What Is Frozen Shoulder and How Can It Be Treated?

Frozen shoulder, medically known as adhesive capsulitis, is a condition in which the connective tissue capsule surrounding the shoulder joint becomes inflamed, thickened, and tight. This gradually causes pain, stiffness and a significant loss of shoulder movement. Unlike ordinary shoulder pain, frozen shoulder can make simple activities such as dressing, reaching overhead, fastening clothing or sleeping on the affected side difficult.

It most commonly affects adults aged 40 to 60 and is more common in women. The condition may develop without an obvious injury, but prolonged shoulder immobilisation, previous injury or surgery, diabetes and thyroid disorders can increase the risk.

Frozen shoulder develops when the shoulder capsule becomes inflamed and progressively contracts. This reduces the space available for normal movement and causes the characteristic stiffness.

There are two broad types:

• Primary frozen shoulder: develops without a clear preceding shoulder problem.

• Secondary frozen shoulder: develops after an injury, surgery or another condition that limits shoulder movement.

Risk factors include diabetes, thyroid disorders, previous shoulder trauma and prolonged immobilisation. Diabetes is particularly associated with frozen shoulder, with estimates suggesting that around 10-20% of people with diabetes may develop the condition.

Symptoms usually develop gradually rather than suddenly. The most noticeable features are shoulder pain and progressively restricted movement.

Pain may initially be dull or aching and can become worse at night. As stiffness increases, movements such as reaching behind the back, lifting the arm overhead or rotating the arm outward become increasingly difficult. A key clinical feature is restriction of both active and passive movement - meaning the shoulder remains difficult to move even when someone else tries to move it.

Frozen shoulder generally progresses through three stages:

1. Freezing stage: Pain gradually increases and shoulder movement begins to decrease. Night pain can be particularly troublesome. This phase can last roughly 2-9 months.

2. Frozen stage: Pain may become less intense, but stiffness becomes more pronounced. Everyday movements can remain severely restricted. This stage commonly lasts several months.

3. Thawing stage: Shoulder mobility gradually returns. Recovery is usually slow, with movement improving progressively over several months.

The duration varies considerably between individuals, so the stages should not be treated as fixed deadlines.

Diagnosis is primarily based on the medical history and physical examination. A clinician assesses shoulder movement, pain and stiffness and compares active and passive range of motion.

Imaging may be used when another condition, such as a rotator cuff tear, arthritis or fracture, needs to be ruled out. X-rays do not usually diagnose frozen shoulder directly but can help exclude other causes of shoulder stiffness.

Exercise is an important part of treatment because maintaining and gradually restoring range of motion can help improve function. A physiotherapist can tailor exercises according to the stage and severity of the condition.

• Pendulum exercise: gently allowing the arm to swing while leaning forward.

• Wall walks: using the fingers to gradually walk the affected arm upward.

• Towel or cane-assisted rotation: gently rotating the shoulder with assistance from the opposite arm or a stick.

• Cross-body stretch: gently bringing the affected arm across the chest.

• External rotation stretches: using a doorway or stick to gradually improve outward rotation.

Exercises should be gentle and progressive rather than forceful. Aggressive stretching that significantly increases pain can be counterproductive, particularly during the painful freezing stage.

The two conditions can look similar because both can cause shoulder pain and difficulty lifting the arm, but the underlying problem is different.

Frozen shoulder primarily causes loss of shoulder joint mobility, including when the arm is moved passively. Rotator cuff injuries affect the muscles and tendons responsible for shoulder movement and stability and may cause weakness, particularly during specific movements.

A clinical examination is important because the treatment approach differs. A rotator cuff tear, arthritis or other shoulder disorder may require different investigations and rehabilitation.

Treatment depends on the stage, severity and impact on daily activities. Most cases are initially managed without surgery.

• Physiotherapy and structured range-of-motion exercises

• Pain-relieving medication when appropriate

• Heat before stretching for some patients

• Corticosteroid injection, particularly when pain is prominent

• Hydrodilatation in selected cases

• Surgical procedures such as manipulation or arthroscopic capsular release when significant symptoms persist despite nonsurgical treatment

The goal is not simply to reduce pain but to restore useful shoulder movement and function.

Recovery is often measured in months rather than weeks. The freezing stage may last 2-9 months, the frozen stage several additional months and the thawing stage can continue for 5-24 months. Overall, symptoms often improve within 1–3 years, although the timeline varies between individuals.

Consistent rehabilitation can help maintain mobility during this prolonged process. Persistent or worsening symptoms should be reassessed rather than simply attributed to a “normal” recovery period.

Cannabinoid-based medications also work as part of broader pain-management strategies. Current evidence suggests potential benefits for some forms of chronic pain, but they should be considered only under the guidance of a healthcare expert.

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