Understanding Frozen Shoulder (Adhesive Capsulitis)

Frozen shoulder is a condition characterised by progressive stiffness and pain in the shoulder joint. Typically, it develops gradually and progresses through three distinct phases:

• Freezing Stage – Initially, pain develops gradually and is accompanied by increasing stiffness
• Frozen Stage – Subsequently, stiffness becomes more pronounced, even though pain may lessen
• Thawing Stage – Over time, shoulder mobility gradually begins to return

Who Is Commonly Affected

In general, frozen shoulder most commonly affects:

• Adults aged 40–60
• Women, more frequently than men
• Individuals with diabetes or thyroid conditions, who may have a 2–4 times higher risk
• Those recovering from shoulder injuries or surgery, particularly following prolonged immobilisation

Without appropriate intervention, frozen shoulder may persist for 2–3 years. As a result, it can significantly affect quality of life and daily function, and in some cases, residual movement limitations may remain even after recovery.

Causes and Symptoms of Frozen Shoulder

Primary Causes

Idiopathic (Unknown Origin)

Most commonly, frozen shoulder develops without a clear underlying cause.
In these cases, symptoms often appear gradually and are not linked to a specific injury or event.

Secondary Causes

Alternatively, frozen shoulder may develop secondary to other conditions or circumstances, such as:

• Prolonged immobilisation following injury or surgery
• Diabetes mellitus, particularly when poorly controlled
• Thyroid disorders
• Cardiovascular disease
• Parkinson’s disease

Contributing Factors

Additionally, several factors may increase susceptibility, including:

• Shoulder trauma or repetitive strain
• Prolonged poor posture
• Certain autoimmune conditions

Common Symptoms

As the condition progresses, individuals may experience:

• Progressive stiffness, making tasks such as brushing hair or fastening clothing increasingly difficult
• Dull, aching pain, which is often more noticeable at night
• Occasional sharp pain during sudden or unexpected movements
• Significant loss of range of motion in all directions, including:
  • Limited overhead reaching
  • Difficulty reaching behind the back
  • Restricted outward rotation

• Muscle atrophy, which may occur due to prolonged disuse

Comprehensive Assessment

First, a detailed evaluation may include:

• Precise range-of-motion measurements
• Pain mapping and symptom analysis
• Functional movement assessment

Stage-Appropriate Treatment

Freezing Phase (Pain-Dominant Stage)

During this initial phase, management may focus on:

• Pain management strategies
• Modalities aimed at reducing inflammation
• Activity modification guidance
• Joint mobilisation techniques
• Hydrodilatation, where clinically indicated

Frozen Phase (Stiffness-Dominant Stage)

As stiffness becomes the primary concern, treatment may progress to:

• Gradual joint capsule stretching
• Advanced manual therapy techniques
• Therapeutic exercise programmes
• Hydrodilatation, where appropriate

Thawing Phase (Recovery Stage)

Finally, rehabilitation may focus on:

• Progressive strengthening
• Functional movement retraining
• Education on prevention and long-term shoulder care

Advanced Treatment Options

In selected cases, additional options may be discussed, including:

• Hydrodilatation – gentle joint capsule expansion using sterile fluid
• Therapeutic ultrasound to support tissue mobility
• Shockwave therapy for selected chronic presentations

FAQ: Frequently Asked Questions About Frozen Shoulder

1. What is frozen shoulder?

   Frozen shoulder, also known as adhesive capsulitis, is a condition characterised by shoulder stiffness, reduced range of motion, and pain caused by thickening and tightening of the shoulder joint capsule.

2. What commonly contributes to frozen shoulder?

   Frozen shoulder may be associated with prolonged shoulder immobility, previous shoulder injury, surgery, postural strain, or age-related changes. In some individuals, the cause may not be clearly identifiable.

3. What are common symptoms of frozen shoulder?

   Commonly reported symptoms include gradual onset of shoulder stiffness, difficulty lifting or rotating the arm, pain during movement, and discomfort at night, which may affect daily activities.

4. How is shoulder pain evaluated?

   Evaluation typically involves a clinical assessment, including medical history and physical examination. Where appropriate, imaging such as X-ray, ultrasound, or MRI may be used to rule out other shoulder conditions.

5. Is frozen shoulder the same as rotator cuff injury?

   No. Although symptoms may overlap, frozen shoulder primarily affects the joint capsule, while rotator cuff injuries involve the muscles and tendons surrounding the shoulder. Clinical assessment helps differentiate these conditions.

6. What non-surgical management options may be discussed for shoulder pain?

   Depending on clinical findings, non-surgical options that may be discussed include physiotherapy, gentle stretching exercises, activity modification, pain management strategies, or image-guided procedures, where appropriate.

7. Can frozen shoulder affect upper body function?

   Yes. this may limit upper body movement, making activities such as dressing, reaching, or lifting more challenging. Early evaluation may help clarify contributing factors.

8. How frozen shoulder commonly managed over time?

   Management often involves a structured and progressive approach, including education, gradual mobility exercises, physical conditioning, and follow-up review, guided by clinical assessment.