Frozen shoulder treatment

Frozen shoulder, or adhesive capsulitis, is a condition in which the capsule surrounding the shoulder joint becomes inflamed, then thickened and tight. As it contracts, the space inside the joint shrinks, and the shoulder loses movement in every direction. It is a different problem from a rotator cuff tear or arthritis, though the early pain can feel similar.

It most often affects people between about 40 and 60, and is more common in women. People with diabetes are at noticeably higher risk, and so are people with thyroid problems. It can also start after a period of keeping the arm still, for example after a fracture, surgery or a minor injury. In many cases there is no obvious trigger.

Frozen shoulder classically passes through three phases: a painful “freezing” phase, when pain is high and movement starts to go; a “frozen” phase, when pain eases but stiffness dominates; and a “thawing” phase, when movement slowly returns. Left alone, the whole process can take one to three years, and some people never regain full movement.

Treatment depends on the phase. Pain relief and gentle physiotherapy are the base. In the painful phase, a steroid injection into the joint is commonly used to calm inflammation, and some doctors use hydrodilatation, where fluid is injected to stretch the tight capsule. Blood sugar control matters for people with diabetes.

When stiffness persists despite these measures, surgeons may offer manipulation under anaesthesia, in which the shoulder is moved forcibly while you are asleep, or arthroscopic capsular release, in which the tight capsule is cut. Both are followed by intensive physiotherapy. Most people do not need surgery, but they do need a structured plan rather than waiting for the shoulder to thaw by itself.