Frozen Shoulder
Also known as: Adhesive capsulitis، Capsulitis of the shoulder
Frozen shoulder is progressive stiffness and pain of the shoulder joint due to inflammation and thickening of the joint capsule. It affects 2-5% of adults, more commonly women aged 40-60 and people with diabetes.
Common Symptoms
- Gradual onset of shoulder pain over weeks to months
- Deep, diffuse pain that worsens at night
- Pain that prevents lying on the affected side
- Progressive loss of shoulder motion — both active AND passive
- Inability to reach overhead, behind the back, or to the side
- Pain that improves once motion begins, surprisingly
- Pain often unrelated to a specific injury
Causes & Risk Factors
- Diabetes (3-5× higher risk)
- Thyroid disease (hypo or hyper)
- Previous shoulder immobilization (after sling, surgery, fracture)
- Age 40-60 (most common range)
- Female sex (more common in women)
- Heart disease and stroke history
- Often no clear trigger — develops 'idiopathically'
Treatment Options
Time and patience (most important)
Frozen shoulder follows a predictable 3-phase course: freezing (3-9 months), frozen (4-12 months), thawing (6-24 months). Most cases resolve in 1-3 years even without treatment. Understanding the natural history helps with patience.
Cortisone injection
Most evidence-based treatment for the painful 'freezing' phase. Significant pain reduction within 1-2 weeks; speeds overall resolution. Often combined with hydrodilatation (saline + cortisone) for stretching the capsule.
Targeted physical therapy
Different exercises for each phase. Aggressive stretching in the freezing phase worsens pain; gentle pendulums and range-of-motion work better. In thawing phase, more aggressive stretching is helpful.
NSAIDs for pain control
Helpful in the painful freezing phase. Less needed in the frozen and thawing phases as pain decreases.
Manipulation under anesthesia
For stubborn cases not improving after 9-12 months. Surgeon forcibly moves the shoulder under anesthesia to break adhesions. Followed by intensive physical therapy.
Arthroscopic capsular release
Surgical alternative when manipulation under anesthesia isn't enough. Keyhole surgery to cut the thickened capsule. Recovery 8-12 weeks with intensive PT.
When to See a Doctor
- Shoulder pain combined with progressive loss of motion
- Pain that prevents sleep on the affected side
- Diabetic patient with new shoulder pain (high risk for frozen shoulder)
- Shoulder pain after surgery, sling, or immobilization
- Inability to perform daily tasks (reaching, dressing, hair care)
Frequently Asked Questions
How long does frozen shoulder last?
Untreated: 1-3 years total. With early diagnosis and treatment (cortisone injection + physical therapy): typically resolves in 6-12 months. The disease has 3 phases — freezing, frozen, thawing — each lasting several months.
Can frozen shoulder be prevented?
Partially. Maintaining shoulder range of motion after any injury or surgery, controlling diabetes tightly, and avoiding prolonged shoulder immobilization reduce risk. Many cases develop without an identifiable cause.
Do I need surgery for frozen shoulder?
Most cases (>90%) resolve with conservative treatment — cortisone injection plus physical therapy. Surgery (manipulation under anesthesia or arthroscopic capsular release) is reserved for the 5-10% of cases that don't improve after 9-12 months.
Is frozen shoulder the same as rotator cuff tear?
No, they're entirely different. Frozen shoulder has limitation of BOTH active and passive motion (the joint is stuck). Rotator cuff tear has limitation only in active motion (the muscle is torn but the joint moves freely when passively assisted). Treatment differs substantially.
Can frozen shoulder come back?
Recurrence in the same shoulder is uncommon — typically once it resolves, it doesn't return. However, about 10-20% of patients develop frozen shoulder in the opposite shoulder within 5 years. Diabetic patients have higher recurrence risk.