What is the condition?

Frozen shoulder, or adhesive capsulitis, is a condition where the capsule of the shoulder joint becomes inflamed, stiff, and thickened, leading to pain and restricted movement. It develops gradually and often goes through three distinct phases (freezing, frozen and thawing). It is a self-limiting condition and over 90% of frozen shoulders resolve after 18-24 months.

 

What are the symptoms?

· Gradual onset of shoulder pain, often worse at night

· Increasing stiffness and reduced ability to move the arm in all directions

· Difficulty with everyday tasks like dressing or reaching overhead

· Pain that may persist even when the arm is not moving

 

What are the risk factors?

· Most common between ages 40 and 60

· More common in women than men

· Diabetes, thyroid disease, or other metabolic conditions

· Shoulder immobilisation after surgery or injury

· Previous frozen shoulder in the opposite arm

 

How is it diagnosed?

· Diagnosis is based on a clinical examination of movement and stiffness

· X-rays are used to rule out other causes of shoulder pain (e.g. arthritis)

· An MRI may show thickening of the shoulder capsule or rule out rotator cuff tears

 

What are the treatment options?

· Non-surgical treatment is the mainstay and includes physiotherapy, anti-inflammatory medication, and cortisone injections.

· Management of diabetes and thyroid disorders is critical.

· Cortisone injections during early stages if pain severe

· Gentle stretching exercises help restore movement over time

· In resistant cases, options include hydrodilatation (joint capsule stretch with fluid), manipulation under anaesthesia, or arthroscopic release (rarely indicated)

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When is surgery required?

· Surgery is rarely required as the majority of frozen shoulder will resolve with time

· Indications would be non-functional range of motion despite maximal conservative measures (18-24 months)

· Surgical involves an arthroscopic release of the tight capsule together with a controlled manipulation of the joint

 

How long is the recovery following surgery?

· Freezing phase (0–6 months):

o Increasing pain and gradually worsening stiffness

o Pain is often the most limiting factor

o Focus is on pain control and gentle mobility

· Frozen phase (6–12 months):

o Pain may improve, but stiffness remains

o Daily activities are affected due to restricted range of motion

o Stretching and physiotherapy are important

· Thawing phase (12–24 months):

o Gradual return of movement

o Pain resolves and function improves

o Full recovery may take up to 2 years

 

What are the expected outcomes of surgery?

· Most patients recover well with non-operative treatment

· Some residual stiffness may remain, especially in diabetics

· Adherence to stretching programmes improve outcomes

· Surgical release provides good results in selected cases

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What does the rehabilitation/recovery involve?

To find out more about rehabilitation and recovery after shoulder surgery please see our Rehabilitation Protocols here.