Frozen Shoulder (Adhesive Capsulitis)
Frozen shoulder (adhesive capsulitis) is a condition in which the shoulder joint capsule becomes inflamed and thickened, causing pain and loss of movement in all directions [4]. It is more common between the ages of 40 and 60 and in people with diabetes or thyroid disease.
Stages
- Painful (freezing) stage: increasing pain, especially at night
- Stiff (frozen) stage: pain eases but stiffness is marked
- Recovery (thawing) stage: movement gradually improves
The whole process may take many months to a few years.
Further reading: the guide “Shoulder Pain” and the articles Hip Pain: Common Causes and Treatment and Hip Impingement (Femoroacetabular Impingement Syndrome).
Treatment
Treatment aims to reduce pain and maintain or restore movement [1, 2]:
- Corticosteroid injection into the joint, which can relieve pain and improve movement in the early stage [1]
- Physiotherapy and exercise, adapted to the stage; manual therapy and exercise may help [3]
- Pain medicines
- In persistent cases, hydrodilatation, manipulation under anaesthesia or arthroscopic release
What happens in the shoulder
The shoulder joint is surrounded by a capsule, a sleeve of connective tissue. In frozen shoulder this capsule first becomes inflamed and then thickened and contracted (fibrosis, meaning scar-like stiffening), so the joint has less room to move. A typical sign is that the arm cannot be moved further even when another person tries to move it for you, especially in rotating the arm outwards.
Causes and risk factors
Often no clear cause is found (primary frozen shoulder). Recognised risk factors include:
- Diabetes, which is associated with a higher risk and often a longer course
- Thyroid disease
- A period of immobility after injury, surgery or a fracture
- Age between 40 and 60, and female sex
Assessment
Diagnosis is mainly clinical: your history and an examination showing painful loss of both active movement (moving the arm yourself) and passive movement (the examiner moving it). An X-ray is often taken to rule out arthritis or other bony causes. Ultrasound or MRI may be used when the diagnosis is unclear or a rotator cuff tear is suspected. Blood sugar testing may be advised, because frozen shoulder can be the first clue to diabetes.
Treatment by stage
- Painful stage: the priority is pain control, gentle movement within comfort and good sleep. A corticosteroid injection into the joint may give earlier relief in selected patients
- Stiff stage: stretching becomes more important and is progressed gradually
- Recovery stage: strengthening and return to normal daily and sporting activities
Hydrodilatation (stretching the capsule by injecting fluid into the joint), manipulation under anaesthesia and arthroscopic release are options for persistent, disabling stiffness. Evidence comparing these options is limited, and each has benefits and risks that should be discussed individually [1].
Home measures
- Do short sessions of gentle exercise several times a day rather than one long, painful session
- Use heat before exercise if it helps you relax the shoulder
- Find a comfortable sleeping position, for example with a pillow supporting the arm
- Keep using the arm for light daily tasks within comfort
- If you have diabetes, good blood sugar control is part of overall care
Red flags
Seek prompt assessment if shoulder pain follows a fall or injury, if the arm is suddenly weak, or if there is fever, a hot swollen joint, chest pain or shortness of breath.
When to see your physical medicine and rehabilitation specialist
Seek assessment if pain is severe, keeps getting worse, wakes you at night or does not start to improve within a few weeks; if numbness, weakness or any warning sign appears; or if you are unsure what your test results mean. Your physical medicine and rehabilitation (PM&R) specialist, a doctor trained to diagnose and treat musculoskeletal and nerve problems without surgery, examines you, explains the findings and plans treatment together with the physiotherapist. Whether injections or other advanced treatments are suitable for you is decided by a PM&R specialist after examination. Prof. Dr. Engin Çakar works in this field and can be consulted online or in person; otherwise, please consult a PM&R specialist near you.
To make the most of the consultation, it helps to bring:
- A short timeline of your symptoms and what makes them better or worse
- A list of your medicines and other health conditions
- Previous imaging (the images themselves, not only the reports), test results and treatment summaries
- Your questions and goals, such as returning to work, sport or a particular activity
Frequently asked questions
Should I force the shoulder through pain? No. Aggressive stretching in the painful stage can worsen symptoms; exercises are adapted to the stage.
Does frozen shoulder recur? It rarely recurs in the same shoulder, but the other shoulder may be affected. See Supraspinatus tendinitis.
Is frozen shoulder the same as a rotator cuff problem? No. In rotator cuff problems passive movement is usually preserved, whereas in frozen shoulder both active and passive movement are restricted. The two can coexist, so examination is important.
Will my shoulder return to normal? Most people regain good function over time, although some have a degree of persistent stiffness. Recovery time varies and cannot be predicted precisely.
Assessment and contact
You can request an appointment or a second-opinion review of existing reports and imaging: Contact & second opinion (WhatsApp). This page is general health information. Diagnosis and treatment decisions are made individually after examination.
Sources
- Rangan A, et al. What is the most effective treatment for frozen shoulder?. BMJ. 2016. PMID: 27554676
- Kelley MJ, et al. Shoulder pain and mobility deficits: adhesive capsulitis. J Orthop Sports Phys Ther. 2013. PMID: 23636125
- Page MJ, et al. Manual therapy and exercise for adhesive capsulitis (frozen shoulder). Cochrane Database Syst Rev. 2014. PMID: 25157702
- Millar NL, et al. Frozen shoulder. Nat Rev Dis Primers. 2022. PMID: 36075904