Frozen shoulder · Adhesive capsulitis · Vienna
First the pain, then the stiffness: week by week the shoulder moves less, and sleeping on that side becomes impossible. A frozen shoulder is exhausting – but it is one of the few shoulder conditions that almost always heals by itself. What matters is doing the right thing in each phase. And being told honestly that surgery is rarely needed.
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In a frozen shoulder – medically, adhesive capsulitis – the capsule of the shoulder joint becomes inflamed, thickens and shrinks. The shoulder is not just painful, it becomes truly blocked: it cannot be moved freely even passively, from the outside.
Why it develops is not always clear. It occurs more often with diabetes and thyroid disease, and after prolonged immobilisation – for example following an injury or operation. Women between 40 and 60 are most commonly affected.
Increasing stiffness in all directions – lifting the arm, reaching behind the back becomes impossible
Night pain: lying on the affected side is barely possible
Restricted even passively: the hallmark – the shoulder blocks even with guided movement
Gradual onset without a clear trigger, often progressing over weeks
A frozen shoulder runs through typical phases. What helps depends entirely on which phase you are in – the most common treatment mistake is forcing things too early.
Pain dominates and increases, movement starts to become restricted. Now the priority is pain and inflammation control – not forced stretching, which only makes things worse at this stage.
The pain slowly eases, the stiffness remains. Now is the right time for consistent, gently progressive physiotherapy to win back movement step by step.
The capsule releases and movement comes back – in most cases fully. Physiotherapy supports and accelerates this process.
Frozen shoulder is one of the conditions where my most frequent job is to reassure patients: as a rule, no operation is needed. The key is matching the treatment to the phase – pain and inflammation control early, targeted physiotherapy later. A well-placed injection can noticeably shorten the painful early phase.
Only in rare, stubborn cases – when severe stiffness persists after many months of consistent treatment – does an arthroscopic capsular release come into question. That is the exception, and I will tell you openly if your shoulder does not need it.
Why patients with a stiff shoulder come to me
A shoulder that becomes increasingly stiff over weeks, loses motion in all directions and hurts especially at night is typical of a frozen shoulder (adhesive capsulitis). The joint capsule becomes inflamed and shrinks. The hallmark: even passive movement is restricted – the shoulder cannot be moved freely from the outside either. That distinguishes it from many other shoulder problems.
Frozen shoulder (adhesive capsulitis) is an inflammatory shrinkage of the shoulder joint capsule. The capsule thickens, adheres and loses its elasticity – the shoulder becomes progressively stiff and painful. The cause is often unclear; it occurs more frequently with diabetes, thyroid disease and after prolonged immobilisation. Women between 40 and 60 are most affected.
A frozen shoulder classically runs through three phases: a painful freezing phase, a stiff frozen phase, and a thawing phase in which movement slowly returns. The full course often takes between one and two years. The good news: in the vast majority of cases it heals without lasting damage – patience and the right guidance are decisive.
In the vast majority of cases, no. Frozen shoulder is one of the few shoulder conditions that heals by itself – treatment focuses on pain relief, controlling the inflammation and maintaining movement with physiotherapy. Surgery (arthroscopic capsular release) is only considered in rare cases where severe stiffness persists after many months of consistent treatment.
In the painful early phase the priority is pain and inflammation control – with anti-inflammatory medication and, if needed, a targeted injection; forced stretching is counterproductive at this stage. In the stiff phase, gentle, regular physiotherapy to maintain and regain movement takes over. Matching the treatment to the phase is the key.
The decisive difference is passive movement: with a frozen shoulder the joint is truly blocked – it cannot be moved freely even from the outside. With a rotator cuff tear it is mainly active strength that is limited, while the shoulder can usually still be moved passively. Examination and, if needed, imaging reliably distinguish the two.
A frozen shoulder rarely needs surgery – but it always needs the right treatment at the right time. Let's find out where you stand. In English.
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