Frozen Shoulder Info
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Video transcript
Frozen shoulder is a deep, aching pain that comes with stiffness, so the joint gradually becomes harder to move. It often starts for no clear reason, and is more common around middle age, and in people with diabetes. Reaching overhead or behind your back becomes difficult and sore. The pain is often worst at night, and can disturb your sleep. It tends to pass through phases, slowly freezing, staying frozen, then gradually thawing. Most frozen shoulders settle on their own, though it can be a slow journey over many months. The aim early on is to control the pain, and to keep as much movement as possible. Gentle stretching, guided by a physiotherapist, helps maintain range without flaring things up. Anti-inflammatory medication, and a cortisone injection into the joint, can be very helpful in the painful phase. With time and patience, the shoulder usually loosens and the pain fades. When a shoulder stays stiff and painful despite these measures, a keyhole operation can release it. A camera and small instruments are used through tiny incisions. The tight, inflamed capsule around the joint is carefully released, freeing the shoulder to move again. You go home the next day, with the arm resting in a sling. Movement is the key to recovery, so physiotherapy starts soon after surgery, to hold on to the range that has been gained. The sling is mainly for comfort in the first few days. Most people see their movement improve steadily over the following months. The shoulder can ache as it settles, which is a normal part of healing. Keeping up the exercises gives the best long-term result.
Frozen shoulder (adhesive capsulitis) causes pain and stiffness, progressing through freezing, frozen, and thawing phases.
What you're feeling
You likely feel a gradual, dull ache that gets worse over weeks or months. This pain often flares at night, making it hard to sleep on the affected side. You might notice sharp pain when you try to move your shoulder near its new limits. As you use your arm less to avoid this pain, stiffness begins to take hold. This stiffness phase usually lasts 4 to 12 months.
Daily tasks become difficult as your shoulder tightens. You may find it hard to reach behind your back to fasten a bra or tuck in a shirt. Men often struggle to get their wallets from their back pockets. While you feel a constant dull ache, especially at night, the sharp pain during movement can be quite intense. You might see slight muscle wasting, but your X-rays will likely look normal.
Over time, the pain begins to subside, but the stiffness remains a major problem. Without treatment, this stiffness can persist for another 6 to 12 months. As you slowly regain movement during the thawing phase, the pain diminishes. Most patients feel near normal after this process, even if motion does not fully return to normal. You may need to adjust how you perform daily activities to manage these changes.
What's actually happening
Frozen shoulder happens when the sleeve of tissue around your joint, called the joint capsule, becomes inflamed and thickens. This process is similar to Dupuytren's disease in the hand. The tissue inside this sleeve grows too much, making the shoulder tight and stiff. You might not have had any prior shoulder issues before this started. However, it is often linked to conditions like diabetes, heart disease, or thyroid problems.
The condition usually follows three phases. First, you feel a gradual, dull ache that gets worse over weeks to months. This pain is often worse at night and stops you from sleeping on that side. Next comes the stiff phase, which lasts 4 to 12 months. You restrict your movement to avoid pain, but this makes the shoulder tighter. Simple tasks become hard, like reaching into a back pocket or fastening a bra. A dull ache stays with you nearly all the time, and sharp pain hits you when you try to move near your new limits.
Finally, the thawing phase begins. Motion slowly returns over weeks or months while pain fades. Without treatment, this whole process takes about 18 months to resolve on its own. Stiffness often persists for another 6 to 12 months after the pain starts to go away. While most people feel near normal again, your motion may never fully return to how it was before. X-rays usually look normal because the problem is in the soft tissue, not the bone.
What we can do about it
Most people find relief through self-care and guided exercises. Your shoulder condition typically follows three phases: pain, stiffness, and thawing. During the first phase, you will experience gradual pain that is often worse at night. Gentle movement and physiotherapy aim to keep your shoulder moving without causing severe pain. In the second phase, stiffness becomes the main problem and can last 4 to 12 months. You might find daily tasks like reaching into a back pocket or fastening a bra difficult. With supervised treatment, most patients experience resolution with nonoperative measures in a relatively short period.
If exercises alone do not help, your surgeon may recommend medical treatments to manage pain and improve movement. Intra-articular steroid injections are effective and safe for frozen shoulder. These injections relieve pain, improve functional performance, and increase your range of motion. They work by reducing inflammation inside the joint. For some patients, hydrodilatation (using fluid to stretch the capsule) is an option, though about 41% of patients may need further treatment if they cannot tolerate the injection volume. These treatments are part of a step-up approach that moves from conservative care to more invasive options only if symptoms persist.
Surgery is considered when conservative care has reached its limit and your shoulder remains extremely stiff. Procedures like manipulation under anesthesia or arthroscopic capsular release can help when other treatments fail. Early surgical intervention might shorten the overall duration of your symptoms without leading to worse outcomes than waiting. These options are reserved for cases where motion has not returned after months of non-surgical care. Your surgeon will discuss if surgery is right for you based on your specific progress and the phase of your condition.
When to see someone
See your GP if you have shoulder pain that keeps you awake at night or stops you from doing daily tasks like fastening a bra or reaching your back pocket. Ask for a specialist review if your shoulder feels stiff and you cannot move it fully, especially if the pain lasts for weeks. This condition often affects people aged 40 to 60. It usually takes 1 to 3 years to resolve on its own, but stiffness can persist for another 6 to 12 months without treatment. If you have diabetes or a family history of this issue, seek help early. Your surgeon will check for other causes like arthritis or injury before confirming the diagnosis.
