Shoulder Conditions

Frozen Shoulder (Adhesive Capsulitis)

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

Frozen shoulder, also known as adhesive capsulitis, is a condition characterised by progressive pain and stiffness of the shoulder joint, leading to a significant loss of movement. It develops when the capsule surrounding the shoulder joint becomes inflamed, thickened, and contracted, restricting normal motion.

Frozen shoulder can have a substantial impact on daily activities such as dressing, reaching overhead, and sleeping, and it often develops without a clear injury or trigger.

What causes frozen shoulder?

The exact cause of frozen shoulder is not fully understood, but it involves inflammation and fibrosis (thickening) of the shoulder joint capsule.

Frozen shoulder is commonly classified as:

1 Primary (Idiopathic) Frozen Shoulder

This occurs without an identifiable cause. It often develops gradually and is more common in:

2 Secondary Frozen Shoulder

This develops following another shoulder problem or period of immobilisation, such as:

This combination leads to persistent pain and progressive stiffness, even with simple movements.

Why frozen shoulder causes pain and stiffness

The shoulder is designed to be the most mobile joint in the body, relying on a flexible capsule to allow movement in multiple directions.

This combination leads to persistent pain and progressive stiffness, even with simple movements.

Symptoms of frozen shoulder

Frozen shoulder typically progresses through three overlapping phases.

Although the timing and severity vary between individuals, they are approximately 6 months each:

Frozen shoulder can persist for 1–3 years or longer. Average time course is 18 to 24 months. A full recovery is expected in almost all cases

Freezing (Painful) Phase

Frozen (Stiff) Phase

Thawing (Recovery) Phase

How frozen shoulder is diagnosed

Diagnosis is primarily clinical, based on:

Imaging such as X-rays or MRI may be used to:

Imaging findings alone do not define frozen shoulder, and diagnosis relies heavily on specialist assessment.

Non-surgical treatment for frozen shoulder

Frozen shoulder will improve over time with non-operative management, particularly when treatment is matched to the phase of the condition.

Non-operative options may include:

Activity modification
Physiotherapy focused on gentle mobility and muscle tone
Pain management strategies
Anti-inflammatory medications, where appropriate
Corticosteroid injections to reduce inflammation, particularly in the early painful phase.
Hydrodilatation - Performed at specialised radiology centres under image giudance. This is cortisone mixed with saline and local anaesthetic and injected uner pressure. The shoulder joint is expanded to some degree and the cortisone can spread effectively throughout. Occasioally a popping is experienced however this is not required for effect, and it is normal for this procedure to be quite painful for the short time the injection is going in. It can be repeated a couple of times.

The goal of treatment is to control pain, maintain as much movement as possible, and support gradual recovery. The best strategy is not to try to force movement, but to live and work using the arm and shoulder within a more limited movement range until it fully resolves.

Strength is not technically impaired (it may feel weak due to pain) and physical use including lifting is permitted within the restricted movement range. This will not damage the shoulder. Manual work may continue if possible.

When Surgery may be Recommended for Frozen Shoulder

Surgery is not required for most people with frozen shoulder. However, surgical treatment may be considered when:

Procedures performed may include:

Manipulation under anaesthetic – The shoulder is stretched while under full anaethetic to improve movement
Manipulation under anaesthetic combined with Arthroscopic Capsular Release - A minimally invasive procedure where tight portions of the joint capsule (lining)are carefully released to restore movement. This is often combined with:
Removal of inflamed lining (synovectomy)
Treatment of any additional shoulder damage (e.g. rotator cuff tear, if large)

Surgery is typically followed by early physiotherapy and regular home-based exercises to maintain the regained motion.

Recovery Time and Prognosis for Frozen Shoulder

Recovery from frozen shoulder is very gradual, over 18 to 24 months. Recovery and improvement from surgery if performed is extremely quick (days to a few weeks) to the degree of recovery the surgery allows, however the time to full resolution is the same (18 to 24 months).

Long-term outcomes are very favourable with restoration of full movement (or near full movement) and strength. Surgery if performed quickly improves movement and reduces pain, but does not change the final outcome.

Specialist Assessment and Individualised Care for Frozen Shoulder

Frozen shoulder can be challenging due to its prolonged recovery timeline and sometimes in arriving at the correct diagnosis for a painful and restricted shoulder

Dr Richard Dallalana provides specialist assessment of shoulder stiffness and pain, with a focus on:

Confirming an accurate diagnosis, including distinguishing frozen shoulder from other causes of stiffness
Identifying contributing or co-existing shoulder conditions, such as rotator cuff pathology or arthritis
Tailoring treatment to the stage of frozen shoulder and your individual symptoms, functional needs, and goals

This structured approach helps ensure management is appropriate, timely, and aligned with your stage of recovery.

When to See a Shoulder Specialist for Frozen Shoulder

A specialist shoulder assessment may be appropriate if you experience:

Persistent shoulder pain and stiffness that does not improve
Progressive loss of shoulder movement
Night pain that interferes with sleep
Difficulty with daily activities, such as dressing, reaching, or personal care, despite initial treatment
If the diagnosis is unclear

A specialist review can help clarify the diagnosis, determine whether frozen shoulder is the primary cause of your symptoms, and guide the most appropriate management pathway based on your individual presentation.

If you’re experiencing ongoing pain, stiffness, or reduced movement that is affecting your daily activities or quality of life, a thorough orthopaedic assessment can help determine the cause and guide the most appropriate treatment options for your situation.