Progress in the Treatment of Adhesive Capsulitis with External Therapies of Traditional Chinese Medicine: A Comprehensive Review.

Adhesive capsulitis (AC), commonly known as frozen shoulder, is a common shoulder disorder featured by joint capsule contracture, pain, stiffness, and dysfunction. It has a prolonged course and a high recurrence tendency, which seriously impairs patients' quality of life and imposes a certain social and economic burden. At present, western medicine for AC has certain limitations, such as single intervention modality, potential risks of invasive procedures, obvious adverse reactions and a high long-term recurrence rate. External therapies of Traditional Chinese Medicine (TCM) are safe, effective, and minimally invasive with few adverse reactions. This review systematically summarizes clinical research and mechanisms of acupuncture, tuina (massage), topical Chinese herbal therapy, and combined external TCM therapies for AC. Key findings show that these therapies effectively relieve shoulder pain, improve range of motion, inhibit inflammation, and reduce joint capsule fibrosis via multi‑target regulation. Combined TCM external therapies yield better efficacy than single modalities. However, standardization of manipulations and high‑quality evidence remain insufficient. Given the challenges for systematic review posed by the heterogeneity of TCM external treatment techniques and the complexity of their potential mechanisms, this study critically summarizes the mechanistic basis and symptom-improving efficacy of current TCM external therapies for AC, aiming to construct a comprehensive theoretical framework, provide guidance for future related research, and optimize the standardized clinical application of TCM external therapies in the management of AC.