Frozen Shoulder (Adhesive Capsulitis)

Frozen shoulder, or adhesive capsulitis, is a condition in which the capsule surrounding the shoulder joint becomes inflamed, thickens and tightens. The shoulder turns painful and then progressively stiff in every direction, even when another person tries to move it.

It gets better in most people without surgery, but slowly, typically over 1 to 3 years, and some are left with a mild permanent restriction. Treatment aims to control pain and shorten the course. It mainly affects people between 40 and 60.

Symptoms

• A deep ache in the shoulder and upper arm
• Pain at night, particularly when lying on that side
• Increasing difficulty reaching overhead, behind the back or into a back pocket
• Loss of outward rotation, such as trouble reaching for a seat belt
• Sharp pain with sudden movements
• Stiffness that remains after the pain has eased

Causes and risk factors

Primary frozen shoulder begins without an obvious reason. It is strongly associated with diabetes, in which up to 1 in 5 people are affected and the course is often longer, with thyroid disease, Dupuytren's contracture, and periods of keeping the arm still. Secondary frozen shoulder follows an injury, a fracture, shoulder or breast surgery, or a stroke. It passes through three phases: a painful freezing phase of 2 to 9 months, a stiff frozen phase of 4 to 12 months and a thawing phase of 6 months to 2 years.

How it is diagnosed

• Clinical examination: Equal loss of active and passive movement, especially outward rotation, with a normal X-ray is the typical finding.
• X-ray: Excludes arthritis, calcium deposits and an unrecognised dislocation, all of which can also stiffen the shoulder.
• Ultrasound or MRI: Not needed for the diagnosis. Used when a rotator cuff tear is suspected.
• Blood sugar and thyroid tests: Worth checking, because frozen shoulder can be the first sign of diabetes.

Treatment options

• Pain relief and gentle movement: Painkillers, heat and movement within comfort during the painful phase. Forceful stretching at this stage makes it worse.
• Steroid injection into the joint: Gives good pain relief and improves movement in the early phase. Best done under ultrasound guidance.
• Hydrodilatation: Saline, local anaesthetic and steroid are injected under pressure to stretch the capsule, followed immediately by physiotherapy.
• Physiotherapy: A programme of stretching and home exercises once the pain allows. It is the main treatment in the stiff phase.
• Manipulation under anaesthesia: The surgeon frees the shoulder by moving it while you are asleep. There is a small risk of fracture or tendon injury.
• Arthroscopic capsular release: Keyhole division of the tight capsule for stiffness that persists after 6 to 12 months of treatment. Intensive physiotherapy must start the next day.

When it is urgent

A frozen shoulder is not an emergency. Seek urgent care for shoulder pain with fever and a hot swollen joint, after a fall with sudden loss of movement, or for left shoulder or arm pain with chest tightness, sweating or breathlessness, which may be the heart.

Travelling to Türkiye for treatment

Most treatment consists of injections and months of exercises, which are better done near home. A visit can be reasonable for diagnosis with an ultrasound-guided injection or hydrodilatation, or for arthroscopic release in long-standing cases. Understand that the result of surgery depends on daily physiotherapy for 6 to 12 weeks afterwards. Arrange that at home before booking, and allow 7 to 10 days on site.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

Frequently Asked Questions