Frozen Shoulder: Why It Happens and How to Get Your Movement Back

What Is Frozen Shoulder?

Frozen shoulder — adhesive capsulitis — is an inflammatory condition of the shoulder joint capsule. The capsule, which normally allows the shoulder its extraordinary range of movement, becomes inflamed, thickened, and scarred. The result is pain and progressive loss of movement in all directions — lifting the arm, reaching behind the back, and rotating outwards all become difficult and eventually impossible without treatment.

It affects approximately 2–5% of the population, is more common in women, and has a strong association with diabetes — diabetic patients have a 3–5 times higher risk.

The Three Phases

Frozen shoulder classically progresses through three phases:

• Freezing phase (2–9 months): Pain predominates, often worst at night. Movement begins to decrease.
• Frozen phase (4–12 months): Pain may reduce but stiffness is maximal. Daily activities become significantly limited.
• Thawing phase (5–24 months): Gradual spontaneous recovery of movement.

Without treatment, the natural history is 1–3 years to resolution. With appropriate treatment, this can be shortened to 3–6 months in most cases.

Effective Treatment Options

The most effective treatment combines physiotherapy with corticosteroid injection, ideally early in the freezing phase:

• Physiotherapy: Targeted stretching to restore capsular mobility. Must be performed consistently — daily stretching at home is as important as clinic sessions.
• Corticosteroid injection: An ultrasound-guided injection into the shoulder joint significantly reduces inflammation and pain, allowing physiotherapy to be more effective.
• Hydrodilatation: An injection of fluid under pressure that stretches and breaks up the scarred capsule. Highly effective for the frozen phase — Dr. Hargovind Singh performs this procedure for appropriate patients.

When Manipulation or Surgery Is Needed

A small minority of patients — particularly those with diabetes or severe scarring — do not respond adequately to physiotherapy and injections. For these patients, manipulation under anaesthesia (MUA) or arthroscopic capsular release provides excellent results. Arthroscopic capsular release is a day procedure that consistently achieves full restoration of movement in appropriate patients.

Starting Treatment Early Makes a Difference

The earlier frozen shoulder is diagnosed and treated, the better the outcome. Patients who begin treatment in the freezing phase respond much more rapidly than those who present in the fully frozen phase after months of waiting for it to "get better on its own."

If you have had progressive shoulder stiffness and pain for more than 4–6 weeks, particularly if you have diabetes, seek assessment with Dr. Hargovind Singh at Bombay Hospital, Jaipur promptly.