Frozen Shoulder

What is Frozen Shoulder?

Frozen shoulder, also known as adhesive capsulitis, is a condition where the shoulder joint becomes painful, stiff, and progressively difficult to move. It occurs when the connective tissue surrounding the shoulder joint, called the capsule, thickens and tightens, forming adhesions that restrict movement.

This condition typically develops in stages, and can last several months to a few years. It commonly affects adults between the ages of 40, and 60, and is more prevalent among individuals with diabetes, thyroid disorders or those recovering from shoulder injuries or surgery. Although the exact cause is not always clear, immobility or limited use of the shoulder often triggers its onset.

stages of frozen shoulder.
Frozen shoulder progresses in stages, from early pain to severe stiffness, and eventual recovery.

Stages of Frozen Shoulder

Frozen shoulder develops in 3 distinct stages, namely:

STAGESCHARACTERISTICS
Stage 1: Freezing StageThis initial stage lasts from 6 weeks to 9 months. You will notice increasing pain and a gradual loss of shoulder movement. The pain may worsen at night and limit your ability to perform daily activities.
Stage 2: Frozen StageDuring this stage, which can last 4 to 12 months, pain may begin to ease, but stiffness remains. Shoulder movement becomes extremely limited, affecting tasks such as dressing or reaching overhead.
Stage 3: Thawing StageThe recovery phase may last between 6 months to 2 years. During this stage, movement slowly improves as the shoulder capsule loosens. Additionally, pain continues to decline and function begins to return.

What causes Frozen Shoulder?

Often, frozen shoulders are the result of inflammation and tightening of the shoulder capsule. However, the exact causes are not always identifiable and can range between:

  • Age and gender.
  • Medical conditions such as diabetes, Parkinson’s disease, stroke, or thyroid diseases.
  • Prolonged immobility, such as from fractures or rotator cuff injuries.
  • Prior shoulder trauma or surgery that required prolonged rest, which can lead to stiffness and eventual capsule thickening.
age and gender
Age and gender
stiff shoulder
Stiffness, particularly when trying to raise the arm, rotate the shoulder or reach behind.

Symptoms of Frozen Shoulder

The symptoms of frozen shoulder generally worsen over time, and vary by stage. The most common symptoms include:

  • Persistent shoulder pain, which is often dull or aching that affects movement, and sleep.
  • Restricted range of motion that hinders performing basic daily tasks, such as putting on clothes or combing hair.
  • Stiffness, particularly when trying to raise the arm, rotate the shoulder or reach behind.
  • Worsening pain at night.

What complications can arise from Frozen shoulder?

While frozen shoulder often improves over time, delayed or inadequate treatment can result in long-term complications that significantly impact quality of life. These include:

  • Chronic pain – persistent inflammation within the shoulder joint capsule can lead to ongoing pain, even during rest. This discomfort may interfere with sleep, reduce overall activity, and contribute to emotional stress or anxiety.
  • Compensatory joint strain – when shoulder movement is restricted, the body often compensates by overusing other joints, and muscle groups, such as the neck, upper back or opposite shoulder. This can lead to secondary issues, including neck pain, postural imbalance, and repetitive strain injuries in otherwise healthy joints.
  • Long-term stiffness or restricted movements – in cases where the shoulder capsule remains tight, and scarred, stiffness may not fully resolve. This can lead to permanent limitations in shoulder movement, affecting basic tasks such as lifting objects or reaching overhead.
  • Muscle weakness – limited use of the shoulder due to pain, and immobility can result in muscle wasting (atrophy) around the joint, particularly in the deltoid, and rotator cuff muscles. Weaknesses make it more difficult to support, and stabilise the shoulder, which can slow down recovery, and increase the risk of reinjury.
complications of frozen shoulder.
If frozen shoulder is left untreated, it can result in long-term stiffness, and persistent functional limitations.

Who is at risk of Frozen Shoulder in Singapore?

Although frozen shoulders can affect anyone, certain groups are more vulnerable, such as:

frozen shoulder diagnosis Singapore.
Diagnosing frozen shoulder involves a thorough assessment of symptoms, movement limitations, and medical history.
  • Age – Frozen shoulder most commonly affects people aged
    40 to 60 years old. As you age, natural changes in connective tissues and joint flexibility can make the shoulder more prone to inflammation and stiffness.
  • Gender – Women, particularly those going through menopause, face a higher risk, likely due to hormonal shifts that influence inflammation and tissue health. In fact, frozen shoulders are twice as common in women as in men.
  • Diabetes – Those living with diabetes are 5 times more likely to develop frozen shoulder. Fluctuating blood sugar levels can affect connective tissues, making them prone to thickening and scarring.
  • Medical conditions – Other health issues such as thyroid diseases, heart diseases, or Parkinson’s disease can increase the risk of frozen shoulder by affecting inflammation levels or restricting movement.
  • Post-surgery or post-injury recovery – The limited use of the shoulder following an injury or surgical procedure can lead to scar tissue buildup and joint stiffness, which are key triggers for frozen shoulder.
  • Sedentary lifestyle – Long hours spent sitting or working at a desk, especially with poor posture, can reduce shoulder mobility over time. When the joint is not moved regularly through its full range, the risk of frozen shoulder rises.

How is Frozen Shoulder diagnosed?

At Apicare Pain Clinic,  understand that shoulder pain can interfere with everything from dressing to sleep. That is why we take a comprehensive, patient-focused approach to diagnosing frozen shoulders. That way, we not only confirm the condition, but also understand the severity, and root cause.

Medical history review
Our doctors will begin by discussing your symptoms in detail. They may ask when the symptoms started

The diagnostic steps may involve:

  • Medical history review – our doctors will begin by discussing your symptoms in detail. They may ask when the symptoms started, how they have progressed, and how they affect your daily life. They will also ask about any previous shoulder injuries, surgeries or underlying health conditions such as diabetes or thyroid disorders that may increase your risk.
  • Physical examination – our doctors will examine your shoulder’s range of motion by gently guiding your arm through different movements. Limited ability to move the shoulder actively, and passively (when someone else moves it for you) is a key feature of frozen shoulder. They will also check for areas of pain, tenderness, and muscle weakness.
  • Imaging tests – to rule out other possible causes of shoulder pain, they may recommend imaging tests such as:
    • Magnetic resonance imaging (MRI) to obtain a detailed view of soft tissues, including tendons, and ligaments to confirm inflammation or thickening of the joint capsule.
    • X-rays to help exclude bone-related conditions like osteoarthritis.

What are the treatment options for Frozen Shoulder in Singapore?

Treatment for frozen shoulder focuses on relieving pain, restoring movement, and preventing long-term stiffness through a combination of non-surgical, evidence-based therapies.

  • Physiotherapy – a key part of recovery, physiotherapy focuses on gentle stretching, and strengthening exercises to restore shoulder mobility over time. As pain improves, we progress to active range of motion, and resistance training. 
  • Corticosteroid injections – for more intense or persistent pain, we offer corticosteroid injections administered under ultrasound guidance. This ensures accurate delivery into the joint capsule, helping reduce inflammation, and allowing for more effective physiotherapy.
  • Heat therapy and ultrasound therapy – applying heat to the affected shoulder can help relax the muscles, and improve blood flow, making stretching easier. Therapeutic ultrasound may also be used to reduce deep tissue inflammation, and accelerate healing.
  • Pain relief medications – anti-inflammatory medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), help reduce pain, and swelling, particularly during the early freezing phase when symptoms are most severe. However, these may be used short-term to support comfort during physiotherapy.
  • Specialised pain management – if symptoms persist despite standard treatments, our doctors may offer image-guided procedures or nerve blocks for targeted, long-lasting relief. These interventions are especially helpful during severe flare-ups or when mobility is severely restricted.

Summary

Frozen shoulders can be long, and painful. But you do not have to go through it alone. At Apicare Pain Clinic, we offer comprehensive, and personalised care to help manage your pain, restore mobility, and return to the activities you enjoy. With targeted treatments, and a strong focus on recovery, we tailor your care to what matters most: your quality of life.

Book a consultation with us today to find out how we can help you regain control of your movement, and well-being.

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