Frozen Shoulder/Adhesive Capsulitis

What is frozen shoulder?

Frozen shoulder happens when the shoulder joint capsule (the strong connective tissue that surrounds and stabilises the shoulder) becomes inflamed and stiff. Over time, scar tissue (adhesions) forms and the lubricating joint fluid reduces, severely limiting movement.

The shoulder is called “frozen” because pain leads to reduced use, which then causes further stiffness and loss of movement.

Stages of frozen shoulder

  1. Freezing: Increasing pain, stiffness, worse at night, movement gradually reduces- 6 weeks – 9 months

  2. Frozen: Pain may reduce, but stiffness is severe and daily tasks are difficult- 2- 6 months

  3. Thawing: Pain settles, movement gradually improves- 6 months – 2 years

Causes

The exact cause is unknown, but inflammation leads to:

  • Thickened and tight joint capsule

  • Scar tissue (adhesions)

  • Reduced joint lubrication

This combination restricts shoulder movement in all directions.

Risk factors

You’re more likely to develop frozen shoulder if you have:

  • Age: 40–60 years

  • Sex: More common in females

  • Shoulder immobilisation: After injury or surgery (e.g. sling use)

  • Diabetes: 10–20% of people with diabetes are affected

  • Other conditions: Stroke, thyroid disorders, Parkinson’s disease, heart disease

Symptoms

  • Shoulder pain (often worse at night)

  • Progressive stiffness

  • Difficulty lifting the arm, dressing, grooming, or reaching overhead

  • Loss of both active and passive range of motion

     

Diagnosis

Frozen shoulder is diagnosed through:

  • Clinical history and symptom pattern

  • Physical examination showing reduced active and passive movement

  • X-rays to rule out arthritis

  • MRI or ultrasound only if another condition (e.g. rotator cuff tear) is suspected

     

Treatment

Treatment focuses on pain control first, then restoring movement.

Conservative treatment (most common)

  • Pain relief (NSAIDs, paracetamol)

  • Corticosteroid injection into the shoulder joint- Steroid Injections are considered early as the condition might get chronic.

  • Physical therapy (stretching & mobility exercises)

  • Home exercise program

  • Heat/ice

  • TENS for pain relief

     

Surgical options (if symptoms persist >12 months)

  • Manipulation under anaesthesia

  • Arthroscopic capsular release
    (often combined for better results)

     

Prognosis

  • Most people recover without surgery

  • Improvement usually occurs within 12 months

  • Full or near-full recovery may take up to 2 years

  • Even untreated cases gradually improve, though more slowly

Understand Your Shoulder Movements: What movements are restricted and painful.

Physiotherapy Rehab Exercises