Core Physiotherapy Services: Frozen Shoulder

Frozen Shoulder 101: Causes & Reliable Treatments

What is a Frozen Shoulder?

Frozen Shoulder, also known as adhesive capsulitis, is the gradual and often painful onset of diffuse shoulder pain and stiffness. The shoulder gets inceasingly difficult to move over time.

Frozen shoulder usually improves after a period of increased symptoms, but it might take up to three years to fully heal. The primary treatment for frozen shoulder is physical therapy with an emphasis on shoulder flexibility.

People between the ages of 40 and 60 are most likely to suffer from frozen shoulder, and women are more likely to suffer from it. People with diabetes are also more likely to get frozen shoulder as a result of their diabetes.


Sometimes there can appear to be a trigger for Frozen Shoulders such as an injury or inflammation, but often it is insidious (unknown). It can occur when the shoulder has been immobilised for a long time by injury, surgery, or illness.

A connective tissue capsule surrounds the bones, ligaments, and tendons that make up your shoulder joint. When the capsule thickens and tightens around the shoulder joint, it prevents it from moving freely.

There are also links to development in people with diabetes or other systemic diseases such as Tuberculosis, Parkinson’s Cardiovascular disease, or an overactive or underactive thyroid. As such, cautious management of some presentations is important.

Signs & Symptoms

Frozen shoulder typically develops slowly and with 3 phases of presentation. 

  1. Freezing Phase
    Initially, there is often an aching pain that can be sharp. From here motion starts to reduce particularly in external rotation, internal rotation, and abduction. This is a progressive process where unfortunately the shoulder becomes stiffer.
  2. Frozen Phase
    During this phase, it will remain stiff and difficult to use, but be less painful.
  3. Thawing Phase
    Gradually during the thawing phase, movement is able to be returned slowly through manual therapy and exercise.


This condition tends to get worse if not treated. Education regarding timeframes and appropriate management in each ‘phase’ of the frozen shoulder process is important – freezing, frozen, or thawing.

Treatment can include the following to maintain and improve range where possible:

  • Nonsurgical

    • Non-steroidal anti-inflammatory drugs (NSAIDs). Pain and swelling are reduced by medications such as aspirin and ibuprofen.
    • Hydrodilatation. Hydrodilatation may be recommended by your doctor if other nonsurgical procedures do not alleviate your problems. To extend and stretch the shoulder joint capsule, this treatment includes gently injecting a large volume of sterile fluid into the joint. A radiologist utilises imaging to guide the placement of fluid during hydrodilatation.
    • Physical therapy. Motion may be restored through certain workouts. These can be done at home or under the guidance of a physical therapist. Stretching and shoulder range of motion exercises are part of the treatment. Before stretching, heat may be utilised to loosen up the shoulder.
  • Surgical

    • Manipulation under anesthesia. You will be put to sleep during this treatment. The capsule and scar tissue in your shoulder will stretch or rip as a result of your doctor forcing it to move. This loosens up the muscles and opens them up to a wider range of motion.
    • Shoulder arthroscopy. Your doctor will cut through the joint capsule’s tight areas during this treatment. Using small incisions around your shoulder, pencil-sized equipment are introduced through the incisions.To get the best results, many times manipulation and arthroscopy are performed together. With these operations, the majority of patients have satisfactory results.


If a true frozen shoulder is diagnosed, it may take up to 2 years to regain full function but most resolve within 6-9 months. A large majority of people find that symptoms improve with simple exercise and pain control.

If you need help with pain or immobility to get you moving again, or need a tailored exercise program, book in for your treatment now with one of our exercise, physio, or pain specialists via 1300 012 273 or head to our website and book a session at your nearest clinic.