Frozen shoulder (adhesive capsulitis) is one of the most frustrating conditions in orthopaedics — for patients because it lasts so long, and for doctors because nothing makes it disappear overnight. But it follows a predictable path, and each stage has a right response.

What is actually happening

The capsule — the sleeve of tissue around the shoulder joint — becomes inflamed and then thickens and tightens, like a shirt shrunk in the wash. The result is pain first, then stiffness that stops you reaching behind your back or overhead. It is more common between 40 and 60, in people with diabetes or thyroid problems, and after a period of not using the arm — a fracture, a surgery, even a bad bout of tendon pain.

Stage one: freezing (roughly 2–9 months)

Pain dominates, often worst at night, and movement starts to shrink. This is the stage where injections help most — a steroid injection into the joint can take the edge off the pain enough to sleep and to do gentle exercises. Forcing the shoulder through pain now does not speed things up; it usually makes the night pain worse.

Stage two: frozen (roughly 4–12 months)

The pain settles but the stiffness peaks. This is the stage for steady, daily stretching within a tolerable range — pendulum swings, wall walks, using a stick to assist the arm up. Physiotherapy earns its keep here. Progress is slow and measured in centimetres of reach per month, which is exactly why patients give up; do not.

Stage three: thawing (roughly 6–24 months)

Movement returns, often faster than it left. Most people regain a functional range; a small proportion keep some permanent tightness that rarely limits daily life.

When more than exercises is needed

  • Injections in the painful stage, to make exercises possible.
  • Hydrodilatation (stretching the capsule with fluid under imaging) in some cases.
  • Arthroscopic capsular release — keyhole surgery to cut the tight capsule — for the minority whose stiffness is severe and not improving after many months of proper treatment, or whose work demands it.

What to check before accepting the diagnosis

Frozen shoulder is a diagnosis made on examination, and it is over-used. A rotator cuff tear, shoulder arthritis and a locked dislocation can all masquerade as it, and an X-ray is needed to rule out arthritis. If your "frozen shoulder" was diagnosed without an examination or an X-ray, it is worth a second look.

You cannot hurry a frozen shoulder. You can make sure it is really one, keep it moving, and keep sleeping.