Frozen Shoulder: Stages, Causes & Physiotherapy Treatment in Hyderabad

Frozen shoulder — medically known as adhesive capsulitis — is a condition characterised by inflammation and fibrosis (scarring) of the shoulder joint capsule. It causes progressive pain and severe restriction of shoulder movement that, without treatment, can last 2–3 years.

The Three Stages of Frozen Shoulder

Stage 1: Freezing (Pain-Dominant) — Weeks 1–12

Gradually increasing shoulder pain — especially at night and when reaching overhead or behind the back. Movement starts to become restricted but pain is the dominant symptom. Anti-inflammatory treatment and gentle physiotherapy are the priority.

Stage 2: Frozen (Stiffness-Dominant) — Weeks 10–36

Pain decreases but the shoulder becomes profoundly stiff. Cannot raise the arm sideways, reach overhead, or put your hand behind your back. This is the stage for intensive physiotherapy — mobilisation, capsular stretching, strengthening.

Stage 3: Thawing (Recovery) — Months 9–24

Gradual spontaneous return of shoulder movement. Physiotherapy accelerates this phase significantly — most treated patients achieve full or near-full movement much faster than the natural timeline.

Who Gets Frozen Shoulder?

Frozen shoulder is particularly common in:

• People with diabetes: 2–5× more likely; often bilateral and more severe
• Thyroid disorders: Hypothyroidism and hyperthyroidism
• After shoulder immobilisation: Following arm fracture, rotator cuff surgery, or cardiac surgery
• Age 40–60: Peak incidence
• Women: More commonly affected than men
• Parkinson's disease

Diagnosis

The hallmark clinical finding is loss of external rotation with the elbow by the side — this is almost pathognomonic for frozen shoulder. Dr. Harisha at Sri Anand CNC performs a detailed shoulder assessment to confirm the diagnosis and stage, and to rule out other causes (rotator cuff tear, impingement, referred neck pain).

Physiotherapy Treatment at Sri Anand CNC

Freezing stage:

• Pendulum exercises (Codman's exercises) — gravity-assisted gentle mobilisation
• TENS and therapeutic ultrasound for pain relief
• Moist heat application
• Gentle range-of-motion exercises within pain limits

Frozen stage:

• Joint mobilisation — Maitland Grade III-IV techniques to stretch the capsule
• Aggressive capsular stretching — particularly external rotation and elevation
• Rotator cuff and scapular stabiliser strengthening
• High-velocity low-amplitude thrust techniques where appropriate

Thawing stage:

• Progressive strengthening with resistance
• Functional training — return to sport, overhead activities, work tasks
• Maintenance programme to prevent recurrence

Corticosteroid Injection — When Is It Helpful?

A corticosteroid injection into the shoulder joint is most effective in the freezing stage — it significantly reduces inflammation and pain, enabling physiotherapy to proceed more aggressively. Dr. Harisha coordinates referral for this where appropriate.

Optimising Diabetes for Frozen Shoulder Recovery

If you have diabetes, optimising blood glucose control significantly improves frozen shoulder outcomes. Poorly controlled diabetes makes the capsular fibrosis worse and recovery slower. Work with your GP or endocrinologist alongside physiotherapy for best results.

For frozen shoulder assessment and physiotherapy: Sri Anand CNC, Chanda Nagar, Hyderabad. Call +91 90633 66983.