Frozen shoulder (adhesive capsulitis) is one of the causes for treatment

Have you ever experienced severe shoulder pain accompanied by difficulty moving it? The cause might be frozen shoulder, also known medically as adhesive capsulitis. This condition gradually restricts shoulder movement, causing stiffness and chronic pain that can affect your daily life. In this Dalili Medical article, we will explore the causes of frozen shoulder, its symptoms, treatment options including medications and exercises, the latest surgical techniques, as well as important tips for prevention and restoring natural shoulder movement.

What is Frozen Shoulder?

Frozen shoulder, also known as adhesive capsulitis, is a condition that causes pain and stiffness in the shoulder joint. It occurs because the connective tissue around the joint (the shoulder capsule) becomes thickened and tight, limiting shoulder movement. The more pain you experience, the less you use your shoulder, which increases stiffness and makes the shoulder feel “frozen.”

Is Frozen Shoulder Dangerous?

Frozen shoulder is usually not considered dangerous, but it can be very painful and may last for years if left untreated. If it affects your daily life or causes severe pain, you should see a specialist and start treatment.

Is Heat Beneficial for Frozen Shoulder?

Yes, applying heat helps reduce pain and stiffness. You can use warm compresses or take a warm bath to improve shoulder mobility and relieve discomfort.

How Should I Sleep with a Frozen Shoulder?

Find a comfortable position that does not put pressure on the affected shoulder. You can use a pillow to support your arm or shoulder, or even sleep in a reclined chair to reduce pressure and improve comfort at night.

Is Frozen Shoulder Common in Diabetic Patients?

Yes, frozen shoulder, or adhesive capsulitis, is more common in people with diabetes compared to the general population. Diabetes increases the risk of developing frozen shoulder.

Will Frozen Shoulder Heal on Its Own?

Frozen shoulder can improve over time, but it often requires treatment to relieve symptoms and restore full range of motion. Without treatment, it may take months to years to resolve on its own.

Can Frozen Shoulder Cause Chest Pain?

Frozen shoulder usually does not directly cause chest pain. However, people with frozen shoulder may change their posture or movement patterns, which can strain muscles or cause discomfort in the chest area. If you experience chest pain, it is important to seek medical evaluation to rule out other causes.

Which Doctor Should I See for Frozen Shoulder?

Orthopedic surgeons, rheumatologists, and physiatrists (physical medicine and rehabilitation specialists) usually treat frozen shoulder. Consulting your primary care physician is also a good first step for assessment and referral.

Can Massage Help Treat Frozen Shoulder?

Massage therapy can provide temporary relief by relaxing muscles and reducing tension. However, it is important to consult a healthcare professional before starting any massage treatment to ensure it is safe and appropriate. In some cases, specific physical therapy exercises may be more effective in improving shoulder range of motion and function.

What is the Root Cause of Frozen Shoulder?

Frozen shoulder occurs when the connective tissue around the shoulder joint becomes thickened and tight, reducing mobility and causing pain. The exact cause is not always clear, but it is often linked to:

• Shoulder injuries

• Surgery

• Certain medical conditions such as diabetes or thyroid disorders

How to Recover Quickly from Frozen Shoulder

To speed up recovery:

• Follow a consistent treatment plan that includes physical therapy and stretching exercises.

• Perform the exercises recommended by your doctor regularly to improve shoulder mobility.

• Stay active and manage any underlying conditions, such as diabetes, to support faster recovery.

Is It Safe to Massage a Frozen Shoulder?

Gentle massage can help relieve muscle tension and improve blood circulation.
However:

• Avoid aggressive or painful massage.

• Consult your doctor before any massage session to ensure safety.

What Happens if Frozen Shoulder is Left Untreated?

Leaving frozen shoulder untreated may lead to:

• Long-term stiffness

• Persistent pain

• Difficulty using the shoulder in daily activities

Treatment helps speed up recovery, reduce pain, and improve comfort, even though the shoulder may improve gradually over time.

How Long Does Frozen Shoulder Last?

Full recovery may take up to 3 years, though most people notice gradual improvement within 1 to 2 years.
The main cause is inflammation of the shoulder capsule, which thickens and tightens, limiting joint movement.

Who is Most at Risk of Frozen Shoulder?

• People over 40 years old, with women being more prone than men

• People with diabetes

• Individuals with thyroid problems

• Patients with Parkinson’s disease

• People with heart disease

• Stroke survivors

• Those with rotator cuff injuries or previous shoulder surgery

• People who must keep their shoulders immobile for extended periods

Note: Frozen shoulder can sometimes occur without any clear risk factors.

Root Cause Recap

Frozen shoulder or adhesive capsulitis occurs when the connective tissue around the shoulder joint thickens and tightens, reducing movement and causing pain. It is often associated with:

• Previous shoulder injuries

• Shoulder or chest surgery

• Certain medical conditions like diabetes or thyroid disorders

How to Recover Quickly from Frozen Shoulder

• Stick to a consistent treatment plan including physical therapy and stretching exercises.

• Perform exercises prescribed by your doctor regularly to improve shoulder mobility.

• Stay generally active and manage any underlying health conditions, such as diabetes, to support faster recovery.

Is It Safe to Massage a Frozen Shoulder?

Gentle massage can help relieve muscle tension and improve blood circulation.

Guidelines:

• Avoid aggressive or painful massage.

• Consult your doctor before starting any massage sessions.

What Happens if Frozen Shoulder is Left Untreated?

Leaving a frozen shoulder untreated may lead to:

• Persistent pain and long-term stiffness.

• Difficulty using the shoulder in daily activities.

Although the condition may improve gradually over time, treatment speeds up recovery and reduces pain and discomfort.

How Long Does Frozen Shoulder Last?

• Full recovery may take up to 3 years.

• Most people notice gradual improvement within 1 to 2 years.

• The main cause is inflammation of the shoulder capsule, which thickens and narrows, limiting joint movement.

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Types of Frozen Shoulder (Adhesive Capsulitis)

1. Primary Frozen Shoulder

• Cause: Unknown, occurs without prior injury.

• Most affected group: Usually between 40–60 years old.

• Associated factors: Sometimes diabetes or thyroid disorders.

2. Secondary Frozen Shoulder

• Cause: Resulting from an injury or another medical condition.

• Common causes:

  • Direct shoulder injury (fracture or tendon tear)

  • Shoulder or arm surgery (e.g., fracture fixation)

  • Chronic medical conditions like diabetes, thyroid, heart, or lung disease

  • Reduced shoulder movement after prolonged immobilization or casting

3. Post-Surgical Frozen Shoulder

• Occurs after shoulder, arm, or chest surgeries.

• Usually due to limited movement or inflammation after the operation.

• Requires physical therapy and careful follow-up to prevent permanent stiffness.

4. Diabetic Frozen Shoulder

• More common in people with diabetes.

• Often more severe and takes longer to recover compared to other types.

• Requires careful monitoring and blood sugar control during physical therapy.

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Symptoms of Frozen Shoulder

• Persistent pain: Starts mild to moderate, worsens with movement, often worse at night.

• Stiffness and limited motion: Difficulty moving the arm forward, sideways, or behind the back; may not be able to lift the arm above shoulder level.

• Loss of active and passive range of motion:

  • Active: Patient cannot lift the arm independently.

  • Passive: Even when the doctor moves the arm, stiffness is noticeable.

• Stages of progression:

  1. Painful Stage: 6–9 weeks, pain dominates.

  2. Frozen Stage: 4–6 months, severe stiffness, less pain.

  3. Thawing Stage: 6 months–2 years, gradual return of movement.

• Secondary symptoms:

  • Altered shoulder posture due to pain and stiffness

  • Muscle weakness from inactivity

  • Difficulty performing daily activities

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Stages of Frozen Shoulder

Freezing Stage

• Duration: 6–9 weeks, can extend to 3 months

• Symptoms: Gradual pain, progressive stiffness

• Physiological changes: Inflammation and gradual fibrosis of the capsule

Frozen Stage

• Duration: 4–6 months

• Symptoms: Less pain than first stage, severe stiffness

• Physiological changes: Capsule very tight, limiting movement significantly

Thawing Stage

• Duration: 6 months–1 year or more

• Symptoms: Gradual decrease in stiffness, movement gradually returns

• Physiological changes: Tissue relaxes, joint function nearly restored

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Complications of Frozen Shoulder

• Loss of normal range of motion

• Muscle weakness due to inactivity

• Persistent pain, especially in early stages

• Difficulty performing daily activities

• Psychological and social impact: anxiety, depression, decreased quality of life

• Potential for other joint problems: permanent stiffness or chronic inflammation if untreated

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Medications for Frozen Shoulder

Pain Relievers

• Paracetamol: For mild to moderate pain

• NSAIDs (Non-Steroidal Anti-Inflammatory Drugs): Reduce pain and inflammation

Stronger Anti-Inflammatories

• Oral corticosteroids for severe cases under medical supervision

• Local corticosteroid injections to quickly relieve inflammation and improve range of motion (limited number based on response)

Muscle Relaxants

• Help reduce shoulder muscle spasms

• Short-term use under medical supervision

Important Notes:

• Avoid long-term use of painkillers without doctor supervision

• Monitor for side effects like stomach pain or increased blood pressure

• Medications complement physical therapy but are usually not enough alone to restore shoulder movement

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Exercises for Frozen Shoulder

Early Stage – Pain Relief

Goal: Maintain gentle shoulder movement without strain

1. Pendulum Exercise:

   • Lean on a table or chair

   • Let the affected arm hang freely

   • Move the arm in small circles 10–20 times each direction

2. Wall Walk (light start):

   • Face a wall, place fingers on it

   • Walk fingers up the wall gradually as high as possible without severe pain

   • Repeat 5–10 times

Middle Stage – Flexibility

Goal: Gradually restore range of motion

1. Cross-Body Stretch:

   • Hold affected arm with opposite hand and gently pull across the chest

   • Hold 15–30 seconds, repeat 3–5 times

2. External Rotation with Towel:

   • Place a small towel between elbow and body

   • Rotate affected arm outward slowly

   • Repeat 10–15 times

3. Internal Rotation with Towel or Strap:

   • Hold opposite end of strap with other hand, pull affected arm inward gently

   • Repeat 10–15 times

Advanced Stage – Strengthening

Goal: Strengthen shoulder muscles to stabilize joint and prevent recurrence

1. Resistance Band Exercises:

   • External rotation: Pull band outward

   • Internal rotation: Pull band inward

   • 10–15 reps per direction, 2–3 sets

2. Front and Side Arm Raises:

   • With light weight (0.5–1 kg) or none

   • Lift arm to shoulder level forward or sideways, then slowly lower

   • 10–15 reps

3. Scapular Stabilization (Ball Press):

   • Place a small ball on the wall, press with shoulder then relax

   • Strengthens shoulder and upper back muscles

Exercise Tips:

• Move slowly and avoid sharp pain

• Practice 2–3 times daily depending on tolerance

• Consult a doctor or physiotherapist before starting new exercises

• Use warm compresses before exercise and cold compresses afterward to reduce inflammation

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Prevention of Frozen Shoulder

1. Maintain Shoulder Mobility:

   • Perform light daily shoulder exercises, especially after injury or surgery

   • Avoid keeping the shoulder in one position for long periods

2. Early Treatment of Shoulder Injuries:

   • Seek medical attention for any shoulder pain or injury

   • Appropriate treatments like painkillers or physical therapy reduce stiffness risk

3. Post-Surgical Prevention:

   • Follow prescribed physical therapy programs after surgery

   • Gradual shoulder movement under supervision prevents joint stiffness

4. Manage Chronic Diseases:

   • Control diabetes, thyroid disorders, and other conditions to reduce risk

   • Adhere to medications and monitor sugar or hormone levels regularly

5. Prevent Infections:

   • Avoid infections in the shoulder or body, as they can worsen stiffness

6. Regular Exercise:

   • Moderate activities like swimming or gentle shoulder exercises enhance joint flexibility and strengthen surrounding muscles

   • Avoid aggressive or sudden movements that may cause injury