It can last up to nine months.

  • Fase 2 - pain usually gradually subsides but the shoulder is stiff. Movement can become more limited. External rotation is usually very limited. This phase lasts between 4-12 months.

  • Fase 3 - the shoulder becomes less stiff. There is an increase in the range of movement. This phase usually lasts 1-3 years.

Rigidez, dor e perda de movimento com início insidioso são geralmente os principais sintomas.

Diagnóstico de ombro congelado (investigações)

• O diagnóstico é clínico:

  • Todo o ombro pode estar sensível à palpação.

  • O principal teste diagnóstico é a incapacidade de realizar rotação externa passiva.

• X-rays are usually only necessary if the presentation is atypical or the patient is not responding to treatment - they are often normal.

• Considere outras causas de dor no ombro.

• Blood tests and radiography should only be performed if red flag symptoms are present. For a list of these, refer to the separate Dor no ombro artigo.

Tratamento e manejo da capsulite adesiva^{23 4 5}

Consider referral to secondary care if pain and significant disability are present for more than six months despite appropriate conservative management and always refer if there is diagnostic doubt.

Despite over a hundred years of treating this condition the most efficacious treatments are still largely unclear. A holistic approach to treatment should be used, considering psychological and psychosocial factors.

• A primeira fase é a analgesia - paracetamol como primeira linha, com anti-inflamatórios não esteroides (AINEs) como segunda linha, desde que não haja contraindicações. O uso de um aparelho de estimulação elétrica nervosa transcutânea (TENS) também pode ser útil.

• Incentive a atividade precoce.

• Physiotherapy with joint mobilisation combined with stretching exercises have been shown to be better than stretching exercise alone in terms of external rotation, abduction range of motion and function score, although a 2023 systematic review was limited by lack of consistency in study designs and found that most of the benefits did not reach statistical significance. The 2025 British Elbow and Shoulder Society patient care pathway rates physiotherapy as 'likely to be beneficial'.⁶⁷

• A mobilização passiva e o alongamento capsular são duas das técnicas mais utilizadas na fisioterapia.

• Injection with corticosteroids:

  • This can reduce pain and duration of symptoms in the early stages and the 2025 British Elbow and Shoulder Society patient care pathway rates injection as 'likely to be beneficial'.⁶

  • It should not be done if a previous such injection has shown no or minimal benefit, or if the patient has passed the pain stage and entered the stiffness stage.

  • Care must be taken to monitor blood sugar after the injection in patients with diabetes (they may be raised for 1-2 days) and the balance of risks and benefits should be carefully considered in those with poorly controlled diabetes.⁸

• A 2012 Cochrane review found no benefit to an ultrasound guided injection versus one without such guidance. More recent smaller studies are divided, with some finding more pain reduction with ultrasound guidance and others finding no difference - the 2025 British Elbow and Shoulder Society patient care pathway also found that this made no difference. An injection should therefore not be delayed to wait for ultrasound guidance to be available.⁹¹⁰¹¹

• Oral steroids are not recommended, although they may reduce pain in the very short term.⁸

• Surgical options include manipulation under anaesthesia and arthroscopic capsulotomy but are generally reserved for cases where non-surgical options have failed.²

Complicações da capsulite adesiva

Long-term pain and shoulder stiffness are possible complications.

Prognóstico da capsulite adesiva

• 80 - 90% of patients with spontaneous frozen shoulder have been shown to recover to normal levels of function and movement by two years without any treatment, with the remaining 10-20% having some residual stiffness or discomfort.²¹²

• Recaídas no mesmo ombro são incomuns.