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Overview

What Is Frozen Shoulder?

Frozen shoulder, also called adhesive capsulitis of the shoulder, occurs when the capsule of tissue surrounding the shoulder joint becomes thick, tight and inflamed. This makes both active movement and passive movement—when someone else moves your arm—more limited. The condition can cause pain and stiffness that gradually affect everyday activities. Frozen shoulder most often affects adults in midlife.

Symptoms

Frozen Shoulder Symptoms

  • Shoulder pain, which may begin gradually.
  • Worsening shoulder stiffness.
  • Reduced range of motion in the shoulder.
  • Pain that is worse at night.
  • Difficulty reaching overhead or behind the back.
  • Difficulty dressing because shoulder movement is restricted.
  • Difficulty lifting or carrying objects.

What Are the 4 Stages of Frozen Shoulder?

Frozen shoulder commonly moves through painful or “freezing,” frozen, and thawing phases, although the timing and severity vary. During the freezing phase, pain increases and movement becomes more limited; during the frozen phase, stiffness is often the main problem; and during thawing, movement gradually returns. Unlike ordinary temporary soreness, frozen shoulder usually causes progressive stiffness and limits both self-directed and assisted movement.

Causes

What Causes Frozen Shoulder?

Frozen shoulder begins with inflammation in the joint capsule, followed by thickening and contraction of this tissue. As the capsule tightens, it restricts the normal gliding motion of the shoulder joint. Some cases are primary, or idiopathic, meaning no clear initiating cause is found. Other cases are secondary and follow another condition, injury, surgery or a period when the shoulder could not move normally.

PRIMARY FORM

No single cause is identified. This form is sometimes called idiopathic adhesive capsulitis.

SECONDARY FORM

Develops after reduced movement, injury, surgery, prolonged immobilization or another shoulder or medical condition.

Risk Factors

Frozen Shoulder Risk Factors

  • Being between 40 and 60 years old increases the likelihood of frozen shoulder.
  • Diabetes is associated with a higher risk of developing frozen shoulder.
  • Thyroid disease may increase the risk.
  • A previous shoulder injury or surgery can lead to prolonged stiffness.
  • Prolonged immobilization or reduced shoulder movement can contribute to secondary frozen shoulder.
  • A stroke may increase the risk because it can reduce normal arm and shoulder movement.
  • Having had frozen shoulder before increases the chance of developing it again or in the opposite shoulder.

Complications

Frozen Shoulder Complications

  • Persistent loss of shoulder motion may remain after the painful phase improves.
  • Shoulder stiffness can interfere with work, dressing, bathing and other self-care tasks.
  • Night pain and difficulty finding a comfortable position can disrupt sleep.
  • Frozen shoulder can recur or affect the opposite shoulder.

SAFETY

Avoid forcing a painful shoulder

Forceful self-stretching can worsen pain and irritate the shoulder. If symptoms are severe, ask a clinician or physiotherapist to adjust your rehabilitation plan.

Diagnosis

How Frozen Shoulder Is Diagnosed

Diagnosis is usually based on your medical history and a physical examination. A clinician looks at the pattern of pain and measures both active and passive range of motion, because frozen shoulder restricts movement even when the arm is moved for you.

  • Medical history helps identify symptom timing, previous injury or surgery, and related health conditions.
  • Shoulder movement and strength testing assesses range of motion and helps distinguish frozen shoulder from other problems.
  • An X-ray may be used to rule out arthritis, a fracture or other bone problems.
  • Ultrasound or MRI may be recommended when another soft-tissue condition is suspected.

Treatment & Management

Frozen Shoulder Treatment and Management

First-Line Frozen Shoulder Treatment

Initial care may include pain control, heat or ice as appropriate, and physiotherapy with gentle range-of-motion exercises. A clinician may recommend nonsteroidal anti-inflammatory drugs (NSAIDs) when they are safe, but these medicines may not be suitable for people with certain stomach, kidney, heart or bleeding problems or those taking particular medicines. Use medication only as directed by a healthcare professional, and progress exercises gradually rather than forcing a painful shoulder.

When Other Treatments May Be Considered

If pain and restricted movement persist despite nonsurgical care, options may include a corticosteroid injection or hydrodilatation, which stretches the capsule with injected fluid. In selected cases, a specialist may discuss manipulation under anesthesia or arthroscopic capsular release. The best approach depends on symptom severity, examination findings, overall health and response to earlier treatment.

EXPECTATIONS

Treatment usually takes time

There is no reliable instant cure for frozen shoulder. Recovery often requires consistent rehabilitation over weeks or months, with the plan adjusted as pain and movement change.

Prevention

Can Frozen Shoulder Be Prevented?

  • Follow the prescribed rehabilitation plan after a shoulder injury or surgery.
  • Maintain gentle shoulder movement when it is medically permitted, particularly after periods of immobilization.
  • Manage diabetes and thyroid disease with guidance from a clinician.

Outlook and Prognosis

Frozen Shoulder Outlook and Prognosis

Frozen shoulder often improves gradually through painful, stiff and recovery phases, but the overall course varies between individuals. Symptoms may last from several months to several years, particularly when stiffness is severe or treatment is delayed. Appropriate pain control and guided movement can support function, although some people retain mild stiffness or later develop symptoms in the other shoulder.

When Should You See a Doctor

When Should You See a Doctor for Shoulder Pain?

  • Arrange medical assessment for shoulder pain or stiffness that persists.
  • Seek care if shoulder movement progressively decreases.
  • Contact a clinician when symptoms prevent normal work, dressing, bathing or other daily activities.
  • Arrange an evaluation for shoulder symptoms that begin after an injury or surgery.
  • Seek medical advice if symptoms do not improve with appropriate home care.

SEEK URGENT CARE

Some shoulder symptoms need prompt attention

Sudden severe shoulder pain, visible deformity, inability to move the arm after an injury, chest pain, shortness of breath, fever, or a hot, red and swollen joint needs urgent medical evaluation. These symptoms may indicate another condition that requires prompt treatment.

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