Frozen shoulder, also known as adhesive capsulitis, is a debilitating condition characterized by pain, stiffness, and restricted mobility in the shoulder joint .Commonly seen in diabetics, frozen shoulder is a musculoskeletal disorder that affects the shoulder joint, leading to progressive pain, stiffness, and decreased range of motion. It is a challenging condition that can significantly impact a person’s daily life and functionality. This article aims to provide a comprehensive understanding of frozen shoulder by examining its definition, symptoms, underlying causes, diagnostic methods, and the various treatment options available.

Frozen shoulder

What is Frozen Shoulder?

Frozen shoulder, medically known as adhesive capsulitis, is a condition characterized by the gradual and often painful loss of motion in the shoulder joint. It typically progresses through stages, each marked by varying degrees of pain and stiffness. The hallmark feature of frozen shoulder is the thickening and tightening of the joint capsule—the connective tissue that surrounds the shoulder joint. This tightening restricts the joint’s ability to move freely.

adhesive capsulitis

Symptoms of Frozen Shoulder

  1. Pain : Individuals with frozen shoulder often experience aching pain in the shoulder, which may worsen during movement or at night.
  2. Stiffness : Progressive stiffness is a prominent symptom. Initially, the shoulder may have limited range of motion, but over time, it can become severely restricted.
  3. Limited Range of Motion : As the condition advances, patients find it increasingly difficult to perform daily activities that involve raising the arm, such as reaching overhead or behind the back.
  4. Difficulty Sleeping : Pain and discomfort in the shoulder can disrupt sleep patterns, leading to sleep disturbances and fatigue.
  5. Progressive Nature : Frozen shoulder tends to progress through stages, including the “freezing” stage, “frozen” stage, and the “thawing” stage, each with distinct symptoms.

Causes of Frozen Shoulder

The exact cause of frozen shoulder is not always clear, but several risk factors and contributing factors have been identified:

  1. Age and Gender : It predominantly affects individuals between the ages of 40 and 60, and it is more common in women.
  2. Prior Injury or Surgery : A history of shoulder injury or surgery can increase the risk of developing frozen shoulder.
  3. Systemic Diseases : Certain medical conditions, such as diabetes, cardiovascular disease, and autoimmune disorders, have been associated with a higher risk of frozen shoulder.
  4. Immobilization : Prolonged periods of shoulder immobility due to injury or illness can trigger the development of adhesive capsulitis.
  5. Genetic Predisposition : Some genetic factors may make certain individuals more susceptible to developing frozen shoulder.

Diagnosis of Frozen Shoulder

Diagnosing frozen shoulder typically involves:

  1. Medical History : The healthcare provider will review the patient’s medical history and inquire about their symptoms and any previous shoulder injuries or surgeries and very importantly check for History of Diabetes.
  2. Physical Examination : A thorough physical examination, including an assessment of the shoulder’s range of motion and palpation of the joint, is conducted.Painfully limited range of movement is often observed in the early stages and it progresses to more limitation and less pain as the disease progresses.
  3. Imaging : X-rays, MRI scans, or ultrasound may be ordered to rule out other shoulder conditions and assess the extent of the joint’s tightness and inflammation.

Treatment for Frozen Shoulder

The treatment approach for frozen shoulder is often tailored to the stage of the condition and the severity of symptoms. Common treatment options include:

  1. Physical Therapy : Physical therapy exercises aim to improve range of motion , trying to gradually break the adhesions and reduce pain.
  2. Medications : Non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroid injections can provide pain relief and reduce inflammation.
  3. Heat and Ice : Applying heat or ice to the affected area can help alleviate pain and promote relaxation of the shoulder muscles.
  4. Home Exercises : Patients are often prescribed home exercises to perform daily to gradually improve shoulder mobility.
  5. Hydrodilatation : This procedure involves injecting sterile water into the joint capsule to stretch it and improve range of motion.
  6. Manipulation Under Anesthesia (MUA) : In some cases, MUA may be recommended to break up adhesions in the joint capsule under anesthesia.
  7. Surgery : Surgical intervention is rarely necessary but may be considered in severe, refractory cases. Procedures may include capsular release or arthroscopic surgery.

AT ALLEVIATE, we have seen more than 90% success rate with frozen shoulder patients treated with our combined approach involving hydrodilatation, suprascapular nerve block and manipulation followed by 2-3 weeks of physical therapy.



Suprascapular Nerve Block using Fluoroscopy

Suprascapular Nerve Block using Fluoroscopy


Frozen shoulder, or adhesive capsulitis, is a painful and debilitating condition characterized by shoulder pain, stiffness, and restricted mobility. While its exact cause remains elusive, various risk factors and contributing factors have been identified. Early diagnosis and appropriate treatment are crucial to managing the condition effectively and preventing long-term disability.


Frozen shoulder, medically known as adhesive capsulitis, is a condition characterized by the gradual and painful stiffening of the shoulder joint. It develops when the shoulder capsule, the connective tissue surrounding the shoulder joint, thickens and tightens. The exact cause of frozen shoulder is not well understood, but it often develops as a result of inflammation, injury, prolonged immobilization, or underlying medical conditions.
Common symptoms of frozen shoulder include:
  • Gradual onset of pain in the shoulder.
  • Limited range of motion in the shoulder joint.
  • Stiffness and difficulty performing everyday activities, such as reaching, lifting, or combing hair.
  • Pain that worsens at night.
A healthcare professional diagnoses frozen shoulder through a combination of a physical examination and medical history. They may also use imaging tests like X-rays or magnetic resonance imaging (MRI) to rule out other potential causes of shoulder pain and stiffness.
Frozen shoulder can improve on its own over time, but it may take several months or even years. However, treatment can significantly accelerate the recovery process and provide pain relief and improved shoulder function.
The primary goals of frozen shoulder treatment include reducing pain, improving shoulder mobility, and preventing further stiffness. Treatment options aim to address these goals effectively.
Physical therapy is a crucial component of frozen shoulder treatment. It includes exercises and stretches that help improve shoulder mobility, reduce stiffness, and strengthen the muscles supporting the shoulder joint.
Yes, there are specific exercises known as range-of-motion exercises that can help relieve frozen shoulder pain. These exercises target stretching and increasing the flexibility of the shoulder joint. Your physical therapist can provide guidance on the most appropriate exercises for your condition.
Both heat and ice therapy can be effective for managing frozen shoulder symptoms. Heat can help relax and loosen the shoulder muscles, while ice can reduce inflammation and alleviate pain. The choice between the two depends on the individual's preference and what provides the most relief.
Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can provide relief from frozen shoulder pain and inflammation. However, it is essential to consult a healthcare professional before using these medications, as they may have side effects or interact with other medications.
Corticosteroid injections are sometimes used to reduce inflammation and provide temporary pain relief in cases of frozen shoulder. These injections can be administered directly into the shoulder joint capsule to decrease swelling and discomfort. However, the long-term effectiveness of corticosteroid injections in treating frozen shoulder is a subject of ongoing research.
Some natural remedies and supplements that may help alleviate frozen shoulder pain include turmeric, ginger, omega-3 fatty acids (found in fish oil), and bromelain (a natural enzyme found in pineapple). These substances have anti-inflammatory properties that could potentially offer relief. However, their effectiveness can vary among individuals, and it's important to consult a healthcare professional before trying any supplements.
Lifestyle modifications can play a crucial role in managing frozen shoulder. Maintaining good posture, avoiding activities that exacerbate symptoms, and incorporating gentle shoulder exercises into your daily routine can help improve mobility and reduce pain.
Yes, massage therapy can be beneficial for relieving frozen shoulder pain. Therapeutic massage can help relax and loosen the muscles around the shoulder joint, reduce tension, and promote improved blood circulation. It may aid in reducing pain and enhancing mobility.
The recovery time for frozen shoulder can vary from person to person. In some cases, it may take several months to several years to fully recover. Early intervention and adherence to treatment plans, including physical therapy, can help expedite the recovery process.
Untreated frozen shoulder can lead to several complications, including severe and prolonged pain, ongoing loss of shoulder function, and limitations in daily activities. In some cases, it can also impact the quality of life.
Yes, while it's more common for frozen shoulder to affect one shoulder, it is possible for it to develop in both shoulders simultaneously. This is known as bilateral frozen shoulder.
Frozen shoulder is characterized by stiffness and limited mobility of the shoulder joint due to the tightening of the joint capsule. In contrast, rotator cuff injuries involve damage to the muscles and tendons that make up the rotator cuff. While both conditions can cause shoulder pain and discomfort, they have distinct causes and treatment approaches.
In severe cases of frozen shoulder that do not respond to conservative treatments, surgery may be considered. Surgical procedures, such as manipulation under anesthesia or arthroscopic release, can help break up adhesions in the shoulder joint capsule. The effectiveness of surgery varies, and it is generally considered when other treatments have not provided relief.
Anti-inflammatory medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), can help reduce inflammation and provide relief from pain in frozen shoulder. They are often used as part of a comprehensive treatment plan.
Acupuncture and acupressure therapy are complementary approaches that may offer pain relief and improved shoulder mobility in some individuals with frozen shoulder. These methods involve stimulating specific points in the body, and their effectiveness can vary among patients.
Healthcare professionals monitor the progress of frozen shoulder by assessing your range of motion, the level of pain, and your ability to perform daily activities. Improvement is typically indicated by increased shoulder mobility and reduced pain.
Sleeping on your back with a pillow supporting your arm can be one of the most comfortable positions for individuals with frozen shoulder. Avoid sleeping on the affected side as it can worsen pain and stiffness.
While there are no specific dietary guidelines for frozen shoulder recovery, maintaining a balanced diet rich in nutrients like vitamins C and D, calcium, and omega-3 fatty acids can support overall joint health and potentially aid in recovery.
Chiropractic care may be considered as part of a multidisciplinary approach to frozen shoulder. Chiropractors can offer manual therapy and manipulative techniques to improve joint mobility and reduce pain, but individual responses may vary.
To prevent exacerbating frozen shoulder, avoid sudden, jerky movements, overexertion, and prolonged immobility. Also, refrain from activities that cause pain or discomfort and maintain good posture.
While it's important to stay active, it's crucial to perform gentle exercises and movements that are within your pain tolerance. Consult with a healthcare professional or physical therapist for a tailored exercise plan to avoid aggravating the condition.
Adaptive devices like shoulder slings or braces can help support and stabilize the shoulder, particularly in cases of severe pain or immobility. Consult with a healthcare professional for recommendations.
To maintain shoulder mobility post-recovery, continue performing exercises and stretches as recommended by your physical therapist or healthcare provider. Regular shoulder mobility exercises can help prevent relapse.
Early intervention is crucial in frozen shoulder treatment to prevent the condition from worsening and to achieve better outcomes. Early treatments can help manage pain and preserve shoulder function more effectively.
Stress and anxiety can contribute to muscle tension, exacerbating frozen shoulder pain. Stress management techniques, relaxation exercises, and even therapy can help reduce psychological stress and its impact on physical symptoms.


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