Shoulder Pain

Adhesive Capsulitis / Frozen Shoulder

What is Frozen shoulder or Adhesive Capsulitis?

  • Frozen shoulder or adhesive capsulitis causes pain and stiffness at the shoulder. Over time the shoulder becomes stiff and becomes hard to move.
  • The shoulder capsule becomes tight and hard to move. Stiff bands of tissues called adhesions develop.
  • Essentially you will find the shoulder very difficult to move either by yourself or with someone's help.

Frozen shoulder

The Stages of Adhesive Capsulitis

  • Freezing: In the "freezing" stage, there is gradually more and more pain. As the pain worsens, your shoulder loses range of motion. Freezing typically lasts from 6 weeks to 9 months.
  • Frozen: Pain may actually improve during this stage, but the stiffness remains. During the 4 to 6 months of the "frozen" stage, daily activities may be very difficult.
  • Thawing: Shoulder motion slowly improves during the "thawing" stage. Complete return to normal or close to normal strength and motion typically takes from 6 months to 2 years.

What causes Frozen Shoulder or Adhesive Capsulitis?
The causes of frozen shoulder are not fully understood. There is no clear connection to arm dominance or occupation. A few factors may put you more at risk for developing frozen shoulder.

  • Diabetes: Frozen shoulder occurs much more often in people with diabetes, affecting 10% to 20% of these individuals. The reason for this is not known.
  • Other diseases: Some additional medical problems associated with frozen shoulder include hypothyroidism, hyperthyroidism, Parkinson's disease, and cardiac disease.
  • Immobilization: Frozen shoulder can develop after a shoulder has been immobilized for a period of time due to surgery, a fracture, or other injury.

What are the signs and symptoms of Adhesive capsulitis / Frozen Shoulder?

  • Pain from frozen shoulder is usually dull or aching. It is typically worse early in the course of the disease and when you move your arm.
  • The pain is usually located over the outer shoulder area and sometimes the upper arm.
  • Frozen shoulders generally get better over time, although it may sometimes take up to 3 years.

What are the Treatments Available for Adhesive Capsultis / Frozen Shoulder?

Nonsurgical Treatment: More than 90% of patients improve with relatively simple treatments to control pain and restore motion.

  • Non-steroidal anti-inflammatory medicines.
  • Drugs like ibuprofen reduce pain and swelling.
  • Steroid injections. Cortisone is a powerful anti-inflammatory medicine that is injected directly into your shoulder joint.
  • Physical therapy. Specific exercises will help restore movement which may be under the supervision of a physical therapist or via a home program.
  • Heat is used to help loosen the shoulder up before the stretching exercises.
  • Stretching Exercises: Please see our PDF documents for exercises and rehabilitation.

Surgical Treatment
If your symptoms are not relieved by therapy and anti-inflammatory medicines, surgery may be discussed. The goal of surgery for frozen shoulder is to stretch and release the stiffened joint capsule.

  • Manipulation under anaesthesia: During this procedure, you are put to sleep. Your doctor will force your shoulder to move which causes the capsule and scar tissue to stretch or tear. This releases the tightening and increases the range of motion.
  • Shoulder arthroscopy: In this procedure, your doctor will cut through tight portions of the joint capsule. This is done using pencil-sized instruments inserted through small incisions around your shoulder.

In many cases, manipulation and arthroscopy are used in combination to obtain maximum results. Most patients have very good outcomes with these procedures.

Frozen shoulder arthroscopy

Above photos taken through an arthroscope show a normal shoulder joint lining(left)and an inflamed joint lining damaged by frozen shoulder.

Recovery: After surgery, physiotherapy is necessary to maintain the motion that was achieved with surgery. Recovery times vary, from 6 weeks to three months. Although it is a slow process, your commitment to therapy is the most important factor in returning to all the activities you enjoy.

Long-term outcomes after surgery are generally good, with most patients having reduced or no pain and greatly improved range of motion. In some cases, however, even after several years, the motion does not return completely and a small amount of stiffness remains.

Although uncommon, frozen shoulder can recur, especially if a contributing factor like diabetes is still present.