Shoulder
Frozen shoulder (adhesive capsulitis)
Frozen shoulder is a condition in which the capsule surrounding the shoulder joint becomes inflamed, thickened and contracted, progressively restricting movement. Its defining feature is loss of passive as well as active movement: the shoulder cannot be moved through its range even by someone else, which distinguishes it from most other causes of shoulder pain. It typically follows a prolonged course through distinct stages and, in most cases, resolves over time.
The stages
Recognising the stage matters, because what treatment can achieve differs considerably between them.
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Freezing
Pain increases and movement progressively reduces. Night pain is often prominent. This stage commonly lasts several months and is generally the most painful.
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Frozen
Pain begins to settle but stiffness persists and dominates. Daily tasks that need rotation — reaching behind the back, fastening clothing — are most affected.
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Thawing
Movement gradually returns over months. Most people regain function, though a minority are left with some lasting restriction.
Causes and risk factors
It occurs without any identifiable trigger in many cases, but several associations are well recognised.
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Diabetes
The strongest known association. Frozen shoulder is considerably more common in people with diabetes and may follow a longer course.
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Thyroid disease and other conditions
Thyroid disorders and some other metabolic and inflammatory conditions are associated with increased risk.
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Immobilisation
A period of reduced shoulder movement — after injury, surgery or another illness — can precede onset.
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Age and sex
Most commonly seen between about forty and sixty, and more often in women.
Diagnosis
Frozen shoulder is diagnosed clinically. Imaging is used chiefly to exclude other explanations for a stiff, painful shoulder.
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Loss of passive movement
The key finding. External rotation is characteristically the most restricted direction, and the restriction is present whether the person moves the arm themselves or not.
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Excluding other causes
X-ray can exclude arthritis or a dislocation; ultrasound or MRI can assess the rotator cuff where the picture is atypical or the history includes injury.
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Screening for associations
Because of the association with diabetes, blood glucose testing is sometimes appropriate in people not known to have it.
Common questions
How long does it last?
The whole course commonly runs one to three years, though it varies widely. Most people recover substantial function, and treatment is aimed at reducing pain and shortening the course rather than producing an immediate cure.
How do I know it is not a rotator cuff problem?
The distinguishing feature is passive movement. In frozen shoulder the range is restricted even when someone else moves the arm; in cuff problems passive movement is usually preserved while active movement is painful or weak.
Should I push through the stiffness?
Not during the painful stage. Forceful stretching then tends to increase pain and inflammation. Stretching becomes more useful once the shoulder has moved past that phase.
Can it affect the other shoulder?
It can occur in the other shoulder at some point, though rarely at the same time, and having had it once does not mean it will recur on the same side.
General reference information, and not advice about your own case. It may not reflect the most recent guidance or what is offered on a given day — call (201) 408-5151 to check.
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