Frozen Shoulder

Frozen shoulder, also called adhesive capsulitis, is a condition in which the strong tissue surrounding the shoulder joint (the capsule) becomes thickened, inflamed, and tight. This restricts movement and causes pain, so the shoulder becomes increasingly difficult to move in all directions, whether you try to move it yourself or someone else moves it for you.

It often develops gradually and tends to follow a pattern of stages. While it can be persistent and uncomfortable, frozen shoulder usually improves on its own over time, and most people regain good use of the shoulder, although full recovery can take a long time.

Frozen shoulder usually moves through three overlapping stages. In the first, painful (freezing) stage, the shoulder becomes increasingly painful and movement starts to reduce. This is often the most uncomfortable phase and can last several months.

In the frozen (stiff) stage, pain may ease somewhat but stiffness remains and the shoulder is hard to move, affecting everyday tasks. In the recovery (thawing) stage, movement gradually returns. The whole process commonly takes from around a year to several years, varying from person to person.

The main symptoms are shoulder pain and stiffness that make it hard to move the arm. Pain is often felt in the outer shoulder and upper arm and may be worse at night, sometimes disturbing sleep, particularly in the early stage.

As the condition progresses, stiffness becomes the main problem, making movements such as reaching up, behind the back, or out to the side difficult. Everyday activities like dressing, washing hair, or reaching a seatbelt can become awkward. Both movement by yourself and movement assisted by someone else are limited, which is a typical feature of frozen shoulder.

The exact cause is not always clear. It can develop on its own or after a period of reduced shoulder movement, for example following an injury, surgery, or having the arm in a sling. The capsule around the joint becomes inflamed and tight, though why this happens is not fully understood.

Frozen shoulder is most common in middle age and affects more women than men. The risk is higher in people with diabetes, who may have more severe or longer-lasting symptoms, and in those with thyroid disorders and some other health conditions. Keeping a shoulder still for a long time can also contribute.

Frozen shoulder is usually diagnosed from the typical history of pain and progressive stiffness and from a physical examination of the shoulder. A clinician will check how far the shoulder moves both when you move it and when they move it for you, as loss of movement in both is characteristic.

Tests are not always needed, but imaging such as an X-ray or sometimes an MRI or ultrasound scan may be used to rule out other causes of a painful, stiff shoulder, such as arthritis or a tendon problem. The examination helps distinguish frozen shoulder from other shoulder conditions that are treated differently.

Most frozen shoulders improve with non-surgical treatment aimed at relieving pain and keeping the shoulder moving. This often includes pain relief, guided shoulder exercises and stretches, and physiotherapy. Doing the recommended exercises regularly, within comfort, helps maintain and gradually restore movement.

If pain or stiffness is severe, a clinician may suggest a steroid injection into the shoulder to reduce inflammation and pain, which can make exercises easier. A small number of people whose symptoms do not improve with these measures may be referred for procedures to free up the joint, such as manipulation under anaesthetic or keyhole surgery. The right approach depends on the stage and how much the shoulder is affected.

The outlook is generally good, although patience is needed. Most people recover good movement over time, often over many months to a few years, and many do so without surgery. Continuing gentle exercises as advised supports recovery and helps prevent lasting stiffness.

Frozen shoulder cannot always be prevented, but after a shoulder injury or surgery, keeping the shoulder moving as advised may reduce the risk of stiffness. Managing conditions such as diabetes well is also sensible, as they can affect how the shoulder recovers. If symptoms are not improving as expected, it is worth seeking review.