Recurrence in the same shoulder is uncommon, though some patients may later develop frozen shoulder in the opposite shoulder.

Frozen Shoulder (Adhesive Capsulitis)

Q: How long does frozen shoulder last?

Most cases improve over 12–24 months. Pain typically settles first; stiffness recovers more gradually with guided rehabilitation.

Q: Is physiotherapy safe when it’s very painful?

Yes. Gentle, stage-appropriate therapy focused on comfort, scapular control and short, frequent stretches is helpful. Avoid forceful stretching during the painful freezing phase.

Q: Hydrodilatation vs steroid injection—what’s the difference?

Steroid injection mainly reduces inflammation and pain. Hydrodilatation also stretches the tight capsule under imaging guidance and can accelerate early improvements in pain and range.

About Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis, is a condition where the lining of the shoulder joint (the capsule) becomes inflamed, tight and thickened. This causes pain and a global loss of movement (stiffness) in all directions.

The condition typically progresses through three stages over 12–24 months (ranges vary):

Freezing stage (2–9 months): increasing pain (often severe, worse at night) and progressive stiffness.
Frozen stage (4–12 months): pain gradually eases; shoulder remains very stiff.
Thawing stage (6–12+ months): gradual return of movement and function; pain is minimal.

Most patients recover function over time; early pain control and guided rehabilitation can improve comfort and speed of recovery.

Physiotherapy for Shoulder

Shoulder Arthroscopy

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Diagram of shoulder bones (clavicle, acromion, scapula, humeral head) used to explain frozen shoulder — Frozen shoulder affects the **joint capsule** surrounding the ball-and-socket joint.

Symptoms & Functional Limits

Deep shoulder ache, often radiating to the upper arm; night pain common
Global stiffness: difficulty dressing, reaching the back pocket, fastening bra/seatbelt
Reduced active and passive range in all directions (flexion, abduction, external rotation)

Causes

Frozen shoulder can develop idiopathically (without a clear trigger), but may follow a minor injury or period of immobilisation (e.g. sling use). It can also develop after surgery.

Risk factors include diabetes, thyroid disorders, age 40–65, and sometimes after other shoulder conditions (e.g. rotator cuff problems, impingement/bursitis). Both shoulders can be affected sequentially in a minority of patients.

Investigations

Clinical diagnosis is primary (history + examination with global loss of passive range).
X-ray to exclude arthritis or calcific tendinopathy.
Ultrasound/MRI if symptoms are atypical or to assess coexisting pathology (e.g. rotator cuff).

Treatment of Frozen Shoulder

Most cases improve without surgery. The aim is pain control and a graded program to restore range and function.

Non-operative care

Analgesia/anti-inflammatories: short-term, as advised by your GP.
Physiotherapy: stage-appropriate stretching, scapular control, gentle capsular mobilisation; avoid aggressive forcing during the painful freezing stage.
Image-guided intra-articular corticosteroid injection: useful for night pain and to enable exercise.
Hydrodilatation: a radiology procedure where sterile fluid and steroid are injected into the joint under pressure to stretch the tight capsule; can accelerate pain relief and early range.

Procedural options (selected cases)

Manipulation under anaesthesia (MUA): controlled stretching of the capsule while asleep.
Arthroscopic capsular release: key-hole surgery to carefully release the tightened capsule; often combined with gentle MUA.

Rehabilitation timeline (typical)

Weeks 0–6: pain control, sleep strategies, gentle daily stretches within pain limits, postural/scapular work.
Weeks 6–12: progress range (especially external rotation and elevation), begin light strengthening.
3–6 months: restore near-full range and functional strength; gradual return to sport/heavier tasks.

If pain and stiffness persist beyond 6 months despite high-quality non-operative care, shoulder arthroscopy with capsular release can be an effective option.

Frozen Shoulder FAQs

Frequently Asked Questions

How long does frozen shoulder last?

Most cases improve over 12–24 months. Pain usually settles first; stiffness resolves more gradually.

Will it come back?

Recurrence in the same shoulder is uncommon. A smaller proportion may develop it in the opposite shoulder at a later time.

Is physiotherapy safe when it’s very painful?

Yes—gentle, stage-appropriate therapy focused on comfort, scapular control and short, frequent stretches helps. Avoid forceful stretching during the painful freezing phase.

Hydrodilatation vs steroid injection—what’s the difference?

Steroid injection mainly reduces inflammation and pain. Hydrodilatation also stretches the capsule with sterile fluid under imaging guidance; many patients experience faster early improvements.