Adhesive Capsulitis (Frozen Shoulder): Symptoms, Causes, and Recovery

Adhesive capsulitis, commonly known as frozen shoulder, is a condition characterised by stiffness and pain in the shoulder joint. It occurs when the flexible tissue that surrounds the shoulder joint—known as the capsule—becomes thickened, inflamed, and tight. This reduces the space available for the humerus (upper arm bone) to move, making everyday tasks like reaching for a seatbelt or washing your hair difficult.

In the UK, frozen shoulder most commonly affects people between the ages of 40 and 60 and is more prevalent in women than men. Unlike a simple sprain, frozen shoulder develops gradually and follows a predictable pattern of progression that can last for several years.

Frozen shoulder typically evolves through three distinct clinical phases. Understanding which stage you are in can help manage expectations regarding recovery time.

• Stage 1: The 'Freezing' Phase – This stage lasts between 2 and 9 months. The primary symptom is a slow onset of pain. As the pain worsens, the shoulder loses its range of movement. Pain is often worse at night, particularly when lying on the affected side.
• Stage 2: The 'Frozen' Phase – Lasting 4 to 12 months, the pain may actually begin to subside during this period. However, the stiffness remains or worsens. The shoulder becomes very restricted, and 'end-range' movements are often impossible.
• Stage 3: The 'Thawing' Phase – This final stage can last from 6 months to 2 years. During this time, the shoulder's range of motion begins to improve, and the joint gradually returns to normal or near-normal function.

The exact cause of adhesive capsulitis is not always clear, but several factors increase the likelihood of developing the condition. It is often categorised as either primary (idiopathic, where no cause is found) or secondary (linked to an underlying event or condition).

Diabetes: People with diabetes are significantly more likely to develop frozen shoulder, and symptoms may be more severe or affect both shoulders.

Immobilisation: Recovering from a stroke, a broken arm, or surgery (such as a mastectomy) can lead to the capsule tightening if the shoulder is not moved regularly.

Other Health Conditions: Research suggests links to thyroid problems, heart disease, and Parkinson's disease. However, for many UK patients, the condition appears spontaneously without an obvious trigger.

The goal of treatment is to manage pain and maintain as much mobility as possible while the condition runs its course. According to NICE guidelines, management usually involves a combination of the following:

Pain Relief: Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help reduce inflammation and manage discomfort. For more severe pain, a GP may prescribe stronger analgesics.

Physiotherapy: A physiotherapist can provide specific stretching exercises tailored to your current stage. During the 'frozen' stage, aggressive stretching should be avoided as it can increase inflammation; gentle, controlled movements are preferred.

Corticosteroid Injections: If pain is making it impossible to sleep or perform daily tasks, a steroid injection into the joint can provide significant short-term relief, especially during the early 'freezing' phase.

Hydrodilatation: This procedure involves injecting a mixture of sterile saline and steroids into the joint to stretch the capsule and improve mobility.

If you are experiencing persistent shoulder pain that is interfering with your sleep or daily activities, you should consult a healthcare professional. An online GP can help differentiate between frozen shoulder and other conditions like rotator cuff tears or osteoarthritis.

During a consultation, the GP will discuss your medical history and may ask you to perform specific movements on camera to assess your range of motion. Early diagnosis is beneficial for accessing pain management strategies and ensuring you are performing the correct types of exercises for your stage of the condition. If further investigation like an X-ray or MRI is needed to rule out other issues, the GP can advise on the next steps and provide necessary documentation like sick notes if your mobility issues affect your ability to work.