Adhesive capsulitis, commonly called frozen shoulder, is a condition in which the shoulder joint capsule thickens and tightens, causing pain and progressive loss of motion. It most often affects adults aged 40 to 60, especially women and people with diabetes. Physical therapy can restore range and function. SportsMed Physical Therapy treats it at New Jersey and Connecticut locations.
What Is Adhesive Capsulitis?
Adhesive capsulitis is a disorder of the glenohumeral joint capsule, the sleeve of connective tissue that surrounds the ball-and-socket shoulder joint. In a healthy shoulder that capsule is loose and folded, allowing the arm to rotate freely. In frozen shoulder the capsule becomes inflamed, thickened and contracted, especially in the rotator interval and coracohumeral ligament, and the joint loses volume. The result is stiffness that limits motion in every direction, whether you move the arm yourself or someone moves it for you.
The condition affects roughly 2 to 5 percent of the general population, and up to 20 percent of people with diabetes. It typically appears between ages 40 and 60, is more common in women, and often follows a period of immobility such as a sling, a fracture or surgery. About one in six people eventually develop symptoms in the opposite shoulder as well, usually within five years of the first episode.
What Causes Adhesive Capsulitis?
Primary adhesive capsulitis has no clear trigger. It appears to begin with low-grade inflammation in the capsule that gradually turns into fibrosis, laying down disorganized collagen that shrinks the joint sleeve. Secondary adhesive capsulitis follows an identifiable event, usually a period when the shoulder stopped moving normally: a rotator cuff strain, a wrist or elbow fracture that kept the arm in a sling, a mastectomy, or recovery after shoulder or cardiac surgery. Endocrine conditions strongly raise risk, which is why blood sugar control matters.
It is worth understanding what frozen shoulder is not. It is not arthritis wearing out the joint surface, and it is not a rotator cuff tear, although both can occur alongside it. The restriction comes from the capsule tightening around the joint, which is why the shoulder will not move even when someone else lifts the arm. That distinction shapes the treatment plan.
Common causes and risk factors include:
- Diabetes, especially long-standing or poorly controlled
- Thyroid disease, including hypothyroidism and hyperthyroidism
- Age 40 to 60, with higher rates in women
- Prolonged shoulder immobilization after injury or surgery
- Previous frozen shoulder in the other shoulder
- Cardiovascular disease, stroke or Parkinson’s disease
- Rotator cuff tendon problems that limit daily reaching
What Are the Symptoms of Adhesive Capsulitis?
Frozen shoulder usually moves through three overlapping stages. The freezing stage brings increasing pain, often worse at night and when lying on the affected side. The frozen stage brings less pain but marked stiffness, so reaching a back pocket, fastening a bra or lifting a bag into an overhead bin becomes difficult. The thawing stage brings a slow, steady return of motion. People often first notice the problem through a single task, such as reaching for a seat belt or a high shelf, and only later realize how much range has quietly disappeared.
Typical symptoms include:
- Deep, aching pain in the shoulder and outer upper arm
- Night pain that disrupts sleep
- Loss of external rotation, so the arm will not turn outward
- Difficulty reaching overhead, behind the back or across the body
- Stiffness that is present whether you move the arm or a therapist does
- Compensating shoulder hiking when raising the arm
Seek prompt medical attention if shoulder stiffness follows significant trauma, or comes with fever, redness, unexplained weight loss, chest pain or numbness and weakness spreading down the arm.
How Is Adhesive Capsulitis Diagnosed?
Diagnosis is clinical and rests on one hallmark finding: loss of passive external rotation with the arm at the side. If a clinician cannot rotate your relaxed arm outward, the capsule itself is restricted rather than a muscle guarding the joint. Your therapist will also measure elevation, internal rotation and functional reach, screen the neck, and ask about diabetes, thyroid disease and any recent immobilization.
X-rays are sometimes ordered to rule out arthritis, calcific tendinitis or a missed dislocation. MRI is not usually needed but may be used when a rotator cuff tear is suspected or when stiffness does not follow the expected pattern.
How Physical Therapy Treats Adhesive Capsulitis
Treatment is matched to the stage. During the painful freezing stage, pushing hard into a stretch usually backfires. SportsMed therapists focus on pain modulation, gentle pendulum and active-assisted motion within a comfortable range, scapular and postural work, and education on sleeping positions that reduce night pain. Some patients pair physical therapy with acupuncture for symptom relief during this period.
Once pain settles into the frozen stage, the plan shifts to sustained, progressive stretching and manual therapy. Joint mobilization at the glenohumeral joint, low-load prolonged holds at end range, and home stretches performed several times daily are the strongest drivers of motion gain. As range returns, therapists add rotator cuff and scapular strengthening so the shoulder can control its new range. Patients who need help with dressing, grooming or fine hand tasks may also work with hand and occupational therapy. When a shoulder freezes after surgery, care follows a structured post-operative rehabilitation pathway, and patients who also have stiff, painful hands from osteoarthritis of the hand can be treated for both in the same visit.
Frequency matters more than intensity. A short stretching routine done four or five times a day usually produces more range than one long, aggressive session, and provokes far less night pain. Your therapist also sets expectations honestly, because progress is measured in degrees gained over months rather than sessions.
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How Long Does Recovery Take?
Frozen shoulder is slow. Left alone it commonly runs 12 to 30 months, and structured physical therapy usually shortens that. Many patients notice less night pain within 6 to 10 weeks and better reach by 3 to 6 months. Recovery moves faster with consistent daily home stretching, good blood sugar control and early treatment. It slows with diabetes, long delays before starting care, and sporadic exercise. Some patients benefit from a corticosteroid injection early on, which can make therapy far more productive. A small number need a manipulation or capsular release, and therapy afterward is essential to hold the range gained.
Frozen Shoulder Treatment Near You in New Jersey and Connecticut
SportsMed operates clinics across New Jersey and Connecticut, which matters for a condition that needs frequent, consistent visits over several months. Bergen County patients are treated at physical therapy in Hackensack, NJ, our Englewood clinic on Engle Street, Fort Lee, Fairview and Emerson. We also see patients from Paramus, Ridgewood, Lyndhurst, Bergenfield, Garfield, Fair Lawn, Franklin Lakes and Glen Rock, along with Jersey City and Hamden, Connecticut. Because frozen shoulder often follows a surgery or a fracture, many referrals come from local orthopedic and primary care practices in these communities.
Care spans Bergen, Essex, Hudson, Middlesex, Monmouth, Morris, Ocean, Passaic and Union Counties in New Jersey, plus Fairfield and New Haven Counties in Connecticut. Explore our New Jersey clinics and Connecticut clinics, search the full location list, or schedule a shoulder evaluation.
Frequently Asked Questions About Adhesive Capsulitis
Q: Will frozen shoulder go away on its own?
A: Many cases improve eventually, but the natural course often runs one to three years and some people are left with permanent loss of motion. Physical therapy generally shortens the timeline, reduces pain sooner and improves final range. Waiting is rarely the most comfortable or most complete route back.
Q: Should stretching for frozen shoulder hurt?
A: A mild stretching discomfort that fades within a few minutes is expected and productive. Sharp pain, or soreness that lingers for hours or worsens night pain, usually means the stretch was too aggressive for the current stage. Your therapist adjusts intensity based on how the shoulder responds between visits.
Q: Why is frozen shoulder so common with diabetes?
A: Elevated blood glucose promotes the formation of advanced glycation end products, which stiffen collagen throughout the body, including the shoulder capsule. People with diabetes develop adhesive capsulitis several times more often, tend to have more stubborn cases, and generally benefit from starting therapy earlier.
Q: Is a cortisone injection better than physical therapy?
A: They work best together. An injection can reduce capsular inflammation and night pain during the freezing stage, which lets you tolerate stretching. Injections alone rarely restore motion. Most evidence supports combining an injection with a consistent, progressive therapy program rather than choosing one option.
Q: Do I need a doctor’s referral to start therapy in New Jersey?
A: Both New Jersey and Connecticut allow direct access to physical therapy, so many patients book without a referral. Individual insurance plans may still require one for coverage or limit visits. SportsMed verifies your benefits in advance and explains any authorization requirements before treatment begins.
Q: How often will I need to come in?
A: Most frozen shoulder plans start at two visits per week for six to eight weeks, then taper as motion returns. Clinic sessions matter, but daily home stretching drives most of the progress. Choosing a nearby location, such as Fort Lee or Hackensack, makes that schedule realistic.
If your shoulder has been stiffening for weeks and night pain is affecting sleep, earlier care generally means a shorter recovery. A SportsMed therapist can confirm the diagnosis, identify your stage and build a stretching plan you can sustain at home.
Book an appointment at a clinic near you.Reviewed by the SportsMed Physical Therapy clinical team. Last updated: August 2026.