Frozen shoulder, also called adhesive capsulitis, is a condition where the tissue surrounding the shoulder joint (the joint capsule) becomes inflamed, thick and tight. The shoulder becomes painful and stiff, and moving it, in any direction, becomes difficult.
It affects about 3 in 100 people, most often between the ages of 40 and 70, and is more common in women.1 The exact cause is not fully understood. It can start without any clear reason, or after an injury, surgery or a period when the shoulder has been kept still.
Frozen shoulder can affect anyone, but you are more likely to develop it if you:
Frozen shoulder is more common in people with diabetes. About 1 in 8 people with diabetes (13%) have it, and people with diabetes are around five times as likely to develop frozen shoulder as people without diabetes.3 Looking at it the other way, about 3 in 10 people with frozen shoulder have diabetes.3 It can also come back, especially in people with diabetes.1
If you have not been checked for diabetes, a simple blood sugar test is a sensible step. You can read more in our article Diabetes and frozen shoulder.
Typical features include:
Some people describe three phases: a painful “freezing” phase, a stiff “frozen” phase, and a “thawing” phase as movement slowly returns. In practice, pain and stiffness can overlap and not everyone follows this pattern.1
Go to the nearest emergency department.
Consider an assessment if:
Getting the diagnosis right matters, because other conditions, including rotator cuff problems, arthritis and neck problems, can also cause shoulder pain and may need different treatment.
Frozen shoulder is usually diagnosed from your history and a physical examination, which looks at how far your shoulder moves on its own and when someone else moves it. Scans are not usually needed to confirm it.1 Dr Liu may arrange:
We perform our own in-house ultrasound for shoulder disorders at Alleviate Pain Clinic.
The right treatment depends on how painful and stiff your shoulder is, how long you have had it, and what else is going on. Options include:
Most people recover without surgery.1
No single treatment suits everyone, and it helps to start early. In our clinical experience, shoulder hydrodilatation followed by a guided home exercise programme often gives the best results. Hydrodilatation stretches the tight joint capsule from the inside, and it can ease pain and help the shoulder move again.2 Compared with a steroid injection, it gives similar pain relief, may improve everyday function sooner, and may help you turn your arm outwards more.2
A corticosteroid injection into the joint can also relieve pain and stiffness in the first few months, especially when it is given early, within about a year of symptoms starting.4 Regular home exercises are an important part of recovery, and adding them to an injection may improve recovery further.4 Dr Liu will explain the options that suit your shoulder.
Shoulder hydrodilatation is a minimally invasive treatment for frozen shoulder offered at Alleviate Pain Clinic. A large volume of sterile fluid with local anaesthetic is injected into the shoulder joint to stretch the tight capsule from the inside,. It is effective at reducing pain and improving range of motion in patients with frozen shoulder.
Who may consider it: people with frozen shoulder who have significant pain and stiffness. It is not only for people who have not improved with physiotherapy. It can also be used alongside physiotherapy to help you regain movement.
What to expect:
It may not be suitable if you have an active infection, an allergy to local anaesthetic or steroid medicines, or uncontrolled diabetes. Dr Liu will assess your shoulder first to confirm whether it is right for you.
Shoulder pain and stiffness affecting your sleep or daily life? Find out whether shoulder hydrodilatation is suitable for you.
At your consultation, Dr Liu will ask about your symptoms, sleep, other medical conditions and previous treatment, examine your shoulder and explain what he finds. If a procedure such as hydrodilatation is suitable, he will explain how it is done, what to expect afterwards, the possible risks, and the cost, so that you can decide what is right for you.
Bring any previous scans, reports and a list of your medicines to your appointment.
MOH accredited Pain Specialist and Medical Director of Alleviate Pain Clinic at Farrer Park Hospital. He completed an interventional pain fellowship at the University Health Network in Toronto and was previously a Senior Consultant in Pain Medicine at Singapore General Hospital.
Read more about Dr LiuThis page gives general information and is not a substitute for medical advice. Please see a doctor about your own symptoms and treatment options.
Frozen shoulder can last up to 2 to 3 years if untreated. A small number of people have some lasting stiffness, although this seldom limits daily activities. Treatment aims to ease pain and help you keep your shoulder moving while it recovers.
Frozen shoulder is often self-limiting, but it can take a long time and it can be painful and disruptive in the meantime. Many people choose treatment to ease pain, improve sleep and keep movement while the shoulder recovers.
In frozen shoulder, the joint itself is stiff, so the shoulder is limited whether you move it yourself or someone else moves it. Rotator cuff problems more often cause pain and weakness when lifting the arm, but the joint may still move freely. The two can occur together, so an examination is needed to tell them apart.
Hydrodilatation is an injection of a large volume of fluid with local anaesthetic into the shoulder joint to stretch the tight capsule. Reported side effects are mostly short-lived, such as flushing, dizziness and temporary arm numbness or soreness, but rare complications such as joint infection can occur. Dr Liu will explain the benefits, limits and risks before you decide.
Frozen shoulder is more common in people with diabetes, and it may also be more persistent. The reasons are not fully understood. If you have not been checked for diabetes, your doctor may suggest a blood sugar test.
Many people do best with shoulder hydrodilatation followed by regular home exercises, which is the approach we often recommend. Hydrodilatation stretches the tight joint capsule and can ease pain and help the shoulder move again. A corticosteroid injection can also relieve pain and stiffness, particularly when it is started early, and exercises add to the benefit. Dr Liu will explain the options that suit you.
Frozen shoulder can develop in the other shoulder, and it can come back in the same shoulder, particularly in people with diabetes. See your doctor early if symptoms return, so that treatment can start sooner.
A pain specialist is well placed to diagnose frozen shoulder and guide your treatment, from injections and shoulder hydrodilatation to an exercise plan. At Alleviate Pain Clinic at Farrer Park Hospital, Dr Christopher Liu, an MOH accredited pain specialist, will examine your shoulder, use in-clinic ultrasound where helpful, and explain the treatments we offer so that you can decide what is right for you.
Interventional pain procedures are covered by the Ministry of Health's Table of Surgical Procedures (TOSP). They are therefore reimbursable by all Integrated Shield Plans and most corporate insurance plans. However, it is advisable to obtain preauthorisation from your insurer before the procedure. Our clinic staff will guide you through this process.
Effective pain solutions for a better living. Specialist pain management at Farrer Park Hospital, Singapore.
1 Farrer Park Station Road #08-14
Farrer Park Hospital (Connexion)
Singapore 217562
Mon–Fri 9am–5pm
Sat 9am–1pm · By appointment
