Frozen Shoulder

Arm won’t lift, worse pain at night. Is it frozen shoulder?

Not just inflammation, but a problem of frozen movement.

It starts as stiffness, then gradually your arm stops lifting. Pain intensifies when dressing or washing your hair, and sleeping on the affected side becomes unbearable at night.

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Frozen shoulder capsule illustration

Quick Answer: Frozen shoulder occurs when the shoulder capsule stiffens, causing pain and movement restriction together. The order matters. First calm the pain, then gradually regain the frozen range, and then restore use in daily life.

Seek medical attention quickly if:

  • Sudden inability to lift arm or weakness after trauma
  • Fever, swelling, warmth with rapidly worsening pain
  • Night pain so severe it prevents sleep
  • Arm or hand numbness or decreased sensation progressing

3 Key Points on This Page

  • What symptoms suggest frozen shoulder
  • The mechanism behind why it keeps stiffening and hurting
  • How to treat to prevent re-freezing

These symptoms suggest frozen shoulder

  • The arm won’t lift. It is difficult to reach overhead or retrieve items from high places.
  • Worse pain at night. It is tolerable during the day but throbs at night, worse when lying on the affected side.
  • Difficulty dressing and undressing. It is hard to put your arm in a sleeve or reach behind to fasten a bra.
  • Clearly different from the other side. Comparing shoulder range of motion, the affected side lifts much less.
  • Progressive stiffening. It starts with slight discomfort, but over weeks and months movement decreases further.

Why does the shoulder freeze?

Frozen shoulder (adhesive capsulitis) is a condition where the capsule surrounding the shoulder joint thickens and stiffens.

Various causes exist, but the common factor is prolonged ‘reduced movement and decreased circulation.’

  • Prolonged same posture. Not using the shoulder lets the surrounding tissues gradually stiffen.
  • Post-injury sequelae. Not moving the shoulder because of pain after an injury leads to stiffening.
  • Reduced circulation. Decreased blood flow causes fascia to stick together, blocking fine movements.
  • Diabetes and thyroid disease. Metabolic issues increase frozen shoulder incidence.

3 Stages of Frozen Shoulder

Stage 1, freezing.
Pain begins and movement gradually decreases. 2-9 months.

Stage 2, frozen.
Pain decreases but stiffness persists. 4-12 months.

Stage 3, thawing.
The shoulder gradually loosens. 5-24+ months.

Left to natural course without aggressive treatment can take 1-3 years.

Simple Home Check

  1. Raising both arms in front of wall
    Stand facing wall and slowly raise both arms simultaneously. Does one arm lift less or stop midway?
  2. Hands behind back
    Put both hands behind back and try lifting up spine. Does affected hand stop at lower position?
  3. Lifting arms sideways
    Spread arms sideways and lift. Does pain worsen between 60-120 degrees?
  4. Daily movement check
    Are certain daily movements particularly uncomfortable like washing hair, dressing, or using back pocket?

If pain feels severe, stop and don’t force it. Pushing through can cause more damage.

Is it frozen shoulder, or another shoulder problem?

Global shoulder stiffness in all directions is not always frozen shoulder (adhesive capsulitis). Rotator cuff tears and shoulder impingement can appear similar.

Frozen Shoulder (Adhesive Capsulitis)

  • Restricted movement in all directions of the shoulder
  • Cannot fully raise the arm, reach behind the back, or rotate outward
  • Gradual onset. Progressively worsening stiffness.
  • Night pain is common. Symptoms persist for months.

Rotator Cuff Tear

  • Difficulty with specific movements (raising the arm) while other directions remain more accessible
  • Noticeable weakness is a key feature
  • Range of motion is partially preserved in many directions
  • Tendon tear confirmed on ultrasound or MRI

Frozen shoulder has a well-recognised association with diabetes and thyroid disorders. If you develop shoulder stiffness, checking your metabolic health is worthwhile. Impingement syndrome differs from frozen shoulder in that pain occurs only within a specific arc (60-120°) and overall range of motion is preserved.

Our Approach at Yonsei SM Pain Clinic

We view frozen shoulder not just as ‘inflammation,’ but as frozen movement and blocked circulation together. We apply the 3-phase Circulation therapy system.

  • Phase 1: Calm (Circulation HD)
    Restore circulation to stiffened capsule and surrounding tissues. Reduce inflammation and calm pain signals.
  • Phase 2: Activate (Circulation PT)
    Awaken weakened rotator cuff and shoulder muscles, gradually expanding frozen range of motion through 1:1 therapy.
  • Phase 3: Integrate
    Correct movement patterns to naturally use shoulder in daily activities. Change habits to prevent re-freezing.

Frozen Shoulder Intensive Program

Intensive treatment program for frozen shoulder patients.
Systematic treatment combining Circulation HD and Circulation PT.

  • 12-week intensive treatment plan
  • Circulation Combo (HD + PT) applied
  • Focus on range of motion recovery
  • Home care guidance included

Frequently Asked Questions

How do frozen shoulder and rotator cuff tear differ?

Frozen shoulder involves ‘movement restriction itself’ due to stiffened capsule, while rotator cuff issues typically show pain and weakness in specific motions. Accurate differentiation requires evaluation. Differentiation Q&A →

It hurts more at night, is it frozen shoulder?

Night pain is common in frozen shoulder, but other shoulder conditions can also cause night pain. Need to check pain pattern and range of motion together. Night Pain Q&A →

Arm won’t lift. When is examination needed?

Evaluation needed when movement restriction is clear with pain, or if weakness is felt. Particularly careful after trauma with sudden restriction. Arm Raising Q&A →

Hand won’t reach behind. Is this frozen shoulder?

Reaching behind becomes particularly uncomfortable in frozen shoulder. But other shoulder problems can be similar, so we look at range and pain location together. Hand Behind Back Q&A →

How long does treatment take?

Treatment duration varies by stage (pain-centered or freezing stage). Both pain-calming phase and range recovery phase needed together. Treatment Duration Q&A →

Can I keep getting injections?

Injection repeat plans vary by type and purpose. Important to design addressing stiff tissues and function recovery together rather than just briefly reducing symptoms. Injections Q&A →

What should I do at home?

Rather than excessive stretching, range-of-motion exercises appropriate to current stage and lifestyle habit adjustments are important. Safer to establish routine after evaluation as contraindicated movements may exist depending on condition. Shoulder Routine Q&A →

When should Circulation Combo (HD + PT) be considered?

When both pain control and function recovery are needed, it can help design the 3-phase flow together. Composition varies by individual condition.

References

  • Zuckerman JD, Rokito A. Frozen shoulder: a consensus definition. J Shoulder Elbow Surg. 2011;20(2):322-325.
  • Dyer BP et al. Effectiveness of physiotherapy interventions for frozen shoulder: a systematic review and meta-analysis. Br J Gen Pract. 2019;69(681):e259-e268.
  • Challoumas D et al. Comparison of treatments for frozen shoulder: a systematic review and meta-analysis. JAMA Netw Open. 2020;3(12):e2029581. PMC7489762
  • Rangan A et al. Surgical vs nonsurgical treatment of adults with shoulder contracture (frozen shoulder): a randomised controlled trial. JAMA. 2015;314(13):1358-1369.

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