Shoulder
Frozen Shoulder
Frozen shoulder, medically adhesive capsulitis, is the shoulder's capsule tightening and thickening for no obvious reason, so movement is lost in every direction rather than just being painful. It runs its own long course regardless of treatment, and treatment is mostly about making that course shorter and more bearable rather than fixing something broken.
By appointment only, at Kharar (Mohali) or Solan. Your confirmation says which.
What tends to cause it
Most cases have no clear trigger at all. Where there is a pattern, it tends to follow a period of the shoulder being used less than usual, after an injury, a fracture elsewhere in the arm, or a stroke, and it is meaningfully more common in people with diabetes, whose baseline stiffness and recovery time also both tend to be worse.
It typically affects one shoulder between the ages of forty and sixty, more often in women, and runs through three overlapping phases: increasingly painful and gradually stiffening, then predominantly stiff with the pain settling, then slowly loosening again. The whole course commonly runs eighteen months to three years, which is longer than most people expect to hear.
When it needs seeing sooner
Frozen shoulder itself is not an emergency, but a few things about a stiff, painful shoulder are not frozen shoulder and need to be seen sooner:
- The shoulder is hot, swollen and you feel unwell or feverish, which can mean an infected joint
- Weakness rather than stiffness is the main problem, particularly after a fall or a specific injury
- Numbness or weakness spreading down the arm, which points to the neck or a nerve rather than the shoulder
- Unexplained weight loss, night sweats, or a history of cancer alongside the pain
Short of those, book a routine consultation. Nothing about ordinary frozen shoulder gets worse by waiting a few weeks for an appointment.
How it gets assessed
The finding that actually makes the diagnosis is loss of movement in every direction, including when someone else moves the arm for you rather than just when you try to move it yourself. That passive stiffness is what separates frozen shoulder from a rotator cuff problem, which usually still moves freely when someone else does the moving; the two can otherwise feel similar to the person experiencing them.
External rotation, turning the arm outwards from the elbow, is usually the most restricted movement and the most useful single test.
X-rays are often taken and are usually normal; their main job is ruling out arthritis rather than confirming frozen shoulder, which is a clinical diagnosis. An ultrasound or MRI is not routinely needed, and is really only used where the pattern does not fit and a cuff tear needs excluding instead.
What treatment usually looks like
The large majority of frozen shoulders are treated without surgery, and the aim is to get through the painful phase with less pain and to keep as much movement as possible while the capsule is tight.
- A stretching and mobility programme, gentle and consistent rather than aggressive, particularly through the painful phase
- A corticosteroid injection into the joint, often most useful early, while pain rather than stiffness is the main problem
- Anti-inflammatory medication for a defined period
- Time. Even without treatment, most frozen shoulders eventually loosen on their own; treatment shortens that course and makes it more bearable rather than being the only thing that resolves it
For the minority who are still significantly stiff after a genuine trial of the above, usually six to twelve months, an arthroscopic release of the tightened capsule, or manipulation of the shoulder under anaesthesia, can move things on where nothing else has.
Common questions
Can I just wait it out without any treatment?
Often, yes, in the sense that most frozen shoulders do eventually loosen on their own. What treatment changes is how painful and how limiting that year or two is along the way, and there is little reason to spend it in more discomfort than necessary.
Will physiotherapy make it more painful?
Done properly, no. It should work within what the shoulder tolerates, particularly in the painful phase, rather than forcing range against resistance. Physiotherapy that leaves the shoulder consistently worse afterwards is being pushed too hard, and that is worth saying to whoever is treating you.
Does it always come back to full movement?
Most people get back close to full movement, though a genuine minority are left with some permanent restriction, most often in the last few degrees of external rotation. It is usually mild enough not to affect daily life.
I have diabetes. Does controlling it better help?
It helps your overall health and may reduce the risk of the other shoulder developing it, but it will not make a frozen shoulder you already have resolve any faster. The two are linked in how the condition develops, not in how it is treated once it is there.
Related procedures
Where an operation does turn out to be the right answer, these are the ones this problem most often leads to.
Not sure what is causing it?
That is what a consultation is for. Bring any imaging you already have, and any plan you have been given elsewhere.