Understanding Frozen Shoulder or Adhesive Capsulitis

Frozen shoulder, medically known as adhesive capsulitis, is a painful and often debilitating condition that affects the shoulder joint. It’s characterized by a gradual loss of shoulder mobility, resulting in stiffness and pain. This article aims to provide a comprehensive overview of frozen shoulder, covering its definition, risk factors, symptoms, stages, causes, diagnosis, treatment options, prevention, and more.

What Is a Frozen Shoulder?

Frozen shoulder, also known as adhesive capsulitis or stiff shoulder, is a musculoskeletal disorder that primarily affects the shoulder joint. It is characterized by the gradual development of pain and stiffness in the shoulder, which can severely limit the joint’s range of motion. While the exact cause of a frozen shoulder is not always clear, it often involves the thickening and tightening of the shoulder joint’s capsule and the formation of adhesions, which restrict movement.

Who Is at Risk for Developing Frozen Shoulders?

While frozen shoulders can occur to anyone, certain individuals are at a higher risk of developing this condition. The following factors may increase the likelihood of developing a frozen shoulder:

  • Age: Frozen shoulder is more common in individuals between the ages of 40 and 60.
  • Gender: Women are more prone to developing frozen shoulders than men.
  • Medical Conditions: Certain medical conditions, such as diabetes, heart disease, thyroid disorders, and Parkinson’s disease, are associated with a higher risk of frozen shoulder.
  • Shoulder Trauma or Surgery: A history of shoulder injuries, surgeries, or prolonged immobilization of the shoulder can increase the risk of developing a frozen shoulder.
  • Systemic Diseases: Conditions like autoimmune diseases can be associated with an increased risk of frozen shoulder.
  • Genetics: There may be a genetic predisposition to developing frozen shoulders in some cases.
  • Other Factors: Smoking and a sedentary lifestyle may also contribute to the risk of frozen shoulders.

Symptoms of Frozen Shoulder

Frozen shoulder stages usually advance through three separate stages, each marked by its own distinct set of symptoms:

1. Freezing Stage(Stiff shoulder):

  • Pain: Gradual onset of pain in the shoulder, which worsens over time.
  • Stiffness: Increasing stiffness in the shoulder joint, making everyday activities like reaching and lifting difficult.
  • Limited Range of Motion: The range of motion in the shoulder becomes restricted.

2. Frozen Stage:

  • Persistent Pain: Pain may remain constant and intense.
  • Severe Stiffness: Significant loss of range of motion in the shoulder, making even simple tasks challenging.
  • Difficulty Sleeping: Pain and discomfort can interfere with sleep.

3. Thawing Stage:

  • Improvement: Pain and stiffness gradually subside.
  • Recovery: The shoulder’s range of motion slowly returns, but it may not fully reach pre-frozen shoulder levels.

Causes of Frozen Shoulder

The exact cause of frozen shoulder is not always clear, but several factors may contribute to its development:

  • Inflammation: Inflammation in the joint capsule can lead to the thickening and tightening of the capsule, restricting movement.
  • Joint Immobilization: Prolonged immobilization of the shoulder due to injury, surgery, or other medical conditions can increase the risk of developing a frozen shoulder.
  • Autoimmune Conditions: Some autoimmune diseases can trigger inflammation in the shoulder joint.
  • Hormonal Changes: Hormonal imbalances, as seen in conditions like diabetes, may play a role.

Diagnosis and Tests

If you suspect you have a frozen shoulder or are experiencing symptoms, it’s essential to consult a healthcare professional for a proper diagnosis. Diagnosing a frozen shoulder typically involves:

  • Medical History: Your doctor will ask about your symptoms, medical history, and any underlying conditions.
  • Physical Examination: A physical examination will assess your shoulder’s range of motion, strength, and pain levels.
  • Imaging Tests: X-rays and MRI scans may be ordered to rule out other conditions and evaluate the extent of shoulder damage.

Frozen Shoulder Treatment

Treatment for frozen shoulder aims to relieve pain, improve shoulder mobility, and manage the condition’s progression. The approach to treatment may vary depending on the stage and severity of the frozen shoulder:

1. Conservative Management (Stiff shoulder):

  • Physical Therapy: Physical therapists can teach frozen shoulder exercises and stretches to improve range of motion and strength in the shoulder.
  • Pain Relief: Over-the-counter pain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), may help manage pain and inflammation.
  • Heat and Ice: Applying heat or ice packs can alleviate pain and reduce inflammation.

2. Corticosteroid Injections:

Corticosteroid injections: These injections can provide temporary relief from pain and inflammation, especially during the early stages of a frozen shoulder.

3. Hydrodilatation:

Hydrodilatation: In this procedure, the doctor injects sterile water into the joint capsule to stretch and expand it, which can help improve mobility.

4. Manipulation Under Anesthesia (MUA):

MUA: A doctor may perform this procedure to break up adhesions and improve shoulder mobility. It encompasses the manipulation of the shoulder joint while the patient is in an anesthetized state.

5. Surgery:

Surgical Intervention: In severe cases where conservative treatments are ineffective, surgical options such as shoulder arthroscopy or capsular release may be considered to release the tight capsule.


While some risk factors for frozen shoulder, such as age and gender, cannot be controlled, there are steps individuals can take to reduce their risk:

  • Maintain a Healthy Lifestyle: Staying active, eating a balanced diet, and avoiding smoking can promote overall shoulder health.
  • Early Intervention: If you have underlying medical conditions like diabetes or autoimmune diseases, managing them effectively can reduce the risk of developing a frozen shoulder.
  • Regular Shoulder Exercises: Engaging in regular shoulder exercises and stretches can help maintain joint flexibility.

Outlook / Prognosis

The outlook for a frozen shoulder differs from one individual to another. With appropriate treatment and rehabilitation, many individuals can recover full or near-full shoulder function over time. However, the recovery process can be slow, and it may take several months to years to achieve maximum improvement.

Medications for Shoulder Pain

If you are experiencing shoulder pain, several medications can help alleviate discomfort:

  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs like ibuprofen or naproxen can reduce pain and inflammation associated with a frozen shoulder.
  • Corticosteroids: These are powerful anti-inflammatory medications that can be injected into the shoulder joint to provide relief.
  • Pain Relievers: Over-the-counter pain relievers like acetaminophen (Tylenol) can help manage mild to moderate shoulder pain.

Physiotherapy for Frozen Shoulder

Physical therapy assumes a pivotal role in the treatment of frozen shoulder. Here’s how it can help:

  • Range of Motion Exercises: Physical therapists can guide you through specific exercises to improve shoulder mobility and also use shockwave therapy to improve the range of motion.
  • Strength Training: Strengthening exercises help regain muscle tone and support the shoulder joint.
  • Manual Therapy: Hands-on techniques can release tight tissues and improve joint mobility.
  • Pain Management: Therapists can teach you strategies to manage pain and discomfort and also use machines including Ultrasound, LASER, and electrical stimulations to reduce pain 
  • Home Exercise Program: You’ll be given exercises to continue at home to support your recovery.

Can an MRI Detect Frozen Shoulder?

Yes, an MRI (Magnetic Resonance Imaging) can detect a frozen shoulder. It is often used as a diagnostic tool to assess the condition of the shoulder joint, rule out other potential causes of shoulder pain, and visualize the extent of inflammation and adhesions within the joint capsule.

Exercises to Avoid with Frozen Shoulder

While exercise is essential for managing a frozen shoulder, some exercises can worsen the condition or cause further pain. Avoid the following exercises:

  • Overhead Presses: Exercises that involve lifting weights overhead can strain the shoulder joint.
  • Behind-the-Neck Pull-Downs: These exercises can put excessive stress on the shoulder joint and worsen the condition.
  • Excessive Stretching: Aggressive stretching of the shoulder can lead to further injury.
  • Heavy Lifting: Avoid lifting heavy objects that put a significant load on the shoulder joint.

Is the Gym Good for Frozen Shoulder?

The gym can be beneficial for individuals with frozen shoulder, but it’s essential to approach it with caution and guidance:

  • Consult a Professional: Before starting any gym activities, consult a physiotherapist or healthcare provider to create a safe exercise plan tailored to your condition.
  • Focus on Range of Motion: Emphasize exercises that improve shoulder mobility and flexibility.
  • Avoid Overexertion: Do not push yourself too hard, and avoid exercises that cause pain or discomfort.
  • Warm-Up: Always warm up before your gym session to prepare your shoulder muscles and joints.

Lifestyle Adjustments

Living with a frozen shoulder may require some lifestyle adjustments:

  • Adaptive Strategies: Find new ways to perform daily tasks to minimize shoulder strain.
  • Ergonomics: Ensure your work and living spaces are ergonomically designed to reduce unnecessary shoulder stress.
  • Supportive Devices: If recommended by your healthcare provider, consider using braces or slings to support your shoulder.
  • Pain Management: Learn pain management techniques to cope with discomfort.

Exercises for Frozen Shoulder

Here are some gentle exercises that can help improve shoulder mobility in individuals with frozen shoulder:

  • Pendulum Exercise: Stand and bend at the waist, allowing your affected arm to hang freely. Gently swing it in small circles.
  • Towel Stretch: Hold a towel behind your back with one hand and use your other hand to pull it up. This stretches the shoulder gently.
  • Crossover Arm Stretch: Bring your affected arm across your chest and use your opposite hand to gently press it further, feeling a stretch in the shoulder.
  • Finger Walk: Stand facing a wall and use your fingers to “walk” your hand up the wall as high as you can, then walk it back down.
  • Wand Exercise: Hold a long stick or wand with both hands and slowly raise it overhead and behind your back, stretching your shoulders.

How Can I Improve My Shoulder Stability?

Improving shoulder stability is crucial for maintaining overall upper body strength and preventing injuries. Here are some tips to help enhance your shoulder stability:

  • Strength Training: Incorporate exercises that target the shoulder muscles, such as lateral raises, front raises, and rotator cuff exercises. Gradually increase the weight and resistance to build strength.
  • Balance and Coordination: Engage in balance exercises like yoga or stability ball workouts. These activities help improve coordination and control of your shoulder joint.
  • Core Strengthening: A strong core supports proper posture, which is essential for shoulder stability. Include core exercises like planks and Russian twists in your routine.
  • Scapular Retraction: Focus on exercises that strengthen the muscles around your shoulder blades, promoting stability. Engaging in rows and scapular retractions can prove advantageous.
  • Proper Form: Ensure you use proper form and technique during exercises to avoid overloading the shoulder joint and causing instability.
  • Functional Movements: Include functional movements that mimic daily activities to improve overall shoulder function and stability.
  • Stretching: Incorporate stretching exercises to maintain flexibility in the shoulder joint, which can prevent stiffness and improve stability.
  • Consult a Professional: If you’re uncertain about the right exercises or if you have a history of shoulder issues, consult a physical therapist or fitness expert for personalized guidance.

By incorporating these strategies into your fitness routine, you can enhance your shoulder stability, reduce the risk of injuries, and enjoy improved upper body strength and mobility.

Consultation and Support

Dealing with a frozen shoulder can be physically and emotionally challenging. Seek support from healthcare professionals, support groups, or therapists who can provide guidance and emotional support during your journey to recovery.


In conclusion, frozen shoulder, or adhesive capsulitis, is a challenging condition that can disrupt your daily life and cause significant pain and discomfort. However, with the right diagnosis, treatment plan, and rehabilitation efforts, many individuals can experience a significant improvement in their shoulder mobility and a reduction in pain.

This comprehensive guide has covered various aspects of a frozen shoulder, including its causes, symptoms, diagnosis, treatment options, prevention strategies, and exercises for rehabilitation. Remember that each person’s journey with a frozen shoulder is unique, and the approach to managing this condition should be tailored to your specific needs.

If you suspect you have a frozen shoulder or are currently undergoing treatment, consult with a healthcare professional who can provide personalized guidance and monitor your progress.