Dr Alan Cheung
Senior Consultant Orthopaedic Surgeon in Singapore
MBBS (London), MRCS (England), FRCS (Trauma and Orthopaedics, England), Diploma in Sport and Exercise Medicine (UK), Fellow of the European Board of Orthopaedics and Traumatology, American Academy of Orthopaedic Surgeons (AAOS)
Frozen shoulder, also known as adhesive capsulitis, is characterised by pain and progressive restriction of shoulder movement associated with changes in the joint capsule. Both active movement, when you move the arm yourself, and passive movement, when someone else moves it for you, can become restricted.
Frozen shoulders often change over time, with pain and stiffness varying across different stages of the condition. Many patients gradually regain movement, although recovery can be prolonged and some may continue to have residual symptoms. When substantial stiffness persists despite appropriate non-surgical treatment, further intervention may be considered.
Can Frozen Shoulder Improve Without Treatment?
Frozen shoulder can improve over time without treatment, although the course and degree of recovery vary between patients. The condition has traditionally been described in “freezing”, “frozen” and “thawing” phases, but individual symptoms do not always follow these stages neatly.
Some patients gradually experience less pain and improved movement, while others have persistent stiffness that continues to affect daily activities. Non-surgical treatments such as pain relief, physiotherapy or corticosteroid injections may be used to manage symptoms and support recovery, depending on the stage and severity of the condition.
What Factors May Affect Frozen Shoulder Recovery?
Although many frozen shoulders gradually improve, recovery is not always complete or predictable. Certain factors are associated with a more prolonged course or greater restriction of shoulder movement. These factors do not automatically mean that surgery will be required, but they may indicate a need for closer monitoring or more active treatment.
Greater Loss of Shoulder Movement
Patients with marked restriction in several directions may experience a more prolonged recovery. The degree of stiffness is therefore considered alongside pain and functional limitations when monitoring progress and planning treatment.
Diabetes and Other Health Conditions
Frozen shoulder is more common in people with diabetes and may follow a more prolonged or severe course. Patients with diabetes may therefore experience a slower recovery or retain greater movement restriction.
Thyroid disorders and certain other medical conditions are also associated with frozen shoulders. However, their precise effect on recovery varies and should be considered alongside the patient’s overall health.
Frozen Shoulder After Injury or Surgery
Secondary frozen shoulder develops following another event, such as a fracture, tendon injury or shoulder operation. Recovery may be delayed because the original condition continues to cause pain or because movement must initially be restricted to protect healing tissues. Rehabilitation may need to account for both the shoulder stiffness and the original injury or procedure.
Prolonged Shoulder Immobility
Shoulder movement may be reduced because of pain or deliberately restricted after an injury or operation. The appropriate balance between protecting the shoulder and maintaining movement depends on the underlying condition and stage of recovery.
Exercise should be appropriate for the stage and severity of symptoms, as overly aggressive stretching may aggravate pain in some patients.
When Might Surgery Be Considered for Frozen Shoulder?
Surgery is not usually the first treatment for a frozen shoulder. It may be considered when substantial pain or stiffness persists despite appropriate non-surgical treatment and continues to restrict everyday function.
Persistent Symptoms Despite Non-Surgical Treatment
Before considering surgery, non-surgical options may include medication, physiotherapy, corticosteroid injections or hydrodilatation. Surgery may become an option when symptoms continue despite an appropriate course of non-surgical treatment and there is little evidence that shoulder movement is improving.
Significant Loss of Everyday Function
The degree of restriction is considered alongside the duration of symptoms. Surgery may be discussed when stiffness substantially interferes with everyday activities, work or sleep. The threshold may differ according to the patient’s occupation, responsibilities and required level of shoulder movement.
Persistent Restriction of Movement
The degree of stiffness and its effect on function are important when considering surgery. A specialist will assess the pattern of movement restriction, how symptoms have changed over time and the response to previous treatment before deciding whether a surgical procedure is appropriate.
Confirmation of the Diagnosis
Persistent symptoms may not be caused solely by frozen shoulder. Before recommending surgery, imaging may be used when necessary to investigate other conditions that could contribute to pain or restricted movement. Identifying these problems is important because they may change the treatment approach.
Find the Right Treatment for Frozen Shoulder
Frozen shoulder does not follow the same course in every patient. When pain or stiffness remains significantly limiting, an assessment can help determine whether further non-surgical treatment or a procedure may be appropriate.
At the International Orthopaedic Clinic, we provide comprehensive assessment and treatment for frozen shoulder based on each patient’s symptoms, condition stage and recovery needs. Dr Alan Cheung guides patients through suitable options, from medication and rehabilitation to surgery where appropriate. Schedule an appointment with us to have your shoulder assessed and discuss an appropriate treatment plan.
