Frozen Shoulder (Adhesive Capsulitis)
Frozen shoulder, also called adhesive capsulitis, is a condition in which the capsule surrounding the shoulder joint becomes inflamed, thickened, and tight. As the capsule stiffens, scar tissue develops and the shoulder gradually loses its ability to move normally. This can make even simple daily activities difficult and painful.
Stages of Frozen Shoulder
Frozen shoulder usually develops slowly over several months and often progresses through three stages:
Freezing Stage
- Gradually increasing shoulder pain
- Progressive loss of motion
- Pain is often worse at night and may interfere with sleep
Frozen Stage
- Pain may begin to lessen
- Shoulder stiffness becomes more severe
- Everyday activities such as dressing, reaching overhead, fastening a seatbelt, or reaching behind your back become difficult
Thawing Stage
- Shoulder motion slowly improves
- Pain continues to decrease
- Function gradually returns over time
Although frozen shoulder often improves eventually, recovery without treatment can take one to three years or longer. Early evaluation and treatment can often reduce pain, improve motion, and speed recovery.
Risk Factors Associated with Developing Frozen Shoulder
While frozen shoulder can occur without a known cause, several factors increase the risk of developing the condition.
Common risk factors include:
- Age between 40 and 60 years
- Women are affected more often than men
- Diabetes (one of the strongest risk factors)
- Thyroid disorders
- Parkinson’s disease
- Heart disease
- Stroke
- Shoulder injuries such as fractures or rotator cuff tears
- Shoulder surgery
- Prolonged immobilization after an injury or surgery
- Previous frozen shoulder in the opposite shoulder
Patients with diabetes or thyroid disease often experience more severe symptoms and may require a longer recovery.
Symptoms of Frozen Shoulder
The most common symptoms include:
- Gradually worsening shoulder pain
- Significant stiffness that limits movement in all directions
- Difficulty reaching overhead
- Trouble reaching behind your back to tuck in a shirt or fasten a bra
- Difficulty washing or combing your hair
- Pain when putting on a coat or reaching for objects
- Night pain that interferes with sleep
- Difficulty performing work, exercise, or recreational activities
Unlike many other shoulder conditions, frozen shoulder causes both active motion (what you can move yourself) and passive motion (what someone else can move for you) to become significantly restricted.
Diagnosis of Frozen Shoulder
Frozen shoulder is diagnosed through a careful evaluation by one of our orthopedic shoulder specialists.
Your physician will:
- Review your symptoms and medical history
- Discuss any previous injuries or surgeries
- Evaluate shoulder motion, strength, and function
- Compare movement with your opposite shoulder
- Perform a thorough physical examination
The hallmark finding is a marked loss of shoulder motion in nearly every direction.
Imaging studies may include:
- X-rays to rule out arthritis, fractures, or other bone abnormalities
- MRI if another shoulder problem such as a rotator cuff tear or labral injury is suspected
In many cases, the diagnosis can be made based on your history and physical examination alone.
Frozen Shoulder Treatment Options
Non-Surgical Treatment
Non-surgical treatment is successful for the majority of patients and may include:
- Patient education about the natural course of the condition
- Activity modification while remaining as active as possible
- Anti-inflammatory medications when appropriate
- Ice or heat for pain relief
- A structured physical therapy program focused on restoring motion
- Home stretching exercises performed consistently
- Corticosteroid or orthobiologic injections to reduce inflammation and pain, particularly during the early painful stage
- Image-guided injections when appropriate for improved accuracy including hydrodistension
Many patients experience meaningful improvement over several months with a combination of therapy and injections.
Surgical Treatment
Surgery is considered when significant pain and stiffness continue despite several months of appropriate non-surgical treatment.
Surgical options may include:
Manipulation Under Anesthesia (MUA)
- While you are asleep under anesthesia, the surgeon gently moves the shoulder through its full range of motion to break up scar tissue and improve mobility.
Arthroscopic Capsular Release
- Using minimally invasive arthroscopic (keyhole) surgery, the surgeon carefully releases the tight portions of the shoulder capsule to restore movement.
- This procedure allows precise treatment of the contracted tissue while minimizing damage to surrounding structures.
- It is often combined with gentle manipulation under anesthesia to maximize range of motion.
Your orthopedic surgeon will determine which treatment is most appropriate based on the severity of your symptoms and how you have responded to conservative care.
Typical Recovery from Frozen Shoulder Treatment
Recovery with Non-Surgical Treatment
Most patients gradually improve with physical therapy, stretching exercises, and pain management.
Typical recovery includes:
- Pain often begins improving within several weeks after treatment starts.
- Shoulder motion improves gradually over several months.
- Most patients continue to gain flexibility for 6 to 18 months.
- Some patients continue to improve for up to two years.
Consistency with home exercises and physical therapy is one of the most important factors for a successful recovery.
Recovery After Surgical Treatment
Recovery after arthroscopic capsular release or manipulation under anesthesia requires immediate rehabilitation to maintain the improved range of motion.
Typical recovery includes:
First Few Days
- Physical therapy usually begins immediately or within 24 hours after surgery.
- Early motion is essential to prevent the shoulder from becoming stiff again.
First 6 Weeks
- Daily stretching and supervised physical therapy help maintain and improve motion.
- Pain steadily decreases while shoulder mobility improves.
6–12 Weeks
- Strengthening exercises are gradually introduced.
- Most patients notice significant improvements in function and comfort.
3–6 Months
- Most patients return to normal daily activities with minimal pain.
- Continued improvements in strength and flexibility may occur for several additional months.
Most patients achieve excellent pain relief and substantial improvements in shoulder motion, allowing them to return to work, recreation, and everyday activities. At Midwest Orthopedic and Musculoskeletal Alliance, our fellowship-trained shoulder specialists create an individualized treatment plan designed to restore motion, reduce pain, and help you return to the activities you enjoy as quickly and safely as possible.
Schedule Your Frozen Shoulder Consultation
If you are experiencing shoulder pain, stiffness, or limited range of motion, contact Midwest Orthopedic and Musculoskeletal Alliance today at 414-384-6700. Our orthopedic specialists in Southeastern Wisconsin are here to help.