Frozen Shoulder (Adhesive Capsulitis): Causes, Symptoms, Diagnosis and Treatment

Frozen shoulder, medically known as adhesive capsulitis, causes pain and significant stiffness in the shoulder. The condition develops when the capsule surrounding the shoulder joint becomes inflamed, thickened and tight. As a result, shoulder movement gradually becomes difficult.

Many people first notice pain while reaching overhead, putting on clothes, combing their hair or reaching behind their back. The pain may also become worse at night and disturb sleep.

Frozen shoulder usually develops gradually and can take several months to improve. However, appropriate treatment can help control pain, maintain shoulder movement and support recovery.

At Jyoti Hospital, Gurugram, our orthopaedic team can evaluate persistent shoulder pain and stiffness, identify the underlying cause and recommend an appropriate treatment plan based on your symptoms and shoulder movement.

What Is Frozen Shoulder?

Frozen shoulder occurs when the joint capsule surrounding the shoulder becomes inflamed, thickened and contracted.

The shoulder is a ball-and-socket joint that normally allows a wide range of movement. A healthy joint capsule remains flexible and allows the arm to move freely.

With adhesive capsulitis, inflammation and tightening of the capsule restrict this movement. Consequently, you may gradually lose the ability to raise, rotate or move your arm normally.

The condition commonly causes two major problems:

• Shoulder pain
• Progressive stiffness and loss of movement

Frozen shoulder can interfere with everyday activities such as:

• Wearing or removing clothes
• Combing or washing your hair
• Reaching for objects on a shelf
• Reaching behind your back
• Fastening clothes
• Sleeping on the affected side
• Performing household or workplace activities

How Common Is Frozen Shoulder?

Frozen shoulder affects approximately 2% to 5% of the general population and commonly affects adults between 40 and 70 years of age. Women experience the condition more often than men.

People with certain medical conditions, particularly diabetes, have a higher risk of developing adhesive capsulitis.

What Causes Frozen Shoulder?

In many cases, doctors cannot identify one specific cause. This type is called primary or idiopathic frozen shoulder.

However, frozen shoulder can also develop after another condition or event prevents normal shoulder movement. Doctors call this secondary frozen shoulder.

Common situations associated with frozen shoulder include:

1. Diabetes: People with diabetes have a higher risk of developing frozen shoulder. Therefore, maintaining good blood sugar control remains an important part of overall health management.
2. Shoulder injury: A shoulder injury can make you avoid moving the arm because of pain. Prolonged reduction in shoulder movement can contribute to stiffness and, in some cases, adhesive capsulitis.
3. Shoulder surgery: Shoulder or upper-limb surgery may temporarily limit movement. If the shoulder remains stiff for an extended period, a frozen shoulder can develop.
4. Thyroid disorders: Frozen shoulder may occur more frequently in people with thyroid disorders.
5. Prolonged shoulder immobility: Keeping the shoulder still for a long time after an injury, surgery or illness can increase the risk of stiffness.
6. Other medical conditions: Frozen shoulder may also occur in association with certain conditions such as stroke and other illnesses that reduce normal arm movement.

However, many people develop frozen shoulder without an obvious trigger.

Who Is More Likely to Develop Frozen Shoulder?

Your risk may increase if you:

• Are between 40 and 70 years old
• Have diabetes
• Have a thyroid disorder
• Recently had shoulder surgery
• Had a shoulder injury
• Have kept your arm immobilised for a prolonged period
• Have another condition that limits shoulder movement
• Have previously experienced frozen shoulder

Because diabetes increases the risk, people with diabetes should discuss persistent shoulder stiffness with their doctor rather than assuming that it will resolve on its own.

Symptoms of Frozen Shoulder

Frozen shoulder usually develops gradually.

The most important symptoms include:

1. Shoulder pain

Pain may begin gradually and become more noticeable with movement.

Some people experience a dull or aching pain even when they are not moving the shoulder.

2. Night pain

Frozen shoulder can cause significant pain at night. Sleeping on the affected shoulder may make symptoms worse and disturb sleep.

3. Progressive stiffness

As the condition progresses, the shoulder becomes increasingly difficult to move.

You may notice that you cannot:

• Raise your arm as high as before
• Reach behind your back
• Rotate your arm normally
• Put on a shirt or jacket comfortably
• Reach overhead

4. Difficulty performing daily activities

As stiffness increases, simple movements can become challenging.

For example, you may struggle to:

• Comb your hair
• Wash your back
• Wear a shirt
• Reach into a cupboard
• Lift objects overhead
• Fasten clothing behind your back

Why Does Frozen Shoulder Cause So Much Stiffness?

The shoulder capsule normally stretches as you move your arm.

With adhesive capsulitis, the capsule becomes inflamed and progressively contracts. This reduces the amount of space available for normal shoulder movement.

As the capsule tightens, certain movements become particularly difficult, especially external rotation, which means rotating your arm outward.

This characteristic restriction helps our orthopaedic doctor distinguish frozen shoulder from several other causes of shoulder pain.

The Three Stages of Frozen Shoulder

Our doctors commonly describe frozen shoulder in three stages. However, the stages do not always follow exactly the same timeline in every person.

Stage 1: Freezing Stage

During the freezing stage:

• Shoulder pain gradually increases
• Movement becomes increasingly difficult
• Pain may become worse at night
• The range of movement starts decreasing

This stage can last several weeks to several months. Some clinical resources describe the painful phase as lasting approximately 2 to 9 months.

What happens?

Pain often becomes the main problem initially. As the pain increases, you may naturally stop using the shoulder as much.

Stage 2: Frozen Stage

During the frozen stage:

• Pain may gradually become less severe
• Shoulder stiffness becomes more prominent
• Movement remains significantly restricted
• Everyday activities can remain difficult

This stage can also last several months.

Although the shoulder may hurt less than during the freezing phase, the stiffness can continue to interfere with daily life.

Stage 3: Thawing Stage

During the thawing stage:

• Shoulder movement gradually improves
• Stiffness slowly decreases
• Daily activities become easier
• Pain generally continues to settle

Recovery can take a long time. Some people recover within months, while others require considerably longer.

Therefore, patience and appropriate rehabilitation remain important.

Is Frozen Shoulder the Same as Shoulder Arthritis?

No.

Frozen shoulder primarily involves inflammation and tightening of the shoulder capsule, whereas arthritis involves changes within the joint surfaces and surrounding structures.

Both conditions can cause pain and restricted movement. Therefore, our doctor may use an examination and imaging, such as an X-ray, to help distinguish between them.

Frozen Shoulder vs Rotator Cuff Problems

Frozen shoulder and rotator cuff problems can produce similar symptoms, but they are not the same condition.

With frozen shoulder, our doctor usually finds a global restriction of shoulder movement, particularly rotation.

With a rotator cuff problem, certain movements may cause pain or weakness while some passive movements remain relatively preserved.

Because several shoulder conditions can produce similar symptoms, avoid self-diagnosing based only on pain location.

How Is Frozen Shoulder Diagnosed?

Our doctors usually diagnose frozen shoulder through a combination of:

• Medical history
• Physical examination
• Assessment of shoulder movement
• Selected imaging tests

During the examination, your doctor may ask you to move your shoulder in different directions.

Our doctor may also move your arm while you relax it. This helps assess whether the restriction affects both active and passive movement.

At Jyoti Hospital, Gurugram, an orthopaedic evaluation can help differentiate frozen shoulder from conditions such as rotator cuff disease, arthritis, shoulder impingement or other causes of shoulder stiffness.

Do You Need an X-Ray?

Our doctors recommend a shoulder X-ray to rule out other causes of pain and stiffness, particularly arthritis or previous injury.

A typical X-ray may appear normal in frozen shoulder because the main problem involves the soft tissues of the joint capsule rather than obvious bone damage.

Do You Need an MRI?

Not everyone with frozen shoulder needs an MRI.

Our doctors may consider ultrasound or MRI when they suspect another problem, such as:

• Rotator cuff tear
• Tendon injury
• Significant structural abnormality
• Another condition that does not fit the typical pattern of frozen shoulder

Our doctor select imaging based on your symptoms and examination rather than ordering every test routinely.

Treatment for Frozen Shoulder

Treatment depends on the stage of the condition, severity of pain, degree of stiffness and your overall health.

The main goals are to:

1. Reduce pain
2. Maintain or improve shoulder movement
3. Restore daily function
4. Reduce disability
5. Help you return to normal activities

Treatment may include:

• Activity modification
• Pain-relieving medicines
• Physiotherapy
• Home exercises
• Steroid injections
• Hydrodilatation in selected patients
• Manipulation under anaesthesia in selected cases
• Arthroscopic capsular release in selected cases

1. Activity Modification

You do not necessarily need to completely stop using your shoulder.

In fact, keeping the shoulder gently moving within your comfortable range can help prevent further stiffness. However, avoid activities that significantly increase your pain.

For example, you may temporarily modify:

• Heavy lifting
• Repetitive overhead movements
• Exercises that cause significant pain
• Heavy gym workouts involving the affected shoulder

NHS guidance also recommends continuing gentle movement rather than completely immobilising the shoulder.

2. Pain-Relieving Medicines

Our doctor recommend appropriate pain-relieving medicines depending on your medical history.

Commonly used options may include:

• Paracetamol
• Non-steroidal anti-inflammatory drugs (NSAIDs), when appropriate
• Other prescription medicines in selected situations

Do not start or continue NSAIDs without medical advice if you have conditions such as kidney disease, stomach ulcers, certain heart conditions, are taking blood thinners, or have other contraindications.

3. Physiotherapy for Frozen Shoulder

Physiotherapy plays an important role in frozen shoulder management.

Our physiotherapist can assess your range of movement and develop an exercise programme according to your stage of disease and pain level.

Treatment may include:

• Gentle stretching
• Shoulder mobility exercises
• Range-of-motion exercises
• Strengthening exercises
• Posture advice
• Gradual return to normal activities

However, aggressive stretching during a highly painful phase may worsen symptoms. Therefore, your exercise programme should match your condition.

The NHS recommends gentle shoulder exercises and physiotherapy to help restore movement.

4. Heat Therapy

Some people find heat useful before stretching or exercising because it can make the shoulder feel more comfortable.

You can use a warm pack for a limited period while protecting your skin.

Do not place a very hot object directly against your skin.

5. Steroid Injection

Our doctor may recommend a corticosteroid injection into the shoulder joint, particularly when pain significantly limits movement.

Steroid injections can help reduce pain and inflammation, which may allow you to participate more comfortably in rehabilitation.

They do not instantly restore normal shoulder movement. Instead, reducing pain can make movement and physiotherapy easier.

Our doctor will decide whether an injection is appropriate after considering your symptoms, diabetes status and other medical factors.

6. Hydrodilatation

Some patients may benefit from hydrodilatation, also called capsular distension.

During this procedure, a healthcare professional injects fluid, sometimes combined with local anaesthetic and corticosteroid, into the shoulder joint to stretch and expand the tight capsule.

Our doctors may consider this option when pain and stiffness persist despite initial treatment.

The suitability of hydrodilatation depends on the individual patient and local clinical expertise.

7. Manipulation Under Anaesthesia

Our doctors may consider manipulation under anaesthesia (MUA) for selected patients who continue to experience significant stiffness despite appropriate non-surgical treatment.

During MUA, the patient receives anaesthesia while the doctor carefully moves the shoulder to stretch the contracted capsule.

Because manipulation carries potential risks, doctors should select patients carefully.

8. Arthroscopic Capsular Release

Our doctors rarely need surgery for frozen shoulder.

However, if significant pain and stiffness persist despite appropriate non-surgical treatment, an orthopaedic surgeon may consider arthroscopic capsular release.

During this minimally invasive procedure, the surgeon uses small instruments inserted around the shoulder to release portions of the tight joint capsule.

The goal is to improve shoulder movement.

After surgery, rehabilitation remains extremely important because maintaining the restored range of motion forms an essential part of recovery.

Does Frozen Shoulder Need Surgery?

Usually, no.

Most people can manage frozen shoulder without surgery using appropriate pain control, movement, exercises and physiotherapy.

Doctors generally reserve procedures such as manipulation under anaesthesia or arthroscopic capsular release for selected patients who have persistent, significant symptoms despite appropriate conservative treatment.

The decision should depend on:

• Severity of symptoms
• Duration of symptoms
• Functional limitations
• Response to physiotherapy
• Response to other treatments
• Overall health
• Patient preferences

How Long Does Frozen Shoulder Last?

Frozen shoulder can take many months or even years to fully settle.

Recovery varies considerably from person to person. Some people regain function sooner, while others continue to experience stiffness for a prolonged period.

Therefore, do not become discouraged if your shoulder does not return to normal within a few weeks.

At the same time, prolonged symptoms should not automatically be ignored. Persistent pain or stiffness deserves proper assessment to confirm the diagnosis and identify treatment options.

Can Frozen Shoulder Heal Completely?

Many people eventually experience substantial improvement in pain and movement.

However, recovery can be slow, and some people may continue to have a degree of stiffness even after the pain improves.

The treatment goal is therefore not simply to wait for the condition to disappear. Appropriate management can help control pain, maintain movement and improve your ability to perform daily activities.

Frozen Shoulder and Diabetes

The relationship between diabetes and frozen shoulder deserves special attention.

People with diabetes have a higher risk of developing adhesive capsulitis.

If you have diabetes and develop persistent shoulder pain or stiffness:

• Monitor your blood sugar as advised
• Continue your prescribed diabetes treatment
• Discuss the shoulder symptoms with your doctor
• Do not assume that the stiffness will resolve without evaluation

Managing diabetes remains important for your overall health as well as your musculoskeletal health.

Frozen Shoulder Exercises

Gentle exercises can help maintain shoulder mobility.

However, the right exercise and intensity depend on the stage of frozen shoulder.

Common rehabilitation movements may include:

• Pendulum exercises
• Gentle shoulder flexion
• Assisted shoulder elevation
• Gentle external rotation
• Wall-assisted movements
• Gradual strengthening exercises during later recovery

You should perform exercises within a tolerable range and follow the programme provided by your healthcare professional.

Important:

Do not force a severely painful shoulder through aggressive stretching or heavy gym exercises.

The NHS specifically advises against making up strenuous exercises because these can aggravate shoulder pain.

What Should You Avoid With Frozen Shoulder?

If you have frozen shoulder, avoid:

• Heavy lifting that increases pain
• Forceful stretching
• Repetitive painful overhead movements
• Heavy shoulder workouts during the painful stage
• Completely immobilising the shoulder for prolonged periods
• Ignoring worsening symptoms
• Self-injecting steroids or other medicines
• Taking painkillers for prolonged periods without appropriate medical advice

Instead, focus on controlled movement and a structured rehabilitation programme.

Can You Prevent Frozen Shoulder?

You cannot prevent every case of frozen shoulder because many cases develop without an identifiable cause.

However, you can reduce the risk of prolonged stiffness after injury or surgery by following your healthcare professional’s rehabilitation programme.

After a shoulder injury or operation:

• Follow prescribed exercises
• Gradually restore shoulder movement
• Attend physiotherapy when recommended
• Do not immobilise the shoulder longer than necessary
• Follow your surgeon’s activity restrictions

People with diabetes should also maintain appropriate diabetes care because diabetes increases the risk of frozen shoulder.

When Should You See an Orthopaedic Doctor?

Consult our orthopaedic doctor if:

• Shoulder pain persists
• Your shoulder movement gradually decreases
• You have difficulty raising your arm
• You cannot reach behind your back
• Shoulder pain regularly disturbs your sleep
• You have diabetes and develop persistent shoulder stiffness
• Symptoms interfere with work or daily activities
• Shoulder pain continues despite home measures

Early assessment can help determine whether you have frozen shoulder or another shoulder condition requiring different treatment.

When Is Shoulder Pain an Emergency?

Seek urgent medical attention if shoulder pain:

• Starts suddenly after a significant injury
• Causes an obvious deformity
• Prevents you from moving the arm
• Is associated with severe swelling
• Causes persistent numbness or loss of sensation
• Occurs with significant weakness after an injury
• Is associated with fever or feeling seriously unwell

Sudden severe shoulder pain after a fall or accident may indicate a fracture, dislocation or tendon injury rather than simple frozen shoulder.

Also seek urgent medical evaluation if shoulder pain occurs with chest pain, breathlessness, sweating, nausea or other symptoms that could indicate a heart-related emergency.

How Jyoti Hospital Can Help With Frozen Shoulder

At Jyoti Hospital, Gurugram, our orthopaedic team can evaluate persistent shoulder pain and stiffness and determine whether frozen shoulder is responsible for your symptoms.

Your evaluation may include:

• Detailed medical history
• Shoulder movement assessment
• Physical examination
• Appropriate imaging when required
• Assessment for diabetes or other associated conditions
• Individualised pain management
• Physiotherapy and mobility guidance
• Injection treatment when clinically appropriate
• Referral for advanced treatment when conservative treatment does not provide adequate improvement

Because frozen shoulder can resemble other shoulder conditions, a proper clinical examination remains important before starting an exercise or treatment programme.

Final Thoughts

Frozen shoulder, or adhesive capsulitis, causes a combination of shoulder pain and progressive stiffness. The condition often develops gradually and can significantly affect sleep, work and everyday activities.

Although frozen shoulder can take a long time to recover, most patients do not require surgery. Appropriate pain management, gentle movement, physiotherapy and selected treatments such as steroid injections can help manage symptoms and improve function. Our doctors may consider hydrodilatation or surgical treatment in selected patients who continue to experience significant problems.

If shoulder pain or stiffness is affecting your daily life, do not simply wait for it to disappear. An orthopaedic assessment can help identify the cause and guide appropriate treatment.

If you are experiencing persistent shoulder pain, increasing stiffness or difficulty moving your arm, consult the Orthopaedics team at Jyoti Hospital, Gurugram, for evaluation and personalised treatment.

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FAQs

1. What is frozen shoulder?
   • Frozen shoulder, or adhesive capsulitis, occurs when the capsule surrounding the shoulder joint becomes inflamed, thickened and contracted. This causes pain and progressive restriction of shoulder movement.
2. What are the first signs of frozen shoulder?
   • Early symptoms commonly include shoulder pain, particularly with movement and at night, followed by gradually increasing stiffness.
3. Can frozen shoulder go away on its own?
   • Many cases improve over time. However, recovery can take months or longer. Appropriate treatment can help manage pain and restore movement.
4. Is physiotherapy good for frozen shoulder?
   • Physiotherapy can help restore shoulder movement. However, exercises should match your stage of disease and pain level. Gentle, structured exercises are generally preferable to aggressive stretching.
5. Can diabetes cause frozen shoulder?
   • Diabetes is strongly associated with a higher risk of frozen shoulder. People with diabetes who develop persistent shoulder stiffness should seek medical evaluation.