Dr Puah Ken Lee 潘健理
Orthopaedic Surgeon
Shoulder, Elbow & Sports Injuries
Practising at Mount Elizabeth Novena Hospital, Singapore
Appointments by prior arrangement
Dr Puah Ken Lee 潘健理
Orthopaedic Surgeon
Shoulder, Elbow & Sports Injuries
Mount Elizabeth Novena Hospital, Singapore
✔ Subspecialty Focus in Shoulder & Elbow, Sports Injuries
✔ Practising at Mount Elizabeth Novena Hospital
✔ Evidence-based treatment, Individualised Care
Frozen Shoulder Treatment in Singapore (Adhesive Capsulitis)
Frozen shoulder, also known as adhesive capsulitis, causes progressive shoulder pain and stiffness with restriction of both active and passive movement. Everyday activities such as dressing, reaching overhead, reaching behind the back and sleeping comfortably may become difficult.
Most patients with frozen shoulder do not require surgery. Treatment depends on the stage and severity of the condition and may include appropriate exercises and physiotherapy, pain relief, corticosteroid injection and other interventions in selected patients. Arthroscopic capsular release is generally reserved for persistent stiffness that has not responded adequately to non-surgical treatment.
Dr Puah Ken Lee is a fellowship-trained orthopaedic surgeon with a subspecialty focus in shoulder and elbow surgery and sports injuries. He assesses and treats patients with frozen shoulder at 360 Orthopaedics, Mount Elizabeth Novena, Singapore.
What Is Frozen Shoulder?
Frozen shoulder occurs when the capsule surrounding the shoulder joint becomes inflamed, thickened and contracted. This results in pain and progressive restriction of movement.
A characteristic feature is restriction of both:
- Active movement — movement when you move your own arm
- Passive movement — movement when the shoulder is moved by someone else
This helps distinguish frozen shoulder from some other causes of shoulder pain and weakness.
Frozen shoulder commonly develops without a specific injury, although it can also occur after surgery, injury or a period of reduced shoulder movement.
What Are the Symptoms of Frozen Shoulder?
Common symptoms include:
- Gradually increasing shoulder pain
- Pain that may be worse at night
- Progressive shoulder stiffness
- Difficulty reaching overhead
- Difficulty reaching behind the back
- Difficulty dressing or grooming
- Difficulty fastening clothing behind the body
- Reduced ability to exercise or perform sporting activities
- Difficulty sleeping on the affected side
The degree of pain and stiffness varies between patients and may change as the condition progresses.
What Are the Three Stages of Frozen Shoulder?
Frozen shoulder has traditionally been described as progressing through three overlapping stages.
1. Freezing stage
Pain becomes increasingly prominent and shoulder movement gradually decreases.
Night pain can be particularly troublesome during this phase.
2. Frozen stage
Pain may become less severe, but stiffness and loss of movement become more prominent.
Activities requiring the arm to reach overhead, behind the back or away from the body can be difficult.
3. Thawing stage
Shoulder movement gradually begins to improve.
These stages are useful for understanding the condition, but not every patient follows the same timeline or experiences each stage in the same way.
Frozen Shoulder and Diabetes
Frozen shoulder is more common in people with diabetes, and the condition may behave differently in this group.
Patients with diabetes may experience more persistent stiffness and can sometimes have a more difficult recovery. The severity of the frozen shoulder and the individual’s general health therefore need to be considered when planning treatment.
Treatment is still individualised and may include physiotherapy, corticosteroid injection and, for selected patients with persistent stiffness, arthroscopic capsular release.
Research in Frozen Shoulder and Diabetes
This research examined clinical outcomes following arthroscopic capsular release and differences in recovery in patients with and without diabetes.
Published research forms part of Dr Puah’s broader academic work in shoulder and elbow surgery and informs an evidence-based approach to discussing treatment options, expected recovery and realistic outcomes with patients.
→ Read Dr Puah’s research and publications
How Is Frozen Shoulder Diagnosed?
Frozen shoulder is primarily a clinical diagnosis.
Assessment usually includes a detailed history and examination of the shoulder.
The examination looks at:
- Active shoulder movement
- Passive shoulder movement
- The pattern of stiffness
- Shoulder strength
- Areas of tenderness
- Features suggesting another cause of shoulder pain
A marked reduction in passive movement, particularly external rotation, is an important clinical feature.
Imaging may be used when appropriate, but a scan should be interpreted together with the clinical findings.
Do I Need an MRI for Frozen Shoulder?
Not every patient with frozen shoulder requires an MRI.
X-rays may be useful to exclude conditions such as significant shoulder arthritis.
Ultrasound or MRI may be considered when symptoms or examination findings suggest another problem, such as a rotator cuff tear, or when the diagnosis is uncertain.
An MRI can show changes associated with frozen shoulder, but the diagnosis should not be based on the MRI report alone.
Is It Really Frozen Shoulder?
Several shoulder conditions can cause pain and difficulty moving the arm.
These include:
- Rotator cuff tear
- Rotator cuff tendinopathy
- Calcific tendinitis
- Shoulder arthritis
- Pain referred from the neck
- Post-traumatic shoulder stiffness
One important distinction is that patients with frozen shoulder typically have restriction of passive as well as active movement.
A patient with a rotator cuff tear, for example, may have difficulty actively lifting the arm because of pain or weakness while retaining considerably more passive movement.
An accurate diagnosis is important because the treatment for these conditions is different.
→ Learn more about Frozen Shoulder vs Rotator Cuff Tear
How Is Frozen Shoulder Treated?
Treatment depends on the severity and stage of the condition, the degree of pain and stiffness and how much the symptoms interfere with everyday activities.
Most patients can be treated without surgery.
Treatment may include a combination of the following:
Pain Relief and Activity Modification
Pain relief may be useful during the painful phase of frozen shoulder.
Activities that repeatedly aggravate the shoulder may temporarily need to be modified while maintaining appropriate movement.
Completely avoiding shoulder movement for prolonged periods is generally undesirable because stiffness is already a major feature of the condition.
Physiotherapy and Exercises for Frozen Shoulder
Exercises and physiotherapy aim to maintain or progressively restore shoulder movement.
The appropriate programme depends on how painful and irritable the shoulder is.
During a very painful phase, repeatedly forcing the shoulder aggressively through severe pain may not necessarily be helpful. As pain improves, stretching and mobility exercises can usually be progressed.
Rehabilitation should therefore be tailored to the individual rather than following the same programme at every stage.
Corticosteroid Injection for Frozen Shoulder
A corticosteroid injection into the shoulder joint may be considered, particularly when pain and inflammation are prominent.
The objective is primarily to reduce pain and inflammation. Improving pain may also make it easier for the patient to perform appropriate exercises and participate in rehabilitation.
The potential benefits and risks of an injection should be considered individually.
An injection does not mechanically stretch or release the contracted shoulder capsule and should generally form part of an overall treatment programme rather than be considered a substitute for rehabilitation.
Where appropriate, shoulder injections can be performed under ultrasound guidance to guide placement of the injection.
→ Learn more about Ultrasound-Guided Shoulder Injections
What Is Hydrodilatation?
Hydrodilatation, sometimes called hydrodistension, involves introducing fluid into the shoulder joint with the aim of stretching the contracted capsule.
It is one of several interventions that may be considered for frozen shoulder. Outcomes can vary between patients, and patients with diabetes may have a higher risk of treatment failure or recurrence following hydrodilatation.
Whether hydrodilatation is appropriate depends on the stage of the condition, previous treatment, severity of stiffness and the individual patient’s circumstances.
When Is Surgery Needed for Frozen Shoulder?
Most frozen shoulders do not require surgery.
Surgery may be considered when there is:
- Persistent and functionally significant stiffness
- Inadequate improvement despite appropriate non-surgical treatment
- Substantial interference with work, sleep or everyday activities
- A clinical situation in which the expected benefit of surgery justifies its risks
The decision should be individualised rather than based simply on how long the patient has experienced symptoms.
Arthroscopic Capsular Release for Frozen Shoulder
Arthroscopic capsular release is a keyhole procedure that may be considered for selected patients with persistent frozen shoulder.
A small camera is introduced into the shoulder joint through a small incision. Contracted portions of the shoulder capsule are then carefully released to improve movement.
The objective is to restore movement while allowing the shoulder to begin rehabilitation promptly.
Physiotherapy after capsular release is important because movement gained during surgery needs to be maintained during recovery.
As with any operation, potential risks and expected benefits should be discussed before deciding whether surgery is appropriate.
→ Learn more about Arthroscopic Capsular Release
How Long Does Frozen Shoulder Take to Recover?
Frozen shoulder can take many months to improve and, in some patients, the natural course may extend considerably longer.
However, this does not mean that every patient should simply wait for the condition to resolve.
Treatment may be useful for:
- Controlling pain
- Maintaining or improving movement
- Helping patients continue everyday activities
- Facilitating rehabilitation
- Addressing persistent stiffness when recovery is unsatisfactory
The recovery timeline varies considerably.
Factors that may influence recovery include:
- Severity of stiffness
- Stage of the condition
- Diabetes and other medical conditions
- Previous shoulder injury or surgery
- Response to treatment
- Individual biological variation
The aim is not simply to achieve a normal range of motion as quickly as possible, but to restore useful, comfortable shoulder function.
Can Frozen Shoulder Recover Without Surgery?
Yes.
Most patients with frozen shoulder can be managed without surgery.
Improvement may occur gradually with a combination of time, appropriate exercises, physiotherapy and treatment directed at controlling pain where required.
Surgery is generally reserved for selected patients whose stiffness remains significant despite appropriate non-operative treatment.
Frequently Asked Questions About Frozen Shoulder
What is the fastest way to treat frozen shoulder?
There is no single treatment that is appropriate for every patient.
Treatment depends on whether pain or stiffness is the dominant problem, the stage of the condition, underlying medical conditions and how much the shoulder is affecting daily life.
A combination of pain control, appropriate exercises and selected interventions may be used.
Should I exercise a frozen shoulder if it hurts?
Some discomfort during stretching may occur, but repeatedly forcing a highly painful shoulder aggressively is not necessarily beneficial.
The intensity of rehabilitation should be appropriate for the stage and irritability of the shoulder.
Does a steroid injection cure frozen shoulder?
A corticosteroid injection does not mechanically release the contracted capsule.
It may reduce pain and inflammation and can help some patients participate more comfortably in rehabilitation.
Why is frozen shoulder associated with diabetes?
Frozen shoulder occurs more frequently in people with diabetes.
The exact relationship is complex, and patients with diabetes may sometimes experience more persistent stiffness or differences in recovery.
Do I need an MRI for frozen shoulder?
Not routinely.
Frozen shoulder is usually diagnosed clinically. Imaging may be useful when another condition needs to be excluded or the diagnosis is uncertain.
Can frozen shoulder affect both shoulders?
Yes.
Frozen shoulder can affect the opposite shoulder at a different time, although this does not occur in every patient.
Can frozen shoulder come back?
Recurrence in the same shoulder after recovery is less common, but persistent or recurrent stiffness should be reassessed to ensure that frozen shoulder remains the correct diagnosis and that another shoulder condition has not developed.
When should I see a shoulder specialist for frozen shoulder?
Consider an assessment if shoulder pain and stiffness are persistent, interfere significantly with sleep or daily activities, or if you are uncertain whether the problem is frozen shoulder or another shoulder condition.
Assessment may also be useful when symptoms are not improving despite treatment.
About Dr Puah Ken Lee
Dr Puah Ken Lee is an orthopaedic surgeon in Singapore whose clinical practice focuses on shoulder, elbow and sports injuries.
His professional background includes:
- Fellowship training in shoulder and upper-limb surgery
- Former Consultant with the Sports Service at Singapore General Hospital
- Chair, Singapore Shoulder & Elbow Society
- Chair, Chapter of Orthopaedic Surgeons, Academy of Medicine, Singapore
- Corresponding Member of the American Shoulder and Elbow Surgeons
- Published research in shoulder and elbow surgery, including research involving diabetic frozen shoulder
- Invited faculty teaching shoulder arthroscopy at regional and international courses
Dr Puah’s approach is to establish the diagnosis, understand the stage and severity of the condition and discuss the available non-surgical and surgical treatment options.
Most patients with frozen shoulder do not require surgery.
Where an intervention is considered, treatment is tailored to the individual’s symptoms, stiffness, medical conditions, functional requirements and treatment goals.
Related Frozen Shoulder and Shoulder Resources
Frozen Shoulder
- Frozen Shoulder vs Rotator Cuff Tear
- Arthroscopic Capsular Release
- Ultrasound-Guided Shoulder Injections
Other Causes of Shoulder Pain and Stiffness
Shoulder Assessment and Treatment
Research
Frozen Shoulder Assessment at Mount Elizabeth Novena
If you have persistent shoulder pain and stiffness, an assessment can help determine whether the symptoms are due to frozen shoulder or another shoulder condition and which treatment options may be appropriate.
360 Orthopaedics
Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road #07-24
Singapore 329563
Dr Puah Ken Lee
Orthopaedic Surgeon
Shoulder, Elbow & Sports Injuries
Book an appointment or contact the clinic via WhatsApp.
Dr Puah Ken Lee is a Singapore-based orthopaedic surgeon specialising in shoulder, elbow and sports injuries at 360 Orthopaedics, located at Mount Elizabeth Novena. He treats patients with frozen shoulder using a combination of non-surgical and minimally invasive techniques tailored to each stage of the condition.
In selected cases where stiffness persists, procedures such as arthroscopic capsular release may be considered.
Dr Puah is regularly invited to teach shoulder surgery internationally
Frozen shoulder can significantly impact quality of life, but early diagnosis and appropriate treatment can improve outcomes.
Dr Puah Ken Lee is an orthopaedic surgeon in Singapore specialising in shoulder and sports injuries at 360 Orthopaedics, Mount Elizabeth Novena. Patients with persistent shoulder stiffness are encouraged to seek specialist evaluation.