Frozen Shoulder (Adhesive Capsulitis)

 

Introduction

Frozen shoulder, or adhesive capsulitis, is a condition that can have a significant impact on everyday life. It is characterised by stiffness, discomfort, and a progressive reduction in shoulder movement. The condition often develops gradually over months — and in some cases years — which is why early recognition and a targeted management plan can be important in supporting recovery.

At Alton Pain Clinic, our approach involves careful clinical assessment, advanced imaging guidance, and individualised treatment strategies — including ultrasound-guided steroid injections and ultrasound-guided hydrodistension injections — all performed by experienced clinicians.

Anatomy of the Shoulder Joint

The shoulder is the most mobile joint in the human body, designed for a wide range of movements. Structurally, it is a ball-and-socket joint formed where the head of the humerus (upper arm bone) fits into the glenoid cavity of the scapula (shoulder blade).

The joint is surrounded by a capsule, a soft tissue structure that stabilises and protects while allowing mobility.

Key components include:

• Bones — humerus, scapula, and clavicle
• Joint capsule — fibrous tissue enclosing the joint
• Synovial fluid — lubricates and nourishes the joint
• Ligaments and tendons — provide stability
• Muscles — especially the rotator cuff muscles, which support and move the shoulder

In frozen shoulder, the capsule becomes thickened, tight, and may form adhesions, reducing the space within the joint and restricting movement.

Pathophysiology — What Happens in Frozen Shoulder?

Frozen shoulder is marked by inflammation and thickening (fibrosis) of the joint capsule. This leads to a reduction in joint space and mobility. The process typically follows three stages:

1. Initial inflammation — irritation and swelling in the capsule
2. Fibrotic change — gradual thickening and stiffening of the capsule
3. Adhesion formation — fibrous tissue bands further restrict movement

It can be:

• Primary (idiopathic) — no obvious cause
• Secondary — associated with injury, surgery, or systemic conditions such as diabetes or thyroid disease

Clinical Phases of Frozen Shoulder

1. Freezing Phase

• Duration: Weeks to several months
• Symptoms: Increasing stiffness and discomfort, often worse at night
• Range of motion gradually decreases

1. Frozen Phase

• Duration: Several months
• Symptoms: Marked stiffness, although discomfort may reduce
• Functional tasks like lifting, reaching, or rotation remain difficult

1. Thawing Phase

• Duration: Months to years
• Symptoms: Gradual return of movement
• In some cases, full recovery may not be achieved

Common Symptoms

• Persistent stiffness in the shoulder joint
• Dull aching discomfort, especially with movement
• Night pain, often worse when lying on the affected side
• Difficulty reaching overhead or behind the back

Potential Causes and Risk Factors

Frozen shoulder can appear without a clear cause, but certain factors increase the risk:

• Shoulder injury or surgery leading to immobility
• Prolonged sling use
• Diabetes or thyroid conditions
• Age (most common between 40–60 years
• Slightly more frequent in women

Diagnosis at Alton Pain Clinic

Diagnosis begins with a detailed history and physical examination.

At Alton Pain Clinic, our clinicians may:

• Assess active and passive shoulder movements
• Use ultrasound imaging to visualise changes in soft tissues and exclude other conditions
• Review symptom patterns and any underlying medical conditions

Management Options

Lifestyle and Self-Management

• Gentle stretching and mobility exercises
• Heat therapy before movement
• Gradual activity pacing to avoid aggravation

Clinical Interventions at Alton Pain Clinic

Ultrasound-Guided Steroid Injection

• Corticosteroid medication is precisely placed into the shoulder joint using real-time ultrasound guidance

Ultrasound-Guided Hydrodistension Injection

• A sterile solution, often with corticosteroid and local anaesthetic, is introduced to gently expand the joint capsule
• Performed under ultrasound guidance, this can help increase joint space and improve movement in some individuals

Role of Ultrasound Guidance

Using real-time ultrasound allows for:

• Direct visualisation of the target joint space
• Precise needle placement
• Reduced risk of affecting surrounding tissues
• Immediate confirmation for both clinician and patient

When to Consider Injection-Based Interventions

If stiffness and movement restriction persist despite self-management or physiotherapy, an ultrasound-guided injection at Alton Pain Clinic may be considered.

Why Choose Alton Pain Clinic?

• Specialist clinicians experienced in musculoskeletal conditions
• Advanced ultrasound imaging for targeted treatment
• Tailored care suited to each phase of frozen shoulder
• Patient-centred approach in a supportive clinical environment

Recovery and Outlook

The course of frozen shoulder varies — some people recover in months, while others may experience longer-lasting stiffness. Early diagnosis, accurate treatment planning, and a structured approach to rehabilitation can support better function and help maintain daily activity levels.

Conclusion

Frozen shoulder can be a challenging and restrictive condition, but with careful assessment, targeted interventions, and ongoing guidance, many individuals can work towards improved mobility.

At Alton Pain Clinic, we combine clinical expertise, ultrasound precision, and a personalised approach to deliver ultrasound-guided steroid and hydrodistension injections as part of a comprehensive care pathway for frozen shoulder.