Frozen Shoulder (Adhesive Capsulitis)

Unable to lift your arm, unable to reach behind your back, waking up at night with shoulder pain—
These symptoms might be frozen shoulder (adhesive capsulitis).
If left untreated, thinking "it will heal eventually," your joint may stiffen and become even harder to move.

• Receiving appropriate treatment early can shorten your recovery period.
• Thorough examination of your shoulder condition through consultation, palpation, and X-ray.
• Treatment tailored to your stage of symptoms, including pain relief, injections, and rehabilitation guidance.
• Differentiation from other conditions such as rotator cuff tears and calcific tendinitis will also be performed.
• No appointment necessary - same-day visits OK | Open daily from 9 AM to 9 PM.

👉 Same-day visits without an appointment are also available. Please feel free to consult us first.

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What is Frozen Shoulder?

Frozen shoulder is a condition where inflammation occurs in the joint capsule surrounding the shoulder joint and the surrounding tendons and ligaments, leading to pain and limited range of motion. It is formally called adhesive capsulitis, and it received its common name because it frequently affects individuals in their 40s and 50s. While it's called "forty-shoulder" if it develops in one's 40s and "fifty-shoulder" in one's 50s, medically, it refers to the same condition.

The exact cause is not yet fully understood, but it is believed to be related to a combination of age-related changes in the shoulder tissues, decreased blood flow, and inflammation. It often occurs in the dominant arm but can also affect both shoulders. In some cases, the opposite shoulder may also develop the condition several years after the first one.

Frozen shoulder often resolves naturally even if left untreated, but recovery can take anywhere from six months to over two years. It is known that appropriate treatment, stretching, and exercise therapy can significantly shorten the recovery period. If you do nothing, believing "it will heal over time," the joint may remain stiff (contracture) for a long time, so early intervention is important.

⚠️ Seek medical attention early if you experience any of the following:

• Unable to lift your arm above your shoulder, or severe pain when lifting it.
• Waking up at night with shoulder pain (night pain).
• Difficulty changing clothes, washing hair, or reaching behind your back.
• Shoulder pain that has lasted for 2-3 weeks or more.
• Sudden increase in pain (possible calcific tendinitis).
• Weakness in the shoulder or inability to lift the arm (possible rotator cuff tear).
• Grinding or creaking sounds when moving the shoulder.

The 3 Stages of Frozen Shoulder

Frozen shoulder is broadly divided into three stages, each with different symptoms and appropriate treatments.

Stage	Approximate Duration	Main Symptoms	Treatment Policy
Acute Phase (Inflammatory Phase)	Onset ~ several weeks	Pain even at rest, particularly severe pain at night, excruciating pain with slight movement.	Maintain rest to suppress inflammation. Pain relievers, injections, and icing are effective. Avoid strenuous exercise.
Chronic Phase (Stiffening Phase)	Several weeks ~ several months	Resting pain subsides, but the shoulder is stiff and difficult to move. Range of motion is severely restricted.	Actively engage in rehabilitation and stretching to restore joint movement. Move gradually while managing pain.
Recovery Phase	Several months ~ 1-2 years	Pain gradually lessens, and range of motion slowly increases.	Continue rehabilitation to promote recovery. Gradually resume daily activities.

"Forcibly moving during the acute phase" and "resting too much during the chronic phase" both hinder recovery. Correct treatment according to the stage determines the speed of recovery.

Main Symptoms

Pain Characteristics

• Pain when moving the shoulder (especially when lifting the arm, opening it sideways, or reaching behind).
• Pain intensifies during the night and early morning (night pain).
• Dull, continuous pain even at rest during the acute phase.
• Pain may spread from the shoulder to the upper arm.
• Pain intensity varies from day to day.

Movement Restrictions

• Unable to lift arm above shoulder.
• Unable to reach behind the back (difficulty scratching back, fastening/unfastening a bra).
• Difficulty extending arm sideways.
• Difficulty washing hair or reaching for high objects.
• Takes time to change clothes (especially putting on shirt sleeves).

Conditions Easily Mistaken for Frozen Shoulder

Symptoms such as "shoulder pain and difficulty moving" can also occur in conditions other than frozen shoulder. Accurate diagnosis is crucial because treatment methods are entirely different.

Condition	Difference from Frozen Shoulder
Rotator Cuff Tear	A tear in the tendons that move the shoulder. Inability to exert force when lifting the arm or a feeling of weakness at certain angles. Diagnosed with MRI. Severe cases may require surgery.
Calcific Tendinitis	Sudden, excruciating pain due to calcium deposits in the tendons. Characterized by sudden, unbearable pain. Calcification can be confirmed by X-ray.
Osteoarthritis of the Shoulder	Joint deformity due to cartilage wear. Often caused by prolonged overuse, previous fractures, or dislocations. Joint changes confirmed by X-ray.
Cervical Spondylosis / Cervical Disc Herniation	Shoulder and arm pain due to nerve compression in the neck. Numbness in hands, symptoms change with neck movement. Shoulder movement usually not significantly restricted.
Acromioclavicular Joint Arthritis / Sternoclavicular Joint Arthritis	Inflammation of the clavicle joint. Pain when pressed at the end of the shoulder (end of the clavicle).
Rheumatoid Arthritis	Autoimmune joint inflammation. Tends to affect both shoulders. Strong morning stiffness. Rheumatoid factor and anti-CCP antibodies confirmed by blood test.

In particular, rotator cuff tears have symptoms similar to frozen shoulder, making differentiation difficult. It is not uncommon for patients who complain of "inability to lift the shoulder" to actually have a rotator cuff tear. If you experience weakness or a loss of strength during specific movements, tests should be performed with the possibility of a rotator cuff tear in mind.

Our Clinic's Examinations and Treatments

Examinations

Examination	Purpose/Content
Consultation, Palpation, Range of Motion Test	Confirm when, which shoulder, what movements cause pain, presence of night pain, degree of range of motion restriction. Rotator cuff function test also performed.
X-ray Examination	Confirm bone deformation, calcification (calcific tendinitis), and joint changes. In many cases of frozen shoulder, X-rays show no abnormalities.
Blood Test	Performed when differentiation from rheumatoid arthritis, infection, or systemic disease is necessary.

If a rotator cuff tear is suspected, an MRI scan is necessary, but our clinic does not have MRI equipment, so we will provide a referral to a cooperating medical institution.

Treatment

Acute Phase (Period of severe inflammation)

• Pain relievers (NSAIDs, acetaminophen): Oral medication or patches to alleviate inflammation and pain.
• Shoulder joint injection (steroid injection): Steroids injected into or around the joint rapidly quell severe inflammation. Particularly effective for those with severe night pain or impaired daily life.
• Rest: During periods of severe pain, it is important to rest the affected area without forcing movement.

Chronic Phase / Recovery Phase (Period of improving stiffness)

• Stretching and exercise therapy: Gradually loosen the stiff joint. We will guide you on stretching methods you can do at home.
• Warmth: Once the acute phase subsides, warming promotes blood flow and makes it easier to regain joint flexibility (during the acute phase, cooling is more appropriate).
• Hyaluronic acid injection: May be used to aid joint lubrication and make movement easier.

Stretching and Self-Care You Can Do at Home

During the chronic and recovery phases, home stretching significantly impacts recovery. During the acute phase (when pain is severe), avoid forced movement, and start gradually once the pain subsides.

Pendulum Exercise (Codman's Exercise)

Place your non-painful hand on a table or chair back and lean your body slightly forward. Let the affected arm hang relaxed and swing it gently back and forth, side to side, and in small circles. This stretch uses gravity to gradually widen the shoulder joint and is the first exercise to try once the acute phase has settled. Aim for 1-2 minutes per session, 2-3 times a day.

Shoulder Stretch with a Towel

Place a towel behind your back, holding it from above with your non-painful hand and from below with your affected hand. Slowly pull the towel upward with your non-painful hand, allowing your affected arm to move without strain. It's important not to pull too hard and to stop just before pain occurs.

Range of Motion Training with a Wall

Place your fingertips on a wall and slowly "walk" your fingers upward along the wall. Stop when pain begins and aim to gradually increase that position each day. By continuing this daily, your range of motion will slowly expand.

For all stretches, the basic rules are "perform within a pain-free range" and "do not force movement." Forcibly moving through pain can reignite inflammation, so it's important to be patient and consistent.

Flow of Consultation

1. Web reservation or direct visit
   Web reservation is convenient if you are in severe pain. Same-day visits without an appointment are also possible.
2. Reception and filling out a medical questionnaire
   Please fill out details such as when the pain started, which shoulder, what movements cause pain, presence of night pain, and any past shoulder injuries or surgeries.
3. Doctor's examination
   The doctor will check your shoulder's range of motion, muscle strength, and tender points, and differentiate it from conditions like rotator cuff tears or calcific tendinitis.
4. X-ray examination
   Check for calcification, bone changes, and joint condition.
5. Diagnosis, treatment, and guidance
   We will provide treatment appropriate for your current stage (pain relievers, injections, stretching guidance, etc.). We will also carefully explain self-care methods you can do at home.
6. Payment and departure
   We will explain precautions for daily life and the approximate timing for your next visit. Regular follow-up will be conducted as necessary.

Frequently Asked Questions

Will frozen shoulder heal if left untreated?
In many cases, it will heal naturally over time, but it can take anywhere from six months to over two years. If left untreated and the joint stiffens significantly (contracture), recovery will take longer. Appropriate treatment and rehabilitation can often shorten the recovery period, so we recommend seeking early medical attention.

Are injections painful? How many injections are usually given?
There is temporary pain during the injection, but many patients say, "It wasn't as bad as I thought." Many people experience significant pain relief within 2-3 days after the injection. The number of injections will be determined by monitoring the progress of symptoms, but frequent steroid injections to the same area should be avoided, so they are administered with intervals in between.

Should I apply heat or cold?
During the acute phase (when pain is severe and there is warmth), cooling can help reduce inflammation. During the chronic phase (when pain has subsided and stiffness has set in), warming promotes blood circulation and makes stretching more effective. The appropriate method depends on your current stage, so please consult us during your visit.

Can the same symptoms occur in the other shoulder?
Yes. In a certain number of cases, symptoms develop in the opposite shoulder within a few years after one side recovers. If your other shoulder starts to hurt, please come back for a visit.

Is surgery ever necessary?
For frozen shoulder (adhesive capsulitis) itself, surgery is rarely necessary. However, if a rotator cuff tear is also present, or if conservative treatment does not lead to improvement for a long period, specialized hospital treatment may be required. In such cases, we will provide a referral.

Which department should I visit?
You can consult an orthopedic surgeon or an internist (family doctor). Our clinic also offers orthopedic services, including X-rays, injections, and stretching guidance. If you're unsure "where to go," please feel free to consult us first.

Clinic Hours and Access

Item	Details
Clinic Name	Halu Clinic
Clinic Hours	Monday - Sunday 9:00 - 21:00
Closed Days	None (irregular holidays)
Location	J&MALL 1F, 2-27-1 Kamijujo, Kita-ku, Tokyo 114-0034
By Train/On Foot	Approx. 1-2 minutes walk from Jujo Station on the JR Saikyo Line, J&MALL 1F
By Bus	Right in front of the Kokusai Kogyo Bus "Jujo Station" bus stop
By Car	Please use nearby coin parking lots
Contact Us	TEL: 03-6698-2509 / Official LINE: https://lin.ee/DRxcelo

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