Adhesive Capsulitis (Frozen Shoulder): Symptoms and Treatment in the UK

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 surrounding the shoulder joint (the capsule) becomes thickened, inflamed, and tight. This reduces the space available for the humerus (upper arm bone) to move comfortably, leading to a significant restriction in range of motion.

According to NHS data, frozen shoulder most commonly affects people between the ages of 40 and 60 and is more prevalent in women than men. It is also more common in individuals living with certain underlying health conditions, such as diabetes or thyroid disorders. While the exact cause is sometimes unknown, it often follows a period of immobility, such as recovery from surgery or a stroke.

Clinical guidance in the UK typically identifies three distinct phases of adhesive capsulitis, each with unique symptoms:

1. The 'Freezing' Stage

This initial phase is usually the most painful. You may notice a dull ache that worsens at night or when lying on the affected side. Gradually, the shoulder begins to lose its range of motion, making everyday tasks like reaching for a seatbelt or brushing your hair difficult. This stage can last anywhere from six weeks to nine months.

2. The 'Frozen' Stage

During this middle phase, the intense pain may actually start to subside. However, the stiffness becomes more pronounced. The joint becomes so restricted that it may feel completely 'locked'. Muscles around the shoulder may begin to waste slightly (atrophy) due to lack of use. This stage typically lasts 4 to 12 months.

3. The 'Thawing' Stage

In the final phase, the range of motion begins to improve. The stiffness slowly dissipates, and the shoulder returns to its normal or near-normal function. This recovery process is slow and can take between six months and two years.

Management of frozen shoulder in the UK follows NICE (National Institute for Health and Care Excellence) evidence-based pathways. The primary goal is pain management and the maintenance of joint function.

• Pain Relief: Over-the-counter medications such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are often the first line of defence.
• Physiotherapy: A structured exercise programme is vital. A physiotherapist can guide you through gentle stretching exercises designed to prevent further loss of mobility.
• Corticosteroid Injections: For those in the painful 'freezing' stage, a GP may offer a steroid injection into the joint to reduce inflammation and provide temporary relief.
• Hydrodilatation: A more specialised procedure where sterile saline and steroids are injected to stretch the capsule from the inside.

If you are experiencing persistent shoulder pain that is interfering with your sleep or daily activities, consulting a GP is an essential first step. An online doctor can provide a convenient initial assessment via video consultation to discuss your symptoms and medical history.

During a consultation with OnlineDoctor24, our GPs can help by:

• Evaluating your symptoms against clinical criteria for adhesive capsulitis.
• Providing advice on the appropriate use of analgesics (painkillers).
• Issuing a private sick note if your shoulder mobility prevents you from performing your job safely.
• Discussing whether you require a physical examination or a referral to a local NHS musculoskeletal (MSK) clinic or a private specialist.
• Reviewing your current health to ensure conditions like diabetes are well-managed, as this can impact recovery speed.

While professional medical advice is crucial, there are several steps you can take at home to manage the discomfort. Applying a heat pack to the shoulder for 15 minutes before performing gentle stretches can help loosen the tissue. Conversely, an ice pack may be more effective after exercise if the joint feels inflamed.

It is important not to completely stop using your arm. While you should avoid heavy lifting or sudden 'jerking' movements, keeping the joint gently mobile is key to preventing the capsule from tightening further. Modifying your sleeping position—perhaps using a pillow to support the affected arm—can also improve sleep quality during the more painful phases.