FROZEN SHOULDER (ADHESIVE CAPSULITIS)

Frozen shoulder can come from many different factors, ranging from minor injury or overuse to underlying health conditions. These cause inflammation of the connective tissue surrounding the shoulder joint. Common triggers include:

Obvious trauma such as a fall on an outstretched arm, landing on an affected shoulder, or excessive gym weight lifting maybe injures the rotator cuff of the shoulder. Weekend warrior excessive exercises may strain the shoulder muscles.

Metabolic rate slows as one ages, and the muscles will be more deconditioned and less supple. Non-traumatic minor injuries can cause a sprain in the rotator cuff. As the muscles are weaker and less stress-resistant, and blood supply to the shoulder joint is poor, a simple sprain may progress to a serious frozen shoulder.

During peri-menopausal, estrogen fluctuates and wanes, causing increased stiffness, a loss of suppleness of muscles and ligaments, tightness and spasms.

Frozen shoulder typically progresses through three stages. Understanding these frozen shoulder stages helps guide the right treatment at the right time.

This is the most painful stage. The pain will increase gradually and may become worse at night. Shoulder movement will be limited for 6 to 36 weeks.

 Pain may lessen at this stage, but the shoulder remains stiff, making it difficult to do daily tasks and activities. This stage can last 2 to 6 months. 

During this stage, shoulder mobility slowly improves as the pain subsides. The recovery is gradual, but it can take up to 2 years.

Frozen shoulder symptoms can range from mild discomfort to severe, daily limitations. If your pain persists, worsens, or restricts your ability to perform simple actions, it’s best to have it assessed by a specialist.

• Pain and Headaches: Aching or sharp pain in the shoulder that may spread to the upper arm. May cause one-sided or both-sided throbbing pain at rest, particularly at night.
• Stiffness: Reduced ability to move the shoulder, often worse after rest or prolonged rest.
• Loss of Movement: Inability to lift the arm overhead, reach behind the back, or move the arm away from the body, indicating severe joint restriction.
• Difficulty Sleeping: Pain that is intense enough to disturb sleep or prevent lying on the affected side.
• Inability to Perform Daily Tasks: Difficulty with dressing, grooming, and driving due to restricted arm movement.

Treatment for frozen shoulder depends on the stage of your condition, how severe the pain is, and how much movement has been lost. At Singapore Paincare, care follows a step-by-step approach—starting with the least invasive options and progressing only when needed.

If your Frozen Shoulder is in the early freezing stage, you will benefit from conservative treatments, including:

• Physical Therapy: Gentle, guided exercises help maintain movement and reduce stiffness. Therapy must be carefully paced—forceful stretching or painful massage can worsen inflammation.
• Pain Medications: Oral painkillers or anti-inflammatory medication may offer some relief, but on their own they often cannot fully address the pain–stiffness cycle.

If your shoulder discomfort has been persistent or more severe- such as in stage 1, where the shoulder is painful and beginning to develop- minimally invasive treatments can address the exact source without the need for open surgery.

This prevents the condition from progressing to Stage 2, and is far more suitable than inappropriate exertive treatments, such as painful massages, which can worsen symptoms. At Singapore Paincare, we offer precise procedures designed to relieve pain at its origin.

Our pain specialists use nerve blocks to stop pain and allow inflammation to subside, often alongside other treatments for optimal outcomes. Controlling pain in the early stages of frozen shoulder enables the patient to naturally mobilize the shoulder before stiffness or contracture develops.

Coreflex injections are administered to the muscles and ligaments around the frozen shoulder joint to reduce inflammation. These injections have a dual effect: relieving pain and helping reverse the injury, addressing elements that painkillers alone cannot treat.

During a nerve block of the shoulder joint, PRP can be used instead of cortisone to promote healing of injured tendons and improve blood flow in the shoulder affected by adhesive capsulitis. This prolotherapy-based approach enhances circulation, reduces swelling and edema, and stimulates fibroblastic proliferation, supporting faster and more effective recovery.

For Stage 2 Frozen Shoulder, it is necessary to break up the adhesions within the shoulder capsule to release the contractures and strictures that limit shoulder movement. Under anaesthesia, the shoulder muscles are relaxed, allowing safe manipulation of the joint without the usual risk of fracture or dislocation.

Our specialist will discuss with you whether your Frozen Shoulder requires surgery. Before recommending any surgical option, a specialist will review detailed scans of your shoulder joint to understand the exact cause. They will then discuss whether surgery is necessary and explain the potential benefits and risks. Generally, surgery may be recommended if your related causes of frozen shoulder, such as torn tendons, arthritis of the shoulder, or bone spurs of the acromion, require repair, or in severe, unresponsive cases.

• Arthroscopic Surgery: In severe cases, arthroscopic surgery may be performed. This procedure involves inserting a small camera and specialized instruments into the affected joint to carefully cut through the tight portions of the joint capsule. The goal is to release adhesions and restore movement by surgically addressing the restrictive areas, all through a small scope. Intensive rehabilitation will be recommended after this to mobilize the shoulder.

You can reduce the risk by:

• Seeking early assessment for shoulder pain or stiffness
• Avoiding aggressive or painful massage early on
• Starting appropriate therapy after shoulder injuries
• Managing conditions such as diabetes or thyroid disease

Early care during the freezing stage can prevent severe long-term stiffness.

Frozen shoulder may start as a simple ache, but if ignored it can affect how you sleep, work, and manage your home life. A prior minor injury or underlying condition like diabetes can trigger it. If left untreated, the shoulder joint may become contractured and severely limited — potentially causing loss of movement and chronic, throbbing pain.

Many people assume frozen shoulder always points to a simple muscle pull. In reality, a thickening and scarring of the joint capsule are often the real cause. That’s why the first step is always to find out exactly where your pain comes from.

At Singapore Paincare, our Painostic® method goes beyond treating symptoms. We identify the real source of discomfort and build an individualised, minimally invasive plan — so you can move comfortably and confidently again.