Defrosting Your Frozen Shoulder Queries

Frozen shoulder, also known as adhesive capsulitis, is a common condition that causes shoulder pain, stiffness, and a gradual loss of movement. Symptoms usually develop slowly and can interfere with daily activities such as dressing, driving, and sleeping. While frozen shoulder often improves over time, early diagnosis and appropriate treatment can help manage pain and restore shoulder movement more effectively.

Frozen shoulder symptoms & risk factors

Common symptoms include persistent shoulder pain, increasing stiffness, and reduced range of motion. Pain is often worse at night and during movement, particularly in the early stages. Frozen shoulder may develop without a clear cause, but it is more common after shoulder injury, surgery, or prolonged immobilisation. People with diabetes are at higher risk and may experience a longer recovery.

Phases of frozen shoulder in the shoulder joint

In a frozen shoulder, the jacket lining (otherwise known as the capsule) becomes inflamed and thickens, becoming stiff and tight, which limits movement and causes a great deal of pain when the shoulder is moved. In this first phase, known as the freezing stage, pain worsens gradually over 2 to 9 months, especially when reaching, and the thickening of the shoulder capsule further limits movement. Gradually, patients enter the second phase, the frozen stage, which lasts 4 to 12 months and is characterised by worsening stiffness. During this stage, thick bands of tissue called adhesions (scar tissue) develop in the capsule, further restricting movement and making daily activities very difficult.

Eventually, the patient enters the final “thawing” or recovery phase, where shoulder motion slowly improves. Complete return to normal strength and motion can take anywhere from 6 months to 2 years. Most patients achieve a full recovery, although a small proportion experience mild residual symptoms. It can take, on average, 2 1/2 years for the condition to resolve, during which time the patient can be significantly debilitated by shoulder pain and stiffness, consequently limiting their ability to perform daily activities, work, and recreation. Patients who suffer from diabetes or who have developed a frozen shoulder after trauma or surgery often take longer to recover.

Diagnosis

It is important to obtain an accurate diagnosis, and a shoulder specialist can exclude other causes of pain and stiffness, such as arthritis. A simple X–ray can help exclude many other conditions and help confirm the correct diagnosis of frozen shoulder.

Frozen shoulder treatment

Frozen shoulder is often a condition that patients have managed themselves for a period of time using over-the-counter painkillers and visiting therapists. When significant improvement is not achieved, the patient often consults their GP, who may refer them to an Orthopaedic Shoulder Specialist for further assessment and treatment.

For home remedies, applying an ice pack or a bag of frozen vegetables wrapped in a towel as a cold compress can help reduce shoulder swelling and pain. Using a warm shower or applying heat to the shoulder may help relieve pain and discomfort for some patients. Sleeping with proper head and neck support can also help alleviate discomfort from frozen shoulder.

The treatment strategy for this condition depends on which stage of frozen shoulder the patient is in. In the early painful “freezing” phase, the emphasis is on pain control. Painkillers and anti-inflammatories are usually commenced initially. An injection of a steroid into the shoulder joint (intra-articular injection) is also often used to give pain control. During the early “freezing” phase, physiotherapy exercises are often poorly tolerated by the patient due to the pain. However, when the shoulder enters the “frozen” (stiff) phase, and the pain has subsided, physiotherapy with stretching exercises can be commenced and may be beneficial.

Physical therapy may include gentle stretching and range-of-motion exercises designed to improve mobility and reduce symptoms. Exercises are introduced gradually and tailored to the individual stage of frozen shoulder under professional guidance.

If these methods fail to quickly improve the patient’s symptoms, other treatment options are available. Sports medicine specialists may offer non-surgical treatments such as hydrodilatation, which involves injecting a large volume of sterile fluid into the shoulder joint to expand and stretch the joint capsule. Manipulation Under Anaesthetic (MUA) is a day-case procedure in which the surgeon manipulates the shoulder to break down stiff tissue and improve range of motion. Another option is a keyhole procedure called Arthroscopic Capsular Release, which is performed as a day-case procedure. The surgeon inserts a camera into the shoulder, assesses the anatomy, and then carefully releases the stiff capsule, so the patient finishes the procedure with an excellent range of motion. Patients then have physiotherapy after the operation to help maintain the rapid improvements gained from the procedure.

Most people with frozen shoulder improve with relatively simple treatments to control pain and restore motion, but persistent shoulder stiffness may require further intervention. Ultimately, a frozen shoulder will get better on its own, but it can take a long time, cause significant pain, and interfere with work and recreational activities. Therefore, it is recommended to seek a specialist’s opinion to confirm the correct diagnosis and to discuss the pros and cons of all treatment options, choosing the best treatment for the patient’s needs and expectations.