Frozen Shoulder (Adhesive Capsulitis)

Frozen shoulder, also known as adhesive capsulitis, is a condition that causes increasing pain and stiffness in the shoulder. As the condition progresses, movement can become significantly restricted, making everyday activities such as dressing, reaching overhead or reaching behind the back difficult.

Unlike many other shoulder conditions, frozen shoulder is characterised by a progressive loss of both active and passive shoulder movement. This means movement is restricted not only when a person tries to move their own arm, but also when the shoulder is moved by someone else during an examination.

Frozen shoulder can sometimes develop without an obvious injury or cause. In other cases, it may occur following a period of reduced shoulder movement, such as after an injury or surgery. Certain health conditions are also associated with an increased risk of developing frozen shoulder.

The condition typically develops gradually and can persist for a prolonged period. Although frozen shoulder often improves over time, appropriate management can help control symptoms, maintain function and support the gradual recovery of movement.

In this guide, we’ll look at what frozen shoulder is, why it develops, its common symptoms and stages, how it is diagnosed, and the treatment and rehabilitation options available.

What Is Frozen Shoulder?

Frozen shoulder is a condition in which the capsule surrounding the shoulder joint becomes painful and progressively stiff, resulting in a significant reduction in shoulder movement.

The shoulder joint is surrounded by a flexible layer of connective tissue known as the joint capsule. Normally, this capsule allows the shoulder to move freely through its large range of motion. In frozen shoulder, changes within the capsule cause it to become thicker and less flexible, restricting movement of the joint.

A characteristic feature of frozen shoulder is the loss of both active movement — when a person moves their own arm — and passive movement — when the shoulder is moved by someone else. External rotation of the shoulder is often particularly restricted.

Frozen shoulder usually develops gradually rather than following a single traumatic event. Pain may be the dominant symptom initially, followed by increasing stiffness and difficulty performing everyday activities such as reaching overhead, putting on a jacket or reaching behind the back.

The term adhesive capsulitis is commonly used interchangeably with frozen shoulder. However, the condition is more complex than simply the formation of “adhesions”, and the extent of pain and stiffness can vary considerably between individuals.

Symptoms of Frozen Shoulder

Frozen shoulder typically develops gradually, with pain and increasing stiffness being the most characteristic symptoms. The severity and pattern of symptoms can change as the condition progresses.

Pain is often felt around the shoulder and may extend into the upper arm. In the earlier stages, pain can be significant and may occur both during movement and at rest. Night pain is common, and sleeping on the affected shoulder may become particularly uncomfortable.

As the condition progresses, stiffness often becomes more noticeable. People may find it increasingly difficult to lift the arm overhead, reach out to the side or rotate the shoulder.

Everyday activities can become challenging, including:

Putting on or removing a shirt or jacket
Reaching into a high cupboard
Washing or styling hair
Reaching behind the back
Fastening a bra or tucking in clothing
Putting on a seatbelt
Reaching into the back seat of a car
Sleeping comfortably on the affected side

One of the key features distinguishing frozen shoulder from many other shoulder conditions is that both active and passive movement become restricted. External rotation is commonly one of the most noticeably limited movements.

The amount of pain and stiffness can vary considerably between individuals and can also change throughout the course of the condition.

The Stages of Frozen Shoulder

Frozen shoulder is commonly described as progressing through three overlapping stages: freezing, frozen and thawing. These stages describe how pain and stiffness often change over time, although the pattern and duration can vary considerably between individuals.

Not everyone progresses through three clearly defined phases, so the stages are best viewed as a general description of the condition rather than a fixed timeline.

Diagram showing the freezing, frozen and thawing stages of frozen shoulder, including changes in pain, stiffness and shoulder movement.

Freezing stage: Pain usually becomes increasingly prominent and shoulder movement gradually becomes more restricted. Night pain and pain with everyday movements can be particularly troublesome during this period.

Frozen stage: Pain may begin to settle, but stiffness and restricted movement often become the dominant problem. Activities involving reaching overhead, out to the side or behind the back can remain difficult.

Thawing stage: Shoulder movement gradually begins to improve and everyday activities become easier. Recovery can continue over an extended period, and the rate of improvement varies between individuals.

It is important to remember that these stages are not a precise timetable. Frozen shoulder varies considerably from person to person, and treatment should be guided by the individual’s symptoms, stage of the condition and functional limitations.

What Causes Frozen Shoulder?

Frozen shoulder does not always have an obvious cause. In many cases, it develops gradually without a specific injury or event that clearly explains why the shoulder has become painful and stiff. This is sometimes referred to as primary or idiopathic frozen shoulder.

In other cases, frozen shoulder can develop following an injury, surgery or another shoulder condition that results in the arm being used less than usual for a period of time. This is sometimes described as secondary frozen shoulder.

Certain health conditions are also associated with an increased risk of developing frozen shoulder. The association is particularly strong with diabetes, and frozen shoulder is also more commonly reported in people with some thyroid conditions.

Frozen shoulder most commonly affects adults between approximately 40 and 60 years of age, although it can occur outside this age range. It is also more common in women than men.

Importantly, developing frozen shoulder does not necessarily mean that something has been damaged or that the person has done something wrong. The condition involves changes within the shoulder joint capsule, but exactly why these changes develop in some people remains incompletely understood.

Understanding whether frozen shoulder developed spontaneously or following another injury, surgery or period of reduced movement can help guide assessment and management.

How Is Frozen Shoulder Diagnosed?

Frozen shoulder is usually diagnosed through a combination of a person’s symptoms, medical history and physical examination. There is no single test that confirms the condition.

Assessment typically considers how the symptoms developed, how long they have been present and whether there has been a previous shoulder injury, surgery or period of reduced movement. Relevant health conditions, including diabetes and thyroid disorders, may also be considered.

During the physical examination, shoulder movement is assessed in different directions. A characteristic feature of frozen shoulder is a restriction of both active movement — when the person moves their own arm — and passive movement — when the shoulder is moved by the clinician.

External rotation is often particularly restricted, although movements such as lifting the arm and reaching behind the back may also become significantly limited.

Imaging is not always required to diagnose frozen shoulder. However, an X-ray may sometimes be used to help exclude other causes of significant shoulder stiffness, such as arthritis. Ultrasound or MRI may be considered when another shoulder condition is suspected, but imaging findings alone do not diagnose frozen shoulder.

Because several shoulder conditions can cause pain and difficulty moving the arm, diagnosis involves considering the overall pattern of pain, stiffness, movement restriction and clinical history rather than relying on one examination finding or scan.

Treatment and Rehabilitation for Frozen Shoulder

Treatment for frozen shoulder depends on the stage of the condition, the severity of symptoms and how much the loss of movement is affecting everyday activities. Because frozen shoulder can change considerably over time, management may also need to change as pain and stiffness evolve.

During the more painful stages, treatment often focuses on managing symptoms and maintaining comfortable movement. Trying to force the shoulder aggressively through painful ranges is not always helpful, particularly when pain and irritability are high.

As pain begins to settle, rehabilitation can gradually place greater emphasis on restoring shoulder movement and rebuilding strength. Exercises may include gentle mobility work initially, followed by progressive strengthening as the shoulder becomes more tolerant of movement and load.

Pain-relieving medication may sometimes be considered in consultation with a GP or pharmacist. Corticosteroid injections may provide short-term improvement in pain and function for some people, particularly during the earlier painful stages. Other procedures, such as hydrodilatation, may also be considered in certain circumstances.

Most people with frozen shoulder are managed without surgery. However, because recovery can be prolonged, treatment should be tailored to the individual’s symptoms, functional limitations and stage of recovery rather than following the same exercise program throughout the condition.

Explore Frozen Shoulder Treatment & Rehabilitation

How Long Does Frozen Shoulder Last?

Frozen shoulder is usually a slowly evolving condition, and recovery can take considerably longer than many other common shoulder problems. Symptoms often change gradually over many months rather than improving within a few weeks.

Traditionally, frozen shoulder has been described as progressing through the freezing, frozen and thawing stages over approximately one to three years. However, recovery varies considerably between individuals, and these stages do not always occur as clearly or predictably as this description suggests.

Pain often improves before movement has fully returned. During the later stages, people may notice that everyday activities gradually become easier even though some restriction in shoulder movement remains.

Although frozen shoulder is often described as a condition that eventually resolves on its own, not everyone necessarily regains completely normal shoulder movement, and some people can experience residual stiffness for an extended period.

Rather than focusing on a specific recovery deadline, progress can be assessed through changes in pain, movement, sleep, function and the ability to perform everyday activities.

Understanding that recovery can take time is important. Rehabilitation can be adjusted throughout the process as symptoms change, with the goal of maintaining function during the painful stages and progressively restoring movement and strength as the shoulder becomes less irritable.

When Should You Seek Help for Frozen Shoulder?

Frozen shoulder can develop gradually, and early symptoms may initially resemble other common shoulder conditions. Assessment can be helpful when shoulder pain and stiffness persist, movement is becoming progressively restricted, or symptoms are beginning to interfere with everyday activities, work or sleep.

It may be particularly useful to seek assessment if you notice a progressive loss of movement, especially difficulty rotating the shoulder, reaching overhead or reaching behind your back. Identifying the pattern of restriction can help distinguish frozen shoulder from other causes of shoulder pain.

Medical assessment may also be appropriate when symptoms are severe, there has been a significant injury, or the diagnosis is uncertain. Further investigation may sometimes be recommended to exclude other conditions that can cause shoulder pain and stiffness.

People with conditions associated with an increased risk of frozen shoulder, particularly diabetes or thyroid disorders, may also benefit from discussing persistent shoulder symptoms with their healthcare professional.

Because frozen shoulder can last for many months, understanding the condition and having an appropriate management plan can help guide decisions about activity, pain management, movement and rehabilitation as symptoms change over time.

If shoulder pain is accompanied by unusual symptoms such as significant swelling, redness, fever, unexplained illness or sudden severe loss of function following an injury, prompt medical assessment is appropriate.

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