What is frozen shoulder (adhesive capsulitis) and how is it treated?

Frozen shoulder, or adhesive capsulitis, occurs when the capsule surrounding the shoulder joint becomes inflamed, thickens, and tightens, causing pain and a progressive loss of movement. It typically passes through three stages — freezing, frozen, and thawing — that can take one to three years in total. It's more common between ages 40 and 60, in women, and in people with diabetes, thyroid disorders, or a shoulder that has been immobilized after injury or surgery. Diagnosis is usually made from the pattern of symptoms and a clinical exam, with imaging used mainly to rule out other causes of shoulder pain. Treatment centres on physiotherapy and guided stretching to preserve movement, alongside pain relief such as ice or anti-inflammatories. Corticosteroid injections or a hydrodilatation procedure can help when stiffness is significant, and manipulation under anaesthesia or arthroscopic release are reserved for cases that don't improve with conservative care. Left untreated, most cases still resolve eventually, though a small proportion of people are left with some permanent stiffness.

Joint Pain & Rheumatology 2026-09-15

Frozen Shoulder (Adhesive Capsulitis): Symptoms, Causes & Treatment

Frozen shoulder happens when the capsule surrounding the shoulder joint becomes inflamed, thickens, and tightens around the joint. The result is pain and a progressive loss of movement that can make everyday tasks — reaching for a shelf, fastening a bra, combing your hair, reaching into the back seat of a car — increasingly difficult. It usually affects one shoulder at a time, though it can occasionally develop in the other one later, sometimes even before the first has fully recovered.

What causes it

The exact trigger isn't always clear. In many cases, frozen shoulder develops without any obvious cause (referred to as "primary" frozen shoulder). In others, it follows a period of reduced shoulder movement — after a fracture, a rotator cuff injury, shoulder surgery, or a stroke that limits arm use. What's consistent across cases is the underlying process: the joint capsule, a normally loose sleeve of tissue that allows the shoulder its wide range of motion, becomes thickened and scarred, and loses its elasticity. This is why the condition is also called adhesive capsulitis — "adhesive" referring to the capsule sticking to itself and to the surrounding structures.

Recognising the symptoms

The hallmark of frozen shoulder is a dull, aching pain, often deep in the shoulder or upper arm, that is worse at night and can disturb sleep, especially when lying on the affected side. Alongside the pain, movement becomes progressively restricted — both movement you try to make yourself and movement someone else tries to make for you, which distinguishes it from problems like a torn rotator cuff. Reaching overhead, behind the back, or out to the side all become difficult. Some people also notice the shoulder feels weak, though this is usually because pain and stiffness limit effort, rather than true muscle weakness.

The three stages

Freezing: Pain gradually worsens, often at night, and the shoulder starts to stiffen. This stage can last 6 to 9 months.
Frozen: Pain may ease, but stiffness remains and movement is markedly limited. This typically lasts 4 to 6 months.
Thawing: Movement slowly returns, sometimes over 6 months to 2 years.

The total course can run anywhere from 1 to 3 years, and the pace varies considerably from person to person. People with diabetes often experience a longer, more stubborn course.

Who's more at risk

Frozen shoulder most often affects people between 40 and 60, and is more common in women. Risk is higher with diabetes — which can raise the lifetime risk considerably, and both type 1 and type 2 diabetes are implicated — as well as thyroid disorders (both overactive and underactive), and after a period where the shoulder has been kept still, such as following surgery, a fracture, or a stroke. Other associations include Parkinson's disease, cardiac disease, and, less commonly, prolonged immobilisation for any reason.

How it's diagnosed

Frozen shoulder is usually diagnosed clinically, based on the pattern of pain and stiffness together with an examination showing restricted movement in multiple directions, both actively and passively. X-rays are often done to rule out other causes of shoulder pain, such as arthritis, but they don't show the capsule itself. An ultrasound or MRI is occasionally used when the diagnosis is unclear, or to check for a coexisting rotator cuff problem, but isn't needed for a typical, straightforward case.

How it's treated

Ice therapy applied to the shoulder alongside imaging used to assess joint stiffness — Ice, anti-inflammatories, and guided physiotherapy are usually the first steps in managing frozen shoulder.

Physiotherapy with guided stretching is the mainstay of treatment, aimed at preserving as much movement as possible while the shoulder works through its stages. It's most effective when started early and done consistently, though it can also feel uncomfortable in the freezing stage, when the joint is at its most irritable — your physiotherapist or doctor can help pace exercises appropriately. Ice and anti-inflammatory medication help control pain, particularly in the early, more painful phase, and simple analgesics can help with sleep disturbance.

When stiffness is significant or progress with physiotherapy stalls, a corticosteroid injection into the joint can reduce inflammation and pain enough to allow more effective stretching, and a hydrodilatation procedure — which gently stretches the capsule using a mix of fluid and steroid under imaging guidance — can help loosen a particularly tight joint. For the minority who don't improve with these measures after several months, manipulation under anaesthesia (stretching the shoulder while asleep) or a keyhole procedure to surgically release the tightened capsule are options, generally considered once conservative treatment has had a fair trial.

Most cases do eventually resolve on their own, even without any specific treatment, but this can take a long time and the stiffness in the meantime can be disabling. Treatment doesn't necessarily change the total time course, but it can meaningfully reduce pain and shorten the period of significant disability.

Living with it day to day

While the shoulder is stiff, a few simple adjustments help: sleeping with a pillow supporting the affected arm, avoiding sudden or forceful movements that provoke sharp pain, and continuing gentle, regular movement rather than avoiding the shoulder altogether, which can worsen stiffness. Heat before stretching and ice afterwards is a common, useful combination. Staying consistent with prescribed exercises, even on days when the shoulder feels better, gives the best chance of a shorter, smoother recovery.

When to see a doctor

See a doctor if shoulder pain and stiffness are getting worse over several weeks, if pain is disturbing your sleep regularly, or if you notice a marked and progressive loss of movement in one shoulder. It's also worth being assessed if you have diabetes or a thyroid condition and develop new shoulder pain, given the higher risk, and earlier treatment tends to work best. Sudden, severe pain after an injury, or a shoulder that looks deformed or that you can't move at all after a fall, needs urgent attention rather than a routine consultation, as these point to a different problem such as a fracture or dislocation.

Dealing with shoulder pain or stiffness that isn't improving? Message directly and ask.

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This article is general health information and does not replace a medical consultation. In a medical emergency, call SAMU (114) or go to your nearest hospital.

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