- Also known as
- Adhesive capsulitis
- Most common in
- Women 40–60
- people with diabetes
- Natural course
- 12–36 months self-limiting
- First-line
- Education, physiotherapy, injection
- Surgical option
- Arthroscopic capsular release
What frozen shoulder is.
Frozen shoulder — properly called adhesive capsulitis — is a painful inflammatory and fibrotic condition of the shoulder capsule. The capsule is the soft-tissue envelope that surrounds the glenohumeral joint. In frozen shoulder, this capsule becomes inflamed, scarred, and contracted. The result is a shoulder that hurts, then progressively stiffens, then slowly recovers.
The condition is genuinely self-limiting in the vast majority of patients. The textbook course is described in three phases:
- Freezing (2–9 months) — increasing pain, particularly at night, with gradual loss of motion.
- Frozen (4–12 months) — pain begins to settle, but stiffness is at its worst. Range of motion is severely restricted, particularly external rotation.
- Thawing (6–24 months) — motion slowly returns, often (but not always) to near-normal levels.
For many patients the total duration is approximately 18–24 months. Some recover sooner, and a small minority are left with persistent stiffness.
Who develops frozen shoulder.
Frozen shoulder affects approximately 2–5% of the population over a lifetime. It is more common in women, in adults aged between 40 and 60, and dramatically more common in people with diabetes — the lifetime risk in diabetics may be as high as 20%. Other recognised associations include thyroid disease, Dupuytren's contracture, and recent shoulder injury or surgery (post-operative stiffness shares many features).
How the diagnosis is made.
The diagnosis of frozen shoulder is clinical. The cardinal feature is the loss of passive external rotation — that is, even when the examiner moves the arm, it cannot rotate outward. This finding distinguishes frozen shoulder from a rotator cuff tear (where passive motion is preserved). A plain X-ray is taken to exclude alternative diagnoses, particularly glenohumeral arthritis. MRI is reserved for atypical cases or when surgery is contemplated.
Non-operative treatment.
The mainstay of treatment is education, well-placed injections, and time.
- Education — understanding the natural history is half the battle. Patients who know what to expect cope better.
- Glenohumeral corticosteroid injection — performed under image guidance, this is the single highest-yield intervention in the painful phase.
- Hydrodilatation — a radiologist injects local anaesthetic, steroid and saline under pressure into the joint, distending the contracted capsule. This adds a mechanical component to the steroid injection alone, and is particularly useful in patients with significant stiffness.
- Physiotherapy — gentle stretching, scapular control, and respect for pain. Aggressive stretching paradoxically prolongs the condition.
- Analgesia — short courses of anti-inflammatories and night-time analgesia to allow sleep.
When surgery is considered.
Surgical treatment is reserved for the minority of patients in whom the stiffness is severe and persistent despite 6–9 months of well-conducted non-operative treatment. The contemporary procedure is arthroscopic capsular release, in which the contracted capsule is divided under direct vision through small portals, and the shoulder is gently moved through a full range under anaesthetic. Recovery is rapid compared with the natural history, and the results in carefully selected patients are excellent.
Frequently asked questions.
How long does frozen shoulder last?
On average, between 18 and 24 months from first symptom to functional recovery. Some patients recover within a year, and a minority take longer than two.
Will physiotherapy fix my frozen shoulder?
Physiotherapy will not change the underlying biology. It does help with pain management, scapular control, and preserving the motion you have. Aggressive stretching during the painful phase tends to prolong the condition, not shorten it.
Is a cortisone injection worth it?
In the painful phase, yes — a well-placed glenohumeral corticosteroid injection is the single highest-yield non-operative intervention. Hydrodilatation adds a mechanical capsule-stretching effect to the same injection.
Can frozen shoulder come back?
Recurrence in the same shoulder is uncommon. About 10–15% of patients develop frozen shoulder in the opposite shoulder at some point, particularly diabetic patients.
Will I need surgery?
The majority of patients do not need surgery. Arthroscopic capsular release is reserved for the minority in whom stiffness is severe and persistent after 6–9 months of well-conducted non-operative treatment.
References.
- Lewis J. Frozen shoulder contracture syndrome — aetiology, diagnosis and management. Man Ther. 2015;20(1):2–9.
- Rangan A, et al. UK Frozen Shoulder Trial (UK FROST). Lancet. 2020;396(10256):977–989.
- Hand C, et al. The pathology of frozen shoulder. J Bone Joint Surg Br. 2007;89(7):928–932.