Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis, is a condition causing progressive stiffness and pain in the shoulder joint, which gradually restricts movement. It typically develops slowly and can take months to years to fully resolve.

• Gradually worsening shoulder pain, often worse at night and with certain movements
• Progressive stiffness and loss of shoulder movement, both active (moving it yourself) and passive (someone else moving it for you)
• Difficulty with everyday tasks such as reaching overhead, behind the back, or across the body
• The condition typically progresses through stages — worsening pain and stiffness, a plateau of significant stiffness, and then gradual improvement — over many months

• The exact cause is often not identified, though it involves thickening and tightening of the tissue capsule surrounding the shoulder joint.
• Risk is increased by diabetes, prolonged immobility of the shoulder (such as after injury or surgery), and, to some extent, thyroid disease.
• More common in adults aged 40 to 60 and slightly more common in women.

• Diagnosed clinically based on the characteristic pattern of progressive shoulder stiffness affecting both active and passive movement, together with the typical age group and, often, a gradual onset without a specific injury.
• Imaging, such as X-ray, may be used to rule out other causes of shoulder pain, such as arthritis, though it is not needed to confirm a typical case.

Pain relief with paracetamol or an NSAID helps manage discomfort, particularly during the more painful early stage.

Physiotherapy, involving specific stretching and mobility exercises, supports gradual improvement in movement and is a central part of management throughout the condition's course.

A corticosteroid injection into the shoulder joint may help reduce pain and improve movement, particularly when used earlier in the condition's course.

The condition generally improves on its own over one to three years, though physiotherapy can help speed recovery and maintain function during this time.

Persistent, significant stiffness not improving with these measures may be referred for further specialist assessment.

• Manage diabetes well, given its association with increased risk of frozen shoulder.
• Keep the shoulder moving as much as pain allows after any injury or surgery, rather than prolonged immobilisation, where this is safe to do.
• Engage in prescribed physiotherapy exercises consistently, as adherence supports better and faster recovery.
• Be patient with recovery, as frozen shoulder typically takes many months to resolve even with treatment.