Frozen Shoulder (Adhesive Capsulitis): Symptoms, Causes & Treatment

Frozen shoulder, medically called adhesive capsulitis, is a common condition characterized by gradual pain and stiffness in the shoulder joint leading to a large limitation in its movement. This happens due to inflammation, fibrosis, and contraction in the capsule, the tissue envelope surrounding the shoulder joint, so this capsule becomes thick and tight and restricts the joint's movement severely, to the point that the patient may be unable to raise or rotate their arm despite trying.

Frozen shoulder usually passes through three successive stages that together may take several months to years: the freezing (painful) stage, in which pain gradually increases and movement begins to decrease; then the frozen stage, in which pain relatively decreases but stiffness and movement limitation remain at their worst; then the thawing (improvement) stage, in which movement gradually returns. The chances of developing it increase with age (especially between forty and sixty), it is more common in women, and it is closely linked to diabetes (which increases its risk and prolongs its duration), to thyroid disorders, and after long periods of shoulder immobilization (for example after a fracture, surgery, or injury that left the shoulder without movement).

The reassuring news is that frozen shoulder is most often a self-limited condition, meaning it usually improves over time even if that takes long, and that surgery is rarely necessary. Treatment aims to relieve pain and maintain and restore movement as much as possible, and rests on physical therapy and regular stretching and movement exercises (the cornerstone), with anti-inflammatory painkillers to relieve pain, and sometimes local injections decided by the doctor to speed improvement in the painful stage. Persisting with exercises patiently is the key to recovery, while stopping moving the shoulder out of fear of pain worsens the stiffness. In very resistant cases the doctor may resort to additional procedures.

• Gradual shoulder pain that worsens at night.
• Stiffness and severe limitation in shoulder movement (raising/rotating the arm).
• Difficulty with daily activities (dressing, combing hair).
• Passing through three stages: freezing, frozen, thawing.

• Inflammation, fibrosis, and contraction in the shoulder-joint capsule.
• Age (40–60) and being more common in women.
• Diabetes (increases risk and prolongs duration) and thyroid disorders.
• Long shoulder immobilization after a fracture, surgery, or injury.

• Clinical diagnosis from the pattern of pain, stiffness, and movement limitation on examination.
• X-ray to exclude other causes (such as joint arthritis).
• Assessing diabetes and thyroid when suspected.

The cornerstone

• Physical therapy and regular stretching and movement exercises with patience and persistence.

Pain relief

• Anti-inflammatory painkillers, and sometimes local injections decided by the doctor in the painful stage.

Resistant cases

• Additional procedures determined by the doctor, and surgery is rare.

Stopping moving the shoulder worsens the stiffness. This content is educational and does not replace medical advice.

• Permanent movement limitation when treatment and exercises are neglected.
• Weakness of shoulder muscles from disuse.
• Impact on daily activities and sleep for a long period.

• Moving the shoulder early after any injury or surgery (with the doctor's guidance) to avoid stiffness.
• Controlling diabetes and thyroid disorders.
• Not stopping moving the shoulder when pain begins.