A shoulder that hurts when you reach overhead, fasten your clothes or sleep on one side can gradually become difficult to move. Sometimes, the stiffness becomes so noticeable that even simple tasks such as combing your hair or reaching behind your back become uncomfortable.
This may be frozen shoulder, technically known as adhesive capsulitis. It causes pain and progressive stiffness around the shoulder joint. While many people improve with non-surgical treatment, recovery can take time, and the right treatment depends on the stage and severity of the condition.
What is a frozen shoulder?
Frozen shoulder occurs when the tissues surrounding the shoulder joint become inflamed and tighten, restricting movement. It usually develops gradually rather than appearing suddenly.
Doctors generally diagnose the condition based on your symptoms and a physical examination. Imaging such as an X-ray, ultrasound or MRI may sometimes be used when a doctor needs to rule out other causes of shoulder pain.
Frozen shoulder symptoms
The symptoms can develop gradually and may change as the condition progresses. Common signs include:
- Shoulder pain, particularly during movement
- Increasing stiffness
- Difficulty raising the arm
- Trouble reaching behind your back
- Difficulty dressing or grooming
- Pain that may be worse at night
- Reduced ability to perform everyday activities
A typical frozen shoulder restricts both active and passive shoulder movement, which helps doctors distinguish it from some other shoulder problems.
What causes frozen shoulder?
In many cases, the exact cause is not known. However, certain conditions and situations can increase the risk. These include:
Diabetes: People with diabetes have a higher risk of developing frozen shoulder. Keeping blood glucose under control is important for overall health, although it cannot guarantee that the condition will be prevented.
Thyroid problems: Thyroid disorders have also been associated with a higher risk of frozen shoulder.
Shoulder injury or surgery: Keeping the shoulder still for a prolonged period after an injury or surgery may contribute to stiffness.
Other health conditions: Frozen shoulder has also been associated with conditions such as stroke and some metabolic disorders.
Recent clinical guidelines identify diabetes and thyroid disease among important risk factors for primary frozen shoulder.
The stages of frozen shoulder
Frozen shoulder is often described in three stages, although not everyone experiences them exactly the same way.
- Freezing stage: Pain gradually increases and shoulder movement starts becoming restricted. Night-time pain can be particularly troublesome.
- Frozen stage: Pain may settle somewhat, but stiffness can become more prominent. Moving the arm becomes increasingly difficult.
- Thawing stage: Shoulder movements gradually improve. Recovery can be slow and may take several months. The duration varies from person to person; there is no fixed timeline for recovery.
How is frozen shoulder diagnosed?
A doctor will usually ask about your symptoms, previous injuries, medical conditions and how the problem affects daily activities.
During the examination, they may assess:
- How far you can move your shoulder yourself
- How much the shoulder can move when examined by the doctor
- Where the pain occurs
- Whether there are signs suggesting another shoulder condition
Imaging is not always necessary to diagnose frozen shoulder. It may be recommended when the doctor needs to exclude conditions such as arthritis, a rotator cuff problem or another cause of shoulder pain.
Frozen shoulder treatment
Treatment is usually tailored to the severity of pain, stiffness, stage of the condition and your overall health.
Pain relief: A doctor may recommend medicines to help control pain and make movement easier. The choice depends on your medical history and other medicines you take.
Physiotherapy and exercises: Gentle, progressive exercises can help maintain and gradually improve shoulder movement. A physiotherapist can select exercises according to your range of motion and pain level.
Do not force a painful shoulder through aggressive movements. Exercises should be appropriate for your condition and progressed gradually.
Steroid injections: For some people, a corticosteroid injection into the shoulder joint may provide short-term pain relief and improve movement, particularly when symptoms significantly limit activity.
Hydrodilatation combined with steroid injection has also shown to be beneficial in managing frozen shoulder.
Surgery: Most people do not need surgery. In persistent cases where pain and stiffness continue to cause significant disability despite appropriate non-surgical treatment, an orthopaedic specialist may discuss procedures such as manipulation under anaesthesia or arthroscopic capsular release.
The decision should be individualised after assessing the severity of symptoms and response to other treatments.
Frozen shoulder exercises: what can help?
The aim of exercises is to gradually improve mobility without aggravating the symptoms.
Depending on your condition, a physiotherapist may recommend movements such as:
- Pendulum exercises
- Gentle shoulder rotations
- Towel-assisted stretches
- Wall walking
- Assisted elevation of the arm
The appropriate exercise and intensity depend on your stage of frozen shoulder. Aggressive exercise therapy is not recommended. If an exercise causes significant or worsening pain, stop and seek professional advice.
When should you see an orthopaedic doctor?
Consider getting your shoulder assessed if:
- Pain is persistent or getting worse
- Shoulder movement is becoming increasingly restricted
- You cannot perform normal daily activities
- Pain regularly disturbs your sleep
- Symptoms began after an injury
- You have diabetes or thyroid disease and develop significant shoulder stiffness
- Home measures are not helping
Early assessment can also help identify other causes of shoulder pain that may require different treatment.
Can frozen shoulder recover completely?
Many people improve substantially with appropriate non-surgical treatment, although recovery can be gradual. Some people continue to have stiffness or functional limitations for longer than expected.
Conclusion
Frozen shoulder can make everyday movements surprisingly difficult, but it does not mean your shoulder will remain stiff permanently. Treatment usually focuses on pain control, appropriate exercises and gradual restoration of movement.
If shoulder pain is accompanied by increasing stiffness or difficulty with daily activities, getting a timely assessment is important. The right treatment plan can help you manage symptoms and work towards better shoulder function.
How can PB Health support you?
PB Health Hospital, IFFCO Chowk, Gurgaon can help connect you with the right ortho doctor based on your symptoms and needs. A doctor can review your medical history, examine the shoulder, advise investigations if required and guide you towards an appropriate treatment plan.