The lesion is the joint capsule itself. The shoulder sits inside a soft-tissue bag that inflames and lays down scar tissue from the inside, the same kind of scarring as a Dupuytren's contracture in the palm 1. That's why pulling harder doesn't unstick it. The capsule moves through three windows in order: inflammation, then mature scar, then slow remodelling. External rotation goes first, then reaching overhead, then reaching behind your back.
Rest the joint early; stretch it late. In a two-year comparison, gentle pain-respecting movement beat intensive stretching: 89% recovered near-normal function versus 64% of the group pushed past pain 2. A single cortisone shot into the joint plus physiotherapy beats physiotherapy alone for pain at six weeks 3, and pooled trials confirm the short-term edge 4. The gap closes by six months as the natural course catches up, but the shot buys back the worst months.
Surgery rarely earns its place in year one. The biggest trial, 503 patients, found capsular-release surgery no better than manipulation or physiotherapy-plus-injection at twelve months, with more complications 5.
What you do turns on the phase. In the painful early phase (roughly months 0 to 9), the goal is pain control rather than range.
The nights come back first. Within two or three weeks of a shot in the painful phase, the three-a.m. wakeups stop 3. By six weeks you can sleep on either side and carry a grocery bag. By six months, with phase-appropriate physiotherapy, you reach the top shelf again. At one year you're 80 to 90 percent back; at two years, normal. The natural course does the slow work regardless, but the worst months get compressed and you get your sleep back early 5.
The fine print — when to skip it, and what people get wrong
"It's my rotator cuff." The test is passive motion: with a cuff problem someone else can lift your arm, with a frozen shoulder nobody can, the capsule is the brake. "Work through the pain" is the most damaging advice; the early phase is inflammatory, and cranking it extends the disability 2.
Diabetes plus a cortisone shot raises blood sugar for two to five days, often by 50 to 200 mg/dL; don't skip the shot, just coordinate with whoever manages your diabetes 6. If the pain started after a fall, lift, or surgery, it may not be frozen shoulder; get it examined first.
- 1Bunker TD, Anthony PP (1995). The pathology of frozen shoulder. A Dupuytren-like disease. Journal of Bone and Joint Surgery (British). link
- 2Diercks RL, Stevens M (2004). Gentle thawing of the frozen shoulder: a prospective study of supervised neglect versus intensive physical therapy in seventy-seven patients with frozen shoulder syndrome followed up for two years. Journal of Shoulder and Elbow Surgery. link
- 3Carette S, Moffet H, Tardif J, et al. (2003). Intraarticular corticosteroids, supervised physiotherapy, or a combination of the two in the treatment of adhesive capsulitis of the shoulder: a placebo-controlled trial. Arthritis & Rheumatism. link
- 4Sun Y, Lu S, Zhang P, Wang Z, Chen J (2017). Steroid injection versus physiotherapy for patients with adhesive capsulitis of the shoulder: a PRISMA systematic review and meta-analysis of randomized controlled trials. Medicine. link
- 5Rangan A, Brealey SD, Keding A, et al. (2020). Management of adults with primary frozen shoulder in secondary care (UK FROST): a multicentre, pragmatic, three-arm, superiority randomised clinical trial. The Lancet. link
- 6Zreik NH, Malik RA, Charalambous CP (2016). Adhesive capsulitis of the shoulder and diabetes: a meta-analysis of prevalence. Muscles, Ligaments and Tendons Journal. link
დაკავშირებული სახელმძღვანელოში (3)
- — Carpal tunnel and frozen shoulder share the same risk soil - diabetes and an underactive thyroid. Having one raises the odds of the other.
- — An underactive thyroid raises your odds of a frozen shoulder; if it freezes for no clear reason, it's worth checking your TSH.
- — Diabetes sharply raises the odds of a frozen shoulder, and the course can run longer — worth knowing if sugars are high.