Frozen shoulder (capsulitis): why it hurts so much and how it's treated without surgery

Frozen shoulder (its medical name is adhesive capsulitis) is one of the most distressing problems I see in clinic: it hurts a lot, wakes you at night and, little by little, the shoulder stops moving. The good news is that, treated properly, it almost always resolves without surgery. Let me explain why it happens and what we can do.

Why does it hurt so much?

The capsule that wraps the shoulder joint becomes inflamed and gradually retracts, as if it were shrinking. This causes intense pain first and, later, a stiffness that limits everyday movements such as combing your hair, dressing or fastening a bra. It is one of the causes of shoulder pain I treat often.

Its three phases

• Painful phase: the shoulder hurts more and more, especially at night.
• Stiff («freezing») phase: it hurts a little less, but the shoulder barely moves.
• Thawing phase: mobility gradually returns.

Knowing which phase you're in is key, because the treatment changes. That's why I assess your shoulder with ultrasound in the consultation itself.

How it's treated without surgery

The aim is twofold: calm the pain and recover movement. Depending on the phase, we can combine ultrasound-guided injections to reduce inflammation, hydrodilatation (which «unsticks» the capsule with pressurised fluid) and, very importantly, a rehabilitation programme coordinated with your physiotherapist. With this approach, most people improve much sooner than by leaving it to its natural course.