Frozen shoulder adhesive capsulitis

Overview

Frozen shoulder, also called adhesive capsulitis, is a condition where the shoulder joint becomes stiff and painful. It happens when the tissue around the shoulder joint thickens and tightens, making it hard to move the arm. It usually develops slowly and goes away on its own over time, but treatment can help speed up recovery.

Yes, frozen shoulder is fairly common. About 2 to 5 percent of people experience it at some point in their lives.

It affects adults, especially those between 40 and 60 years old. Women are more likely to get it than men. People with diabetes, thyroid disorders, or previous shoulder injuries are at higher risk.

Symptoms

Common symptoms

• Dull or aching pain in the shoulder that may worsen at night
• Stiffness that makes it hard to move the arm, such as reaching overhead or behind the back
• Limited range of motion that gets worse over time

Symptoms in children

• Frozen shoulder is very rare in children, but if it occurs, symptoms are similar: pain and stiffness in the shoulder.

Symptoms in older adults

• Symptoms are the same as in younger adults, but recovery may take longer, and stiffness can be more pronounced.

Causes

Main causes

• The exact cause is not fully understood, but it involves inflammation and thickening of the shoulder capsule (the tissue that surrounds the shoulder joint).
• This can happen after a shoulder injury or surgery, or for no known reason.

Risk factors

• Diabetes (people with diabetes are more likely to get frozen shoulder and it may be more severe)
• Thyroid disorders (overactive or underactive thyroid)
• Previous shoulder injury or shoulder surgery
• Prolonged immobility of the shoulder, such as after a stroke or fracture
• Age 40 or older

When to see a doctor

See a doctor urgently if:

• If you have sudden, severe shoulder pain that does not go away
• If you cannot move your shoulder at all after an injury

Book a routine appointment if:

• If you have shoulder pain and stiffness that lasts more than a few days
• If the pain keeps you from doing normal activities or disrupts your sleep

Diagnosis

A doctor will ask about your symptoms and medical history, and then do a physical exam to check your shoulder's range of motion. They may also press on certain points to see if there is pain.

Tests that may be done

• An ultrasound or MRI scan may be ordered to rule out other problems like a rotator cuff tear or arthritis.
• X-rays are usually normal in frozen shoulder but may be done to check for other causes of shoulder pain.

What to expect at your appointment

The doctor will examine how far you can move your arm in different directions. They may ask you to try to reach above your head or behind your back. The diagnosis is often made based on the pattern of stiffness and pain.

Treatment

Treatment for frozen shoulder focuses on easing pain and improving movement. Most people get better with non-surgical treatments. The goal is to reduce inflammation and help the shoulder regain motion.

Self-care at home

• Apply heat or ice packs to the shoulder for 15–20 minutes several times a day to relieve pain and stiffness.
• Do gentle stretching exercises as recommended by a physiotherapist to gradually improve range of motion.
• Avoid activities that make the pain worse, but try to keep the shoulder moving within pain limits.

Medical treatments

Treatment may include physiotherapy to guide you through exercises, pain relief medication (such as paracetamol or anti-inflammatory drugs) recommended by your doctor, and sometimes a steroid injection into the shoulder joint to reduce inflammation. These treatments are generally safe and effective.

When is surgery considered?

If symptoms do not improve after several months of non-surgical treatment, a procedure called shoulder manipulation under anaesthesia or arthroscopic capsular release may be considered. This involves stretching or cutting the tight tissue to improve movement. Your doctor will discuss the risks and benefits.

Living with this condition

Living with frozen shoulder can be frustrating because everyday tasks like putting on a coat, brushing hair, or reaching for something on a high shelf become difficult. It is important to be patient and to modify activities to avoid pain. Use your other arm for tasks when possible, and take breaks.

Lifestyle tips

• If your dominant arm is affected, learn to use the other arm for tasks like eating, writing, or carrying light items.
• Sleep with an extra pillow to support your shoulder and reduce pain at night.
• Avoid sleeping on the affected side.

Diet and exercise

A healthy, balanced diet can support overall healing. Gentle exercise, especially the stretches prescribed by your physiotherapist, is important to keep muscles from weakening and to prevent further stiffness. Avoid heavy lifting or high-impact activities until your shoulder feels better.

Mental health and emotional wellbeing

Living with chronic pain and limited movement can lead to frustration, anxiety, or low mood. It is normal to feel this way. Talk to your healthcare provider if you are struggling emotionally. They can suggest ways to cope, such as relaxation techniques or counseling.

Prevention

There is no sure way to prevent frozen shoulder, but keeping your shoulder moving after an injury or surgery and managing conditions like diabetes may lower your risk. If your shoulder is stiff after an injury, gentle movement as soon as it is safe might help.

Complications

If left untreated

• Prolonged stiffness and limited mobility that may last for months or years.
• Muscle weakness in the shoulder from lack of use.
• Rarely, permanent loss of some shoulder range of motion.

Long-term outlook

The outlook for frozen shoulder is generally very good. Most people improve significantly within 1 to 3 years, even without treatment. Treatment can help reduce pain and speed up recovery. With patience and proper care, most people regain full or near-full use of their shoulder.

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