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Frozen Shoulder


Frozen shoulder is a condition in which your shoulder becomes stiff and painful to move. In medical terms, this condition is also known as adhesive capsulitis. Your shoulder joints are surrounded by a thick layer of fibrous connective tissue that holds the joint in place. Inflammation of these tissues causes pain which in turn reduces movement. Stiffness in your shoulder joint eventually results from a lack of movement in the shoulder joint. This condition can be treated using medication, surgery, or physiotherapy. 


The causes of frozen shoulder can be divided into primary and secondary. Primary or idiopathic frozen shoulder occurs without any apparent cause. There is no previous history of injury to the shoulder or any other abnormality. It is the less common type.

Secondary frozen shoulder is more common, which can occur due to multiple causes. Joint trauma, injury, or surgical repair in the shoulder area can cause stiffness in the surrounding connective tissues. If you have gone through a surgery that limits the movement of your arm, such as mastectomy, you may develop a frozen shoulder over a period of time. Physiological diseases such as diabetes, thyroid disease, adrenal insufficiency, etc., play a significant role in developing frozen shoulder. 

Risk Factors And Epidemiology

Age is a major risk factor for the development of frozen shoulders. People over the age of 40, particularly women, are at higher risk of getting a frozen shoulder. The presence of a secondary disease such as diabetes, hypo or hyperthyroidism, etc., can contribute to stiffness and immobility of the shoulder joint.

Neurologic diseases such as stroke, Parkinson’s disease, etc., can also affect the movement of your shoulder and arms. People who have undergone shoulder repair surgery or recovering from surgery are also at risk of developing frozen shoulder. Lack of movement of your arm or shoulder joint due to any reason can increase the risk of this painful condition.

Adhesive capsulitis can affect anyone at any age, but it is more common among the older population. About 70% of the people affected by this condition are females. Diabetes is considered the most known secondary disease to cause frozen shoulder. 

Signs And Symptoms

The signs and symptoms of this condition progress in three stages.

The first stage is called the freezing stage. Minor pain and discomfort develop in your shoulder, which worsens over time. Your shoulder also begins to become stiff during this period. Pain and stiffness may be worst at night. This stage can last for about 3 to 9 months.

The next stage is called the frozen stage. The pain gradually reduces during this stage, but your shoulder becomes stiffer. This limits your shoulder mobility, causing difficulty in your daily routine work. This can occur for the next ninth to the fourteenth month.


The last stage is called the thawing stage. Your shoulder begins to lose its stiffness, and you regain movement over a certain period of time. This period can range from a few months to 2 years. 


The diagnosis of frozen shoulder is usually made on the basis of history and physical examination. Your doctor will inquire about the onset duration and severity of your symptoms, past medical and surgical history, and history of any recent injury. Secondary diseases are also noted if present.


A physical examination will include palpation around your shoulder joint to notice tenderness and stiffness. Your doctor will also conduct a range of active and passive movements to check the mobility of your shoulder joint. If your doctor suspects another underlying cause, they may ask for imaging tests such as an x-ray, ultrasound, or MRI. 

Differential Diagnosis

Symptoms of frozen shoulder can mimic other diseases such as rotator cuff injury, rotator cuff tear, subacromion bursitis, cervical disk degeneration, rheumatoid arthritis, lupus, or another autoimmune disease. History, physical examination, and diagnostic tests can aid in differentiating frozen shoulder from other conditions. 


The primary treatment options for frozen shoulder during its initial stage focus on pain control and maintaining a range of motion. Your doctor may prescribe oral medications for reducing pain and inflammation. In some cases, the medicine is injected directly into the shoulder capsule to ease the pain and stiffness. Hot and cold compresses can help with inflamed tissues.

Physiotherapy is recommended for this condition. Your physiotherapist will guide you about multiple exercises that will improve the movement of your shoulder joint. Movement is also necessary to prevent your tissues from getting stiffer. These exercises are practiced for a long time until you regain your shoulder's strength and complete motion range.


If these techniques are not effective, your doctor will consider surgical options. This can include shoulder manipulation or shoulder arthroscopy.

Analgesics are prescribed for pain which includes NSAIDs or corticosteroids. If oral medications are ineffective, a corticosteroid such as cortisone is injected into your shoulder capsule to reduce pain and inflammation. 


The majority of the cases of frozen shoulder improve with medications and physiotherapy alone. The recovery period can vary from a few months to 2 years. 


Frozen shoulder can occur at any time due to certain causes. Therefore, it isn’t easy to prevent it. However, if you have a secondary disease, follow the treatment regime for that condition to reduce the risk of frozen shoulder. Also, if you undergo a surgical procedure involving your shoulder or related areas, consult a physiotherapist afterward to help with the movement of your shoulder. Slow but steady movement can help prevent frozen shoulder to a certain extent.

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 05, 2023.




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