Frozen shoulder (adhesive capsulitis) is a condition in which the capsule of the shoulder joint becomes inflamed, thickens and tightens. The shoulder gradually stiffens until the arm can’t be raised, either by you or by someone else lifting it. It most often affects people aged 40 to 60, and is more common in women and in people with diabetes. For most people it gets better, but slowly: usually within 1 to 3 years.
Symptoms
- Deep pain in the shoulder that gets worse at night.
- Stiffness that increases week after week.
- Difficulty lifting the arm out to the side and forwards, and turning it outwards.
- Difficulty reaching your back pocket or fastening a bra.
- The arm won’t lift even when another person tries to raise it.
A frozen shoulder usually goes through three phases. In the painful phase the pain grows and the shoulder stiffens. In the frozen phase the pain eases, but the stiffness stays. In the thawing phase movement gradually returns. Each phase lasts months. Night pain is often what makes people seek help: it’s hard to find a position where the shoulder doesn’t hurt.
Why it happens
- Often with no clear cause.
- More common in people with diabetes or thyroid disease.
- After a period when the shoulder was kept still: an injury, an operation or a broken arm.
- Being between 40 and 60.
Why the capsule becomes inflamed isn’t fully understood. With diabetes the risk is higher and recovery is often slower. A frozen shoulder rarely comes back in the same shoulder, but in some people it affects the other one years later.
How we treat it
Kaloyan checks whether the movement is still limited when he lifts your arm for you. This tells a frozen shoulder apart from tendon pain, where the shoulder does move if someone else lifts it. If you haven’t seen a doctor yet, he’ll send you to an orthopaedic doctor to confirm it. Bring your X-rays or scans if you have them: with a frozen shoulder they are usually normal, but they rule out other causes.
In the painful phase the aim is to ease the pain and keep the shoulder moving. Kaloyan uses TECAR therapy to warm the joint before gentle mobilisation, and ultrasound therapy for the tissues around the shoulder. Treatment usually combines several things: device treatments, manual mobilisation, dry needling for tight muscles and exercises you do yourself. Once the pain eases, the work moves on to gradually stretching the capsule, with manual therapy. Nothing is forced: stretching too hard in the early phase makes the pain worse. Treatment takes months, with 1–2 visits a week and exercises at home every day.
In the thawing phase the exercises become more active: for strength and for everyday movements, such as reaching for a shelf or behind your back. Kaloyan will tell you what to expect at each stage, because progress is slow and it’s easy to lose heart.
What you can do yourself
- Move your arm every day within the range where the pain is bearable.
- Heat before your exercises usually helps.
- Sleep on your back or on your good side, with a pillow under the sore arm.
- Use the arm for light everyday tasks. Resting it completely makes the stiffness worse.
- Do your exercises in several short sessions through the day rather than one long one.
When to see a doctor first
A frozen shoulder isn’t dangerous, but in these cases you need a doctor first:
- The shoulder stiffened after a fall or a blow.
- The pain is very severe and keeps you awake, even with rest.
- You have a fever, or the shoulder is red or swollen.
- Your arm has become weak or goes numb.
