Frozen Shoulder
ADHESIVE CAPSULITIS
Frozen shoulder is a painful, often debilitating condition in which the shoulder progressively becomes stiff and difficult to move. Both active movement and movement assisted by another person are restricted.
FROZEN SHOULDER
Symptoms
- Gradually increasing shoulder pain, often worse at night
- Progressive loss of movement
- Difficulty reaching overhead, behind the back or across the body
- Problems dressing, grooming, sleeping and performing everyday activities
What Causes the Stiffness?
The capsule surrounding the shoulder joint becomes inflamed, thickened and contracted. This reduces the joint’s normal capacity and restricts movement. Frozen shoulder may occur without an obvious cause or develop after injury, surgery or prolonged immobilization. It is more common in women—particularly during the perimenopausal and postmenopausal years—and in people with diabetes or thyroid disease.
Natural History
Frozen shoulder typically progresses through three overlapping stages. Without active treatment, the timing varies considerably:
Freezing Stage
Approximately 6 weeks to 12 months
Pain gradually increases, often disturbing sleep, while shoulder movement becomes progressively restricted.
Frozen Stage
Approximately 4 to 18 months
Stiffness and loss of function are most prominent, although pain may begin to improve.
Thawing Stage
Approximately 6 months to 3 years
Pain and stiffness gradually settle, and shoulder movement progressively returns.
Treatment
Treatment depends on the stage and severity of the condition and may include:
- Activity modification, heat and pain medication
- Gentle home exercises and physiotherapy
- Ultrasound-guided hydrodilatation, using fluid and corticosteroid to expand and stretch the tightened joint capsule
- Suprascapular nerve block for selected patients
- Manipulation under anesthesia or arthroscopic capsular release for persistent, severe cases
Early Treatment Matters
Early ultrasound-guided joint injection with hydrodilatation may shorten the course of frozen shoulder. Pain control can make stretching and rehabilitation easier. An accurate assessment is important because rotator-cuff disorders, arthritis and other shoulder conditions can cause similar symptoms.
If You Choose a Joint Injection, What Can You Expect?
There may be some discomfort with the initial injection and a feeling of fullness in the joint. For most people, this discomfort settles within 5 to 10 minutes. A reduction in pain is often noticed within several days, while range of motion usually begins to improve after 10 to 14 days.
It is important to continue physiotherapy immediately after the injection to restore range of motion. This should be followed by strengthening exercises for the entire shoulder girdle and rotator cuff to help normal function return as soon as possible.
