Frozen shoulder — also called adhesive capsulitis — is a painful, often frustrating condition where the shoulder becomes stiff and movement is restricted. It usually develops gradually, often without a clear trigger, and can make even simple tasks like dressing, reaching, or sleeping uncomfortable. The problem stems from the capsule of the shoulder joint becoming inflamed, thickened, and tight, which limits movement and drives pain. Frozen shoulder typically follows three stages and can take anywhere from one to three years to fully settle.
Are All Cases of Shoulder Pain and Stiffness Frozen Shoulder?
The term “frozen shoulder” is often overused, especially by non-specialist clinicians, and that can lead to confusion and poor treatment decisions. Many other issues — such as rotator cuff injuries, impingement syndromes, or even pain referred from the neck — can present in a similar way but need to be managed differently because the underlying causes aren’t the same.
A true frozen shoulder happens when the joint capsule becomes inflamed, thickened, and tight. If you’re questioning your diagnosis, or simply want to understand it better, a good place to start is by learning more about the shoulder’s anatomy. If you’d like to explore this in more detail, please see our dedicated Shoulder Anatomy page.
Frozen Shoulder Related Anatomy
The shoulder joint is a complex structure made up of bones, tendons, and ligaments. In the image below, some of these structures are shown, while others are cut away to expose the ball-and-socket joint beneath.
A thick capsule of connective tissue surrounds this joint along with some of the nearby soft tissue. The shoulder has a capsule because it’s a ball-and-socket joint that needs both mobility and stability. This capsule is a flexible, fibrous layer of tissue that keeps the ball of the upper arm bone (humerus) in place while still allowing the wide range of movement the shoulder is known for. In frozen shoulder, this capsule becomes inflamed, thickened, and tight, restricting that normal movement.
What Increases Your Risk of Frozen Shoulder?
While the exact cause of frozen shoulder isn’t fully understood, several factors are known to increase the likelihood of developing it:
Diabetes
People with diabetes are at a much higher risk — studies suggest up to 30% of people with frozen shoulder have diabetes. Although the exact mechanism isn’t clear, long-term high blood sugar levels are thought to affect connective tissue, making the capsule more prone to thickening and stiffness.
Immobilisation
Prolonged periods of reduced movement — for example, after an arm fracture, shoulder surgery, or even just keeping the arm still due to pain — can trigger the condition. Lack of movement allows the capsule to tighten and lose its normal elasticity, setting the stage for stiffness.
Age and gender
Frozen shoulder is most common between the ages of 40 and 65, and it tends to affect women slightly more often than men. Hormonal changes and natural, age-related changes in connective tissue may play a role in this pattern.
Other medical conditions
People with certain health conditions — including thyroid disorders (overactive or underactive), cardiovascular disease, or Parkinson’s disease — also have a higher risk. These associations are well documented but not yet fully understood.
Previous shoulder problems
Having had shoulder pain or injury in the past, such as a rotator cuff tear or a previous episode of frozen shoulder, can make you more susceptible to developing the condition again, either in the same shoulder or the opposite one.
Signs and Symptoms of Frozen Shoulder
In some cases, frozen shoulder is a straightforward diagnosis. However, in the early stages, its symptoms can overlap with other shoulder conditions, making the diagnosis more challenging. Sometimes, a frozen shoulder diagnosis only becomes clear when symptoms progress in a way that is typical of the condition, or when there’s little or no improvement with first-line rehabilitation.
The shoulder capsule doesn’t restrict all movements equally. As part of the assessment, we look for specific ranges of movement that are most commonly limited. To simplify this, we use the acronym LAM:
Over time, people naturally adapt and compensate for pain and stiffness to keep life as normal as possible. This is why, during your assessment, I always compare active movement (what you can do yourself) with passive movement (what I can move for you). This helps us understand whether the joint is truly restricted.
Physiotherapists are also trained to assess what’s called the “end feel” — the quality of resistance felt at the point where movement stops (for example, hard, soft, or springy). In frozen shoulder, the end feel is typically firm but not solid, indicating a soft tissue restriction rather than a bony block.
Imaging in Frozen Shoulder
When the diagnosis of frozen shoulder isn’t obvious, or when we need to confirm it with more certainty, imaging can be useful. It’s important to understand that no scan comes with a convenient arrow pointing to the exact source of your pain.
What we get is a detailed image of your anatomy. It’s the role of an experienced clinician to interpret that image alongside your history, symptoms, and physical examination to decide whether the findings are relevant.
With frozen shoulder, imaging is often used to rule out other causes of pain rather than to directly diagnose the condition itself. Here’s how different imaging tools might be used:
-
X-rays: Helpful for checking for arthritis, bone spurs, or other bony changes that could explain your symptoms.
-
MRI (Magnetic Resonance Imaging):Provides detailed images of soft tissues like the labrum and rotator cuff tendons. Often used to rule out tears or structural injuries that can mimic frozen shoulder symptoms.
-
Ultrasound (USS): Similar to MRI in assessing soft tissues, but with one key advantage: it allows for dynamic assessment. Because the shoulder can be moved during the scan, ultrasound can sometimes pinpoint pain sources during motion that a static MRI might miss. However, it cannot visualise inside the joint itself because bone blocks the sound waves.
In many cases, a thorough clinical assessment is still the most accurate and cost-effective way to reach a diagnosis — with imaging reserved for situations where clarification is needed.
The Famous Stages of Frozen Shoulder
I often joke with patients that I feel a bit awkward using analogies — they can sound a little cheesy — but in my 25 years of practice, I haven’t found a better way to explain this one more clearly. So, here goes…
Frozen shoulder typically progresses through three distinct stages, each lasting several months:
Freezing Stage (Pain-dominant)
In this initial phase, pain occurs with almost any shoulder movement, and range of motion gradually decreases. Night pain is common and often disrupts sleep, making it difficult to find a comfortable position. The early stages of this phase are often the hardest in which to make a firm diagnosis.
Frozen Stage (Stiffness-dominant)
Pain normally eases during this stage, but stiffness becomes the main problem. Shoulder function is significantly reduced, and everyday tasks — like reaching overhead, fastening a seatbelt, or tucking in a shirt — can feel impossible.
Thawing Stage (Recovery)
In the final stage, stiffness gradually improves, and range of motion starts to return. Progress is slow but steady, and consistent, stage-appropriate therapy and exercise help restore function more effectively. Pain is not normally the main problem in the phase but ion my experience can become so if to aggressive a rehab is undertaken causing more acute pain responses again.
It’s important to note that while these stages are well recognised, the timeline varies for each person — and with the right guidance, symptoms can often be managed more effectively throughout the process.
Managing and Treating Frozen Shoulder
It’s no exaggeration to say that frozen shoulder can have a major impact on daily life — simple tasks like dressing, reaching overhead, or even sleeping can become a challenge. However, it’s important to remember that in the vast majority of cases, frozen shoulder will resolve naturally over time, even without aggressive intervention. In fact, pursuing overly aggressive treatments too early can sometimes irritate the joint further and delay recovery.
The goal of treatment is to relieve pain, maintain as much mobility as possible, and support recovery through the three stages of the condition. Evidence supports a combination of approaches tailored to the stage you’re in and your individual needs:
Pain management
-
Over-the-counter medications: Anti-inflammatories like ibuprofen or simple analgesics such as paracetamol can help manage pain and improve function, especially in the early painful stage.
-
Prescription medications: In more severe cases, your GP or consultant may prescribe stronger pain relief or short courses of anti-inflammatories to help you tolerate daily activities and therapy.
Heat and cold therapy
-
Heat packs: Applying gentle heat can help relax surrounding muscles and improve blood flow, reducing stiffness and making exercises more comfortable.
-
Ice packs: Useful for calming flare-ups of pain or inflammation, particularly after activity or exercise.
Physiotherapy
-
Stretching exercises: Tailored, stage-appropriate exercises are the cornerstone of recovery. These focus on gradually restoring movement without overloading the joint capsule.
-
Strengthening exercises: As mobility improves, progressive strengthening helps restore normal shoulder function and prevent secondary problems such as muscle weakness.
-
Manual therapy: Skilled, hands-on techniques can gently mobilise the joint, helping to reduce stiffness and discomfort when used appropriately.
Acupuncture
Some patients report symptom relief with acupuncture, particularly during the painful early stage. While evidence is mixed, it can sometimes complement physiotherapy.
Corticosteroid injections
A carefully targeted steroid injection into the joint can reduce inflammation and pain, particularly in the freezing (pain-dominant) stage, making it easier to engage with exercise. However, current evidence shows that while this can provide short-term pain relief, it does not shorten the overall duration of recovery or guarantee a better long-term outcome.
Hydrodilatation (joint distension)
This involves injecting a sterile solution into the joint capsule to gently stretch it and improve movement. For some patients, particularly those with severe stiffness, this can create a therapeutic window for physiotherapy to be more effective.
Manipulation under anaesthesia (MUA)
In certain severe or resistant cases, the shoulder may be gently manipulated under general anaesthetic to break adhesions and increase movement. This approach should be considered cautiously and is always followed by intensive physiotherapy to maintain any gains in mobility.
Surgery (arthroscopic release)
Surgery is rarely required but may be an option for persistent, severe cases that do not respond to conservative treatment. Arthroscopic capsular release uses keyhole surgery to carefully release the tightened capsule, allowing for significant improvement when followed by structured rehabilitation.
Frozen Shoulder: At-a-Glance Summary
-
What it is: Frozen shoulder (adhesive capsulitis) is a condition where the shoulder capsule becomes inflamed, thickened, and tight, causing pain and stiffness that develops gradually over time.
-
Stages: The condition typically progresses through three phases — freezing (pain-dominant), frozen (stiffness-dominant), and thawing (recovery) — each lasting several months.
-
Symptoms: Pain (especially at night), stiffness in all directions, and difficulty with everyday tasks like dressing, reaching, or driving.
-
Risk factors: More common in people aged 40–65, women, those with diabetes or thyroid issues, and after periods of immobilisation or shoulder injury.
-
Diagnosis: Largely clinical, based on history and physical examination; imaging is mainly used to rule out other causes.
-
Treatment: Focuses on pain relief, maintaining mobility, and gradual rehabilitation. Options include physiotherapy, stage-appropriate exercises, heat/ice therapy, steroid or hydrodilatation injections, and, in rare cases, surgery.
-
Prognosis: Most people recover well over time, though the process can take 12–36 months. Early, evidence-based guidance can help reduce pain and improve function more effectively.
A Quick Note From Chris
It won’t surprise many of you to know that I don’t get any financial reward for writing and sharing these pages. I do it because I genuinely want to help people better understand their conditions and feel more in control of their recovery.
All I ask is that you don’t plagiarise or claim this work as your own — and if you’ve found it helpful, please consider sharing it with friends, family, or anyone else who might benefit from it. Follow my blog for regular updates on new topics, pages and future projects.
Thanks for reading — and for taking your health seriously.
Grow Your Vision
Welcome visitors to your site with a short, engaging introduction.
Double click to edit and add your own text.
Frozen Shoulder FAQ's
Why You Should Choose Chris Heywood Physio
The most important thing when seeking help is finding a practitioner you trust—someone who is honest, responsible, and clear about your diagnosis, the treatment you really need, and whether any follow-up appointments are necessary.
I’m not here to poach you from another therapist, but if you’re looking for a new physiotherapist in Northamptonshire or simply want a second opinion, here’s why many people choose to work with me (read my reviews):
Over 25 Years of Experience & Proven Expertise
With 25+ years of hands-on physiotherapy experience, I’ve built a trusted reputation for clinical excellence and evidence-based care. My approach combines proven techniques with the latest research, so you can feel confident you’re in safe, skilled hands.
Longer Appointments for Better Results
No two people—or injuries—are the same. That’s why I offer 60-minute one-to-one sessions, giving us time to:
-
Thoroughly assess your condition
-
Provide focused, effective treatment
-
Explain what’s really going on in a clear, simple way
Your treatment plan is tailored specifically to you, aiming for long-term results, not just temporary relief.
Honest Advice & Support You Can Trust
I’ll always tell you what’s best for you—even if that means you need fewer sessions, not more. My goal is your recovery and wellbeing, not keeping you coming back unnecessarily. I have low overheads nowadays and I do not have pre-set management targets to maximise patient 'average session per condition' (yes it does happen commonly and I hate it with a passion - read my article here)
Helping You Take Control of Your Recovery
I believe the best outcomes happen when you understand your body. I’ll explain your condition clearly, give you practical tools for self-management, and step in with expert hands-on treatment when it’s genuinely needed.
Looking for a physiotherapist who values honesty, expertise, and your long-term health?
Book an appointment today and take the first step towards feeling better.
Contact Info
On a Monday and Tuesday I work as a specialist contractor but I can still be contacted for enquiries. You are welcome to call but it is often faster for me to reply via a contact form or watsapp message, simply as my phone will be on silent in clinic. Either way, I will reply as soon as possible, which in the week, is almost always on the same day at the latest.
Clinic Opening Hours
The Clinic is located at 2 Old Road, Scaldwell, Northants, NN6 9LA - More info
Mon - Tues
Weds - Fri
Sat -Sun
Closed for Contract Work
0900 - 1330
Closed (Family Time!)
** Please note that online sessions can sometimes be arranged outside of normal clinical hours on request.**