Frozen shoulder, also known as adhesive capsulitis, is a condition that causes inflammation, pain, stiffness and limited mobility in the shoulder. The condition affects the capsule of the shoulder joint, which consists of ligaments that surround the ball and socket joint connecting the upper arm bone to the shoulder socket.
Diagnosis can be challenging because early symptoms may not be obvious and imaging such as MRI may appear normal except for some thickening in the joint capsule. General practitioners might refer patients to specialists if they are uncertain about the diagnosis.
The cause of frozen shoulder is generally unknown, or idiopathic. It has been observed after minor trauma, post-chemotherapy, in individuals with endocrine problems like insulin-dependent diabetes, and following procedures such as mastectomy. Lack of movement or underlying disease processes may contribute to its development.
Women in middle age are most commonly affected by frozen shoulder. There is an association with menopause and endocrine disorders such as thyroid disease and diabetes. The exact reason for increased risk during menopause is unclear but could relate to decreased estrogen levels.
Frozen shoulder progresses through three phases: pain and inflammation; stiffness; and thawing. In the first phase, inflammatory pain limits movement and can last several months. Stiffness follows as pain improves but mobility remains restricted. In the final thawing phase, movement gradually returns after pain subsides.
The duration of these phases varies among individuals but most regain full mobility within three years.
Treatment depends on the stage of frozen shoulder. During the initial painful phase, over-the-counter anti-inflammatory medications like ibuprofen or cortisone injections may help reduce inflammation. Massage therapy can sometimes provide relief by increasing blood flow and relaxing muscles; however, physical therapy is not recommended at this stage due to pain.
As pain decreases in later stages, massage and physical therapy become important tools for restoring mobility more quickly.
Surgery is rarely needed for frozen shoulder and should not be considered during early phases since it may worsen symptoms. In rare cases where stiffness persists after inflammation resolves, a minimally invasive procedure called capsular release may be performed to restore movement. This surgery involves small incisions using a camera (arthroscopy) and requires postoperative physical therapy for recovery.
Prevention is not possible once frozen shoulder begins but understanding what to expect can help patients cope better during recovery.
According to experts: "These are the best things I can tell you about frozen shoulder: First, you can’t make the disease process worse; second, you’re going to get better."
They add: "Sometimes, patients fear that making an inadvertent movement that causes a sudden increase in pain will delay recovery. That’s not the case. The pain hurts, but it doesn’t increase recovery time, and you’ll move through the stages whether you do anything or not."
Interventions such as injections or physical therapy are aimed at improving comfort and helping restore range of motion sooner rather than altering overall prognosis.
Once someone recovers from frozen shoulder on one side it does not typically recur on that same side.
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