Frozen Shoulder – Causes, Symptoms and Treatment Options

By Dr. Amod Manocha in Pain Management

Feb 16 , 2021 | 3 min read

What is Frozen Shoulder?

Frozen shoulder is a painful condition in which the shoulder becomes stiff with loss of shoulder movements. Over a period of time, it may affect all movements of shoulder, impairing the quality of life as everyday tasks such as dressing and bathing become a challenge. Pain in frozen shoulder is poorly localized and felt deep inside the joint. It is constantly present although in initial stages it may only manifest at night when lying on the affected side.

The shoulder joint is formed by three bones – the arm bone or the humerus, shoulder blade or scapula, and the collar bone or clavicle. The large rounded head of the arm bone fits into the shoulder blade socket and this size discrepancy works to our advantage allowing for a large range of shoulder movement. The shoulder joint is surrounded by the strong capsule and this capsule is the source of trouble in frozen shoulder as it becomes thickened, tight and thereby limiting the joint movements. As the condition progresses, scarring or adhesions develop between the capsule and the head of arm bone further limiting the arm movements.

Who is at risk for getting Frozen Shoulder?

The cause behind the condition is not well understood, although this condition is seen more commonly in

  • Women 
  • Individuals between 40-60 years of age
  • Diabetes (five times increased risk compared to non-diabetics ) 
  • Patients with overactive or underactive thyroid
  • After periods of shoulder immobilization  such as after a fracture or stroke
  • Parkinson’s disease

What is the treatment for frozen shoulder?

The treatment for a frozen shoulder is aimed at relieving pain and restoring shoulder’s movements. Some patients with frozen shoulder can improve with simple exercises and pain control; however, it can take as long as 3 years. Limitation of daily activities for this long can have a debilitating effect on quality of life and besides some patients may not regain full function of their shoulder.


Pain clinic is a good place to treat this condition as an experienced pain specialist can help in diagnosing the condition and provide timely interventions such as pain reliving medications, injections and supervised physiotherapy. This multidisciplinary approach has the best chances of improving outcomes and reducing disability.

Treatment options for frozen shoulder are explained below.

  • Medications– a combination of different painkillers is used depending on the severity of pain. Anti-inflammatory drugs can help to reduce the pain and inflammation. These should be used only as advised by your doctor.
  • Interventions– These can play an important role in improving outcomes.  Two key interventions include shoulder joint steroid injection and hydrodistension of the joint capsule. These injections can help reduce pain and improve range of movement.
  • SHOULDER JOINT STEROID INJECTION - This is best performed under ultrasound guidance. Using ultrasound ensures accurate delivery of medications at the intended site and potentially reduces complications. This injection takes little time and can be easily performed as an OPD procedure under local anesthesia. A joint injection is preferred over taking steroid tablets as there are fewer side effects with injections. Also, the lack of long-term benefits makes steroid tablets makes it a less attractive option for this condition.
  • Hydrodistension of the joint- This procedure is best performed under ultrasound guidance. It involves injecting sterile water or local anaesthetic below the joint capsule with the intention of stretching and loosening the capsule to improve the range of shoulder movements. One can consider this as a non-surgical alternative for stretching the capsule and thereby improving the range of motion and reducing pain. Like the steroid injection, this procedure can be performed in the OPD setting under local anaesthesia. There is research evidence supporting the use of a combination of hydrodistention and steroid injection in frozen shoulder, as it can expedite recovery of range of motion.
  • Physical therapy. This is an essential component of treatment. The aim of physical therapy is to maintain, improve range of motion and help in joint strengthening. Combining this with injections has the potential to provide more significant improvement than physiotherapy alone.
  • Surgery. This option is considered if other options fail to produce an improvement. The surgical options include manipulation of the shoulder joint under anaesthesia which involves forcefully moving the shoulder to disrupt the adhesions and loosen up the shoulder tissue. Another option is the arthroscopic release of the shoulder joint