Frozen Shoulder

Frozen shoulder, also called adhesive capsulitis, is a condition that causes significant pain and stiffness in the shoulder joint. It typically affects adults between the ages of 40 and 60, and occurs in around 2% of the population. People with diabetes, thyroid disease, or heart problems are at higher risk, with diabetes being the most strongly linked.

Unlike other joint problems, frozen shoulder is unique in that it almost exclusively affects the shoulder. Although it can be very disabling, the good news is that in most cases it eventually resolves.

Causes

The exact cause of frozen shoulder is still unclear. What is known is that inflammation of the shoulder capsule plays a key role. For many, the condition develops spontaneously without an obvious reason. In others, it may be triggered by:

A shoulder injury
Surgery involving the shoulder or chest (such as cardiac surgery)
Prolonged immobilisation, for example, after a fracture or other medical event

Symptoms

Frozen shoulder is characterised by pain and stiffness:

Pain: A dull, aching pain often felt along the outside of the shoulder and upper arm. It tends to be worse at night and can disturb sleep.
Stiffness: Loss of range of motion develops gradually, making everyday activities such as reaching overhead or behind the back very difficult.

The Three Stages of Frozen Shoulder

Freezing Phase

Gradual onset of pain with increasing stiffness. The capsule becomes inflamed and thickened.

Frozen Phase

Pain improves, but stiffness remains severe due to thickened, fibrous tissue restricting motion.

Thawing Phase

The shoulder gradually regains movement and pain continues to decrease as the capsule remodels.

This process usually lasts 18–24 months, but recovery can take longer in people with diabetes.

Diagnosis

There is no single test that confirms frozen shoulder. Diagnosis is made based on history and physical examination. X-rays may be done to rule out arthritis, while ultrasound or MRI scans can check the rotator cuff and may show thickening of the capsule.

Treatment

Frozen shoulder often resolves on its own, but treatment focuses on relieving pain and restoring mobility.

Non-Surgical Options

Steroid injections: Help reduce inflammation and ease pain, particularly in the early stages.
Physiotherapy: Gentle stretching and guided exercises to maintain mobility.
Pain management: Medication and activity modifications.

Surgical Options

When stiffness is severe or prolonged, surgery may be considered:

Arthroscopic Capsular Release: A minimally invasive procedure where the thickened capsule is carefully released to restore motion. In many cases, patients regain 70–80% of movement immediately after surgery.
Manipulation Under Anaesthesia (MUA): The shoulder is gently moved while under anaesthetic to improve range. Often performed together with arthroscopic release.

Post-surgery, intensive physiotherapy is crucial to maintain and build on the improved range of motion.

Recovery

Most patients experience a dramatic improvement in movement shortly after surgery, followed by steady progress as the condition continues to resolve. While not every shoulder regains perfect motion, surgery combined with physiotherapy offers excellent long-term outcomes.

Comprehensive Care for Frozen Shoulder

Frozen shoulder can make even simple tasks painful and frustrating, but effective treatments are available. With accurate diagnosis, targeted care, and the right rehabilitation, you can regain comfort and mobility.

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