What is frozen shoulder?
Frozen shoulder, also known as Adhesive Capsulitis, is a condition characterised by progressive stiffness and pain in the shoulder joint due to thickening and tightening of the joint capsule. Over time, the capsule becomes inflamed and develops adhesions, which restrict normal movement and significantly reduce the range of motion. The condition typically develops gradually and progresses through stages, starting with increasing pain, followed by marked stiffness, and eventually a slow recovery phase. Frozen shoulder can make everyday activities such as reaching, dressing, or lifting the arm difficult, and it often occurs without a clear cause, although it is more common in individuals with certain medical conditions or after periods of shoulder immobilisation.
Causes
The exact cause is not always clear. It is often associated with prolonged immobilisation of the shoulder, such as after injury, surgery, or a period of reduced use, which can lead to stiffness and adhesion formation. Certain medical conditions, including diabetes, thyroid disorders, and cardiovascular disease, are known to increase the risk. It may also arise following minor trauma or inflammation in the shoulder, triggering an exaggerated healing response that results in capsular tightening. In many cases, however, frozen shoulder develops gradually without a specific identifiable cause, making it an idiopathic condition.
Symptoms
- Gradual onset of shoulder pain: A dull, aching pain that develops slowly, often without a clear injury, and may worsen over time.
- Progressive stiffness: Increasing tightness in the shoulder joint due to thickening of the joint capsule, leading to restricted movement.
- Reduced range of motion (active and passive): Both the patient and examiner are unable to move the shoulder fully, which is a key feature of the condition.
- Night pain: Pain often becomes more noticeable at night, especially when lying on the affected side, disrupting sleep.
- Pain with movement: Discomfort increases when attempting to lift, rotate, or reach with the arm due to capsular restriction.
- Difficulty with daily activities: Tasks such as dressing, reaching overhead, or placing the hand behind the back become challenging with limited mobility.
Diagnosis and imaging
Your surgeon will make a diagnosis through a combination of clinical assessment and imaging to exclude other conditions. The process begins with a detailed history, focusing on the gradual onset of pain and progressive stiffness without a significant injury. During the physical examination, the key finding is a marked restriction in both active and passive range of motion, particularly in external rotation. Imaging is not used to directly confirm frozen shoulder but to rule out other causes of shoulder pain and stiffness. X-rays are typically performed to exclude arthritis or structural abnormalities, while MRI or ultrasound may be used if there is concern for rotator cuff tears or other soft tissue pathology.
Treatment
Conservative (Non Op)
Conservative (non-operative) treatment of Adhesive Capsulitis (frozen shoulder) focuses on relieving pain and gradually restoring shoulder movement over time. Management typically includes pain control with simple analgesics or anti-inflammatory medications such as Ibuprofen, along with the application of heat or ice to ease discomfort. A structured physiotherapy program is essential, involving gentle stretching and range-of-motion exercises to maintain mobility and prevent further stiffness, while avoiding excessive force that may worsen symptoms. As pain improves, strengthening exercises are gradually introduced to support shoulder function. Corticosteroid injections may be used to reduce inflammation and pain, particularly in the early painful stage, allowing better participation in rehabilitation. Most patients improve over time with consistent conservative management, although recovery can take several months to over a year
Surgical treatment
Surgical treatment of Adhesive Capsulitis (frozen shoulder) is considered when symptoms are severe and persist despite prolonged conservative management. The most common procedure is arthroscopic capsular release, a minimally invasive technique in which a surgeon uses a camera and small instruments to cut and release the tight, thickened portions of the joint capsule to improve movement. In some cases, this may be combined with manipulation under anaesthesia, where the shoulder is gently moved through its range to break up adhesions. The goal of surgery is to restore mobility and reduce pain; however, it must be followed by an intensive physiotherapy program to maintain the improved range of motion and prevent recurrence of stiffness.
Recovery
Any movement is acceptable (as limited by pain), usually this means up to shoulder height initially. Sling is for comfort only initially and should be weaned as soon as possible. Maximum 5 days.
When can I return to daily activities?
- Walking for exercise – 1 week
- Light work – 2 weeks
- Driving – 2 weeks
- Exercise bike – 2 – 3 weeks, Road bicycle – 4 weeks
- Heavy work – 2 months
- Gym – 4 – 6 weeks for shoulder exercises
- Swim – when wounds are healed