Frozen Shoulder

Frozen Shoulder

What is it?
Frozen Shoulder is also known as adhesive capsulitis. It is an inflammatory condition that affects the joint lining (or capsule) of the shoulder joint. This causes pain and loss of movement of the shoulder.

Who does it affect?
We believe that approximately 2-5% of the population will develop a frozen shoulder at some point. The condition is more common in 40-65 year olds and affects females more frequently than males. It is also associated with conditions such as diabetes, thyroid disease, hyperlipidaemia.


The cause of Frozen Shoulder is not fully understood and in most cases there is no obvious identifiable trigger. In some cases Frozen Shoulder can occur as a result of mild injury, pain or even surgery.

What are the Symptoms?

The main symptoms of frozen shoulder are pain and stiffness. Muscle spasm can also occur (as can nerve irritation) as a result of the pain, which can contribute additionally to the stiffness. The development and subsequent resolution of Frozen Shoulder is commonly described in three discrete phases:

Here are a few symptoms of Frozen shoulder:

  1. Freezing Phase
    Pain (which is a constant dull ache) is the predominant symptom affecting the shoulder. Patients may notice that they cannot lie on the affected shoulder at night. Stiffness may be subtle at this point. Patients may report worsening pain with reaching movements of the arm or if the shoulder is jolted. This phase can take between 6 weeks and 9 months to occur.
  2. Frozen Phase
    The shoulder becomes very stiff at this point (hence the name frozen shoulder). Interestingly pain generally diminishes during this stage despite the shoulder movements becoming more restricted. This phase will often last between 4 and 12 months.
  3. Thawing Phase
    Shoulder movements slowly become easier as the stiffness subsides. Overall, the average length of time for a frozen shoulder to develop and resolve is approximately 2- 2 ½ years. Some people will have a much shorter duration (1 year) whilst other may experience symptoms many years later.


The diagnosis can often be made from the history of symptoms and a detailed examination. An X-Ray will typically be taken to assess the bony anatomy of the shoulder and to exclude other conditions, such as arthritis and Calcific Tendonitis. An Ultrasound scan or MRI scan may also be arranged to exclude subacromial impingement or injury to the rotator cuff tendons (rotator cuff tear).

Treatment options

Here are treatments for Frozen shoulder:

Pain killers and anti-inflammatory medication may help to reduce and control symptoms, particularly in mild cases.

This aims to improve or maintain shoulder movements and the strength of the rotator cuff tendons. This will be tailored to your individual case and level of symptoms.

An injection of local anaesthetic and steroid may also be given into the shoulder joint to help reduce inflammation. If caught early, it is believed that up to 50% of patients will get better with a single injection. The injection can be a little painful but in combination with physiotherapy, can be very effective.

The natural history of Frozen Shoulder is that symptoms will resolve by themselves, but this can take a long time. If symptoms are deemed to be unacceptable despite the above interventions, surgery can be considered. Historically, this has taken the form of manipulating the shoulder under a general anaesthetic. A more modern technique that is now employed is arthroscopic (keyhole) release of the capsule. This involves carefully dividing a small part of the scarred joint capsule to allow improved movement of the shoulder. These interventions serve to improve the range of shoulder movements whilst the shoulder continues to improve through the ‘thawing’ phase. Ongoing physiotherapy will still be required post-surgery.

We’re ready to give expert advice on Frozen Shoulder