Frozen Shoulder ( Adhesive Capsulitis)

What causes frozen shoulder?

A Frozen Shoulder occurs when there is thickening and swelling of the flexible tissue that surrounds your shoulder joint.  This tissue is known as a capsule.  In cases of frozen shoulder, it is thought that bands of scar tissue form inside the shoulder capsule, causing it to thicken, swell and tighten.

Risk factors for frozen shoulder

The reason why a frozen shoulder occurs is not fully understood.  It may not be possible to identify a cause.  However, there are risk factors that make developing a frozen shoulder more likely, such as:

    • Shoulder injury or surgery
    • Diabetes
    • Other health conditions such as heart disease, lung disease, Parkinson’s disease, stroke or Dupytren’s contracture

Stages, signs and symptoms of frozen shoulder

Stage Duration Signs & Symptoms
1 2 to 9 months Shoulder stiffness

Increasing, significant shoulder pain

2 4 to 12 months Increasingly stiff

Pain stabilises

Some muscle wasting

3 5 months to 2-3 years Pain subsides

Gradual increase in movement


Common problems in frozen shoulder

The pain and stiffness that accompanies frozen shoulder can often interfere with your ability to perform everyday tasks e.g. dressing, bathing, driving etc.  Shoulder stiffness can mean some activities may become very limited e.g. scratching your back, putting your hand in a rear pocket, tying a bra, using a hairdryer, reaching overhead.   In some cases work may be affected.   In the painful stage sleep is often affected.

Treatment of Frozen Shoulder

Frozen shoulder is a self-limiting condition that generally gets better by itself.  Treatment can help to ease pain and stiffness and reduce the period of disability. When receiving treatment for a frozen shoulder it is important to realise that recovery can be a slow process (up to 3 years) and that treatments must be given time to work.

Pain management

In the early painful phase, simple painkillers e.g. paracetamol, are the first line to help control pain.  In some cases anti-inflammatories or medication to aid sleep can be recommended by your doctor to help ease the pain.  If in doubt you should consult your GP or pharmacist before taking any medication.


In the early stages physiotherapy is aimed at relieving pain and maintaining as much movement as possible.  As the pain reduces and stiffness becomes the main problem physiotherapy will aim to increase the movement as much as possible.  Treatments such as joint mobilisations, stretches, muscle based techniques and other soft tissue treatments may help relieve pain and improve movement.  Other pain-relieving techniques may include thermal therapy and electrotherapy.  Your physiotherapist will issue you with exercises to help your shoulder.


  • Use the shoulder:  It is very important to use the arm as much as possible within the limits of your discomfort. Do not stop using it as this may cause the condition to worsen.
  • Ice and heat:  Both can be helpful to relieve pain. Be careful of burns.
  • Pillows:  When sleeping try to lie on the unaffected side and place a pillow under the affected arm to prevent the arm from dropping down.
  • Exercises:  Exercise is advised to maintain available range during all 3 stages.

Medical management

  • A steroid injection can decrease pain and provide relief and its effects can be maximised using physiotherapy and exercise.
  • Surgery is rarely used and only should be considered when symptoms are persistent, debilitating and conservative treatments have failed.
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