The exact cause of frozen shoulder remains unclear, but certain factors may contribute to its development. These include:

Injury or trauma to the shoulder: Previous shoulder injuries or surgeries can increase the risk of developing a frozen shoulder.

Prolonged immobility: Conditions that limit shoulder movement, such as recovery from a stroke or surgery, can lead to the development of adhesive capsulitis.

Systemic diseases: Certain medical conditions, such as diabetes, thyroid disorders, and heart disease, have been associated with an increased risk of developing frozen shoulder. Occasionally, it is the diagnosis of your frozen shoulder, which uncovers an underlying medical problem.

There are said to be three classic stages in the development of a frozen shoulder. These are known as the freezing, frozen and thawing phases. The shoulder typically progresses from one stage to the other although the speed at which this occurs varies and can potentially be impacted by timely treatments:

Freezing stage: During this stage, patients experience a gradual onset of shoulder pain and stiffness. Movements become increasingly restricted, making everyday activities challenging.

Frozen stage: In this stage, shoulder stiffness becomes more pronounced, limiting range of motion even further. Pain may persist, particularly at night, affecting sleep quality and overall well-being.

Thawing stage: The final stage involves a gradual improvement in shoulder mobility and a reduction in pain. However, this process can take several months to years to complete.

When evaluating a patient with suspected frozen shoulder, doctors and physiotherapists typically begin with a comprehensive physical examination. This will involve assessing the range of motion, strength, and stability of the shoulder joint. Imaging studies, such as X-rays, ultrasound or MRI, will generally be performed to rule out other potential causes of shoulder pain and stiffness and confirm the diagnosis of frozen shoulder.

Treatment for frozen shoulder aims to relieve pain and restore shoulder mobility. Depending on the severity of symptoms, treatment options may include:

Physical therapy: Gentle active stretching and strengthening exercises as well as passive mobilisation exercises may help improve shoulder flexibility and reduce stiffness. However, this is often difficult for patients due to their level of pain. Once stiffness has become established in the later stages, regaining range of movement with exercise rehabilitation and manual therapies alone can be very challenging.

Pain management: Over-the-counter pain relievers or prescription medications may be recommended to alleviate discomfort.

Corticosteroid injections: Injections of corticosteroids into the shoulder joint can help reduce inflammation and pain. There is evidence from many medical studies to that an early steroid injection into the shoulder joint, particularly when performed during the painful freezing phase, improves patient outcomes.

Injections can also be performed around nerves the transmit pain from the shoulder joint (suprascapular nerve block).

When the shoulder is very stiff, a procedure called a shoulder hydrodistension can be performed. This involves using X-ray or ultrasound to guide a needle into the joint, after which local anaesthetic, steroid and then sterile saline (typically about 40ml) is injected to stretch the joint capsule and break down the scar tissues that have formed and are limiting movement.

Surgery: Rarely in severe cases where conservative treatments fail to provide relief, surgical intervention may be considered to release tightness in the shoulder joint capsule.

Frozen shoulder is a painful and limiting condition that can significantly impact daily life. Early diagnosis and intervention are key to achieving optimal outcomes and improving quality of life for individuals affected by this condition.