Frozen Shoulder

Frozen shoulder, known medically as adhesive capsulitis, is a condition where the shoulder becomes increasingly painful and then stiff, often with no clear injury behind it. Everyday things like reaching into the back seat, doing up a bra, putting on a jacket or sleeping on that side can become difficult. It’s frustrating, because it takes time, but it does follow a recognisable path and there’s a lot that can be done along the way.

Understanding frozen shoulder

The lining of the shoulder joint becomes inflamed and then tight, which restricts how far the joint can move. It typically moves through overlapping stages:

• Painful (freezing) stage: pain builds, often worse at night, and movement starts to shrink
• Stiff (frozen) stage: pain may ease a little, but the shoulder is very restricted, especially turning the arm outwards and reaching behind you
• Thawing stage: movement gradually returns

It’s most common between about 40 and 60, and it’s more likely in people with diabetes or thyroid conditions, after a period of immobilisation or surgery, or after a minor shoulder injury. Sometimes there’s no obvious trigger at all.

Symptoms we commonly see

• A deep ache in the shoulder, often into the upper arm, that’s worse at night
• Difficulty sleeping on the affected side
• Loss of movement in all directions, particularly turning the arm out and reaching behind your back
• Trouble with dressing, hair care, reaching a seatbelt or high shelf
• Stiffness that’s the same whether you move the arm yourself or someone else does

Our evidence-based approach

Reviews of frozen shoulder describe non-surgical care as the first step for most people, with injection or procedural options considered if symptoms persist. The best treatment depends heavily on which stage you’re in, so the first job is working out where you are. Our approach includes:

1. Assessment to confirm it’s a frozen shoulder and rule out other causes of a stiff, painful shoulder, such as a rotator cuff problem, arthritis or a referred neck problem
2. Education, so you understand the stages and what to expect, which takes a lot of the worry out of a long recovery
3. Pain management, including positioning for sleep, activity pacing and hands-on treatment where it eases symptoms
4. Pain-guided mobility work in the early stage, progressing to more deliberate stretching as irritability settles
5. Progressive strengthening of the rotator cuff and shoulder blade muscles, so strength recovers alongside movement
6. Coordination with your GP on options like a corticosteroid injection when it’s likely to help
7. Supervised strength work in our private gym once you’re moving well, so you can rebuild fully

What to expect: recovery timeline

• Painful stage: often several weeks to a few months, where the focus is comfort and keeping gentle movement going
• Stiff stage: can last many months, with steady work on range of movement and strength
• Thawing stage: movement returns gradually, and strengthening becomes the priority
• Overall: commonly a year or more, and sometimes up to two to three years, with most people regaining good function

When to seek help urgently

Seek prompt medical assessment if your shoulder pain follows a fall or injury, comes with fever, redness, swelling or feeling generally unwell, or if you have chest pain, shortness of breath or pain spreading down the left arm. Constant severe pain that isn’t eased by rest or position also needs review.

References

• Challoumas D, Biddle M, McLean M, Millar NL. Comparison of treatments for frozen shoulder: a systematic review and meta-analysis. JAMA Netw Open. 2020;3(12):e2029581.
• Redler L, Dennis E. Treatment of adhesive capsulitis of the shoulder. J Am Acad Orthop Surg. 2019;27(12):e544-e554.