Frozen shoulder

What it is

Adhesive capsulitis is fibrosis and contracture of the shoulder joint capsule. The capsule thickens and shrinks, so the joint physically cannot move through its range - the limitation is structural rather than muscular, and it applies to passive movement as much as active.

It runs in three phases: freezing, with increasing pain and gradually reducing range; frozen, where the pain settles but the stiffness is at its worst; and thawing, where range slowly returns. The whole course typically runs twelve to thirty months. Aggressive stretching during the painful freezing phase prolongs it - which is exactly the instinct most people and many programmes follow.

What it feels like

• Increasing shoulder pain over weeks, often severe and disturbing sleep
• Loss of range in every direction, particularly turning the arm outward
• Unable to reach behind the back, overhead, or across the body
• The arm feels blocked rather than weak - someone else moving it for you does not help
• Pain settling after months while the stiffness remains

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

Capsular fibrosis and contracture

The joint capsule thickens, inflames and then contracts. Because the restriction is in the capsule itself, the range is lost for passive movement too - which is the feature that distinguishes it from every other stiff shoulder.

Diabetes

The strongest single association. Frozen shoulder is several times more common in people with diabetes, tends to be more severe, lasts longer and is more often bilateral. Glycation of collagen is the likely mechanism.

Thyroid disease

Both overactive and underactive thyroid are associated with an increased incidence, and thyroid function is worth checking in an unexplained case.

A period of immobilisation

After a fracture, surgery or any injury that kept the arm still, a secondary frozen shoulder can develop. This form is more predictable and often responds better.

Rotator cuff problems preceding it

Pain from a cuff problem leads to reduced movement, which in susceptible people is enough to start the capsular process. This is why a shoulder problem that is losing range in every direction needs a different response.

Age and sex

Most common between forty and sixty, and more common in women. It rarely occurs outside that age band, which is a useful part of the picture.

Dupuytren's disease and other fibrotic conditions

There is a recognised association with other fibrotic conditions, pointing at an underlying tendency to abnormal collagen deposition in some people.

Cardiac and stroke history

An increased incidence follows cardiac surgery and stroke, partly through immobilisation and partly for reasons not well understood.

Having had it on the other side

Around one in five people develop it in the other shoulder within a few years, though rarely in the same shoulder twice.

Who tends to get it

• People with diabetes, in whom risk is several times higher
• Adults between forty and sixty, particularly women
• Anyone whose arm has been immobilised after injury or surgery
• People with thyroid disease
• Anyone who has had a frozen shoulder on the other side

What makes it worse, and what settles it

The qFIT routine for this

Ready-made routineShoulder Relief & Overhead Range

qFIT already has this one built. It runs massage first, then stretching, then strength — the order that works on a body that is already sore — and every activity in it carries the reason it is there.

The button below opens your Checklist with this routine already selected, so instead of your whole list you land on just its Categories, Targets and Exercises, each with its checkbox, ready to tick as you work through them.

Have more than one problem? Tick yours under My Problems on My Profile and your Checklist's Routine list gains Recommended for my problems — every routine for the problems you picked, merged into one. Your picks stay private; that filter is the only thing they feed.

Get it checked if…

Sudden loss of all movement after trauma; ask about diabetes and thyroid - both are strongly associated

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

The honest answer is one to three years, and that is worth knowing at the start rather than discovering month by month. Most people recover a functional range though a small residual restriction is common. Early corticosteroid injection shortens the painful phase; physiotherapy matched to the phase improves range. The single most useful thing is to have it identified as frozen shoulder rather than treated as a generic stiff painful shoulder, because the wrong treatment at the wrong phase makes it worse.

Prevalence basis: Shoulder epidemiology; strong diabetes association

Others the same routine covers

These share the Shoulder Relief & Overhead Range routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.