Overview
The shoulder is a ball and socket joint wrapped in a bag of tissue called the capsule. In frozen shoulder the capsule becomes inflamed, then shrinks and tightens, so the bones can no longer move freely against each other.
The medical name is adhesive capsulitis. It usually affects one shoulder, and it is commonest between about 40 and 70 years of age, more often in women.
Symptoms
Pain is usually the first symptom. It is often worse at night, and it can make lying on that side difficult. Stiffness follows, and the shoulder gradually loses movement.
Everyday actions become hard: reaching behind the back, fastening a garment, combing the hair or lifting the arm overhead. Movement is limited both when the person moves the arm and when someone else moves it. Over many months the pain usually settles first, and movement returns slowly afterwards.
When to see a doctor
See a doctor if shoulder pain and stiffness have lasted more than a few weeks, if they are getting worse, if they stop everyday movements such as dressing or washing, or if sleep is regularly disturbed. New numbness, pins and needles or weakness in the arm should also be checked.
Causes
In most people no cause is found: the capsule becomes inflamed without any obvious trigger.
It also develops after a spell in which the shoulder could not move normally, for example after an injury, a fracture, or surgery on the shoulder, the heart or the breast. Diabetes and thyroid problems are clearly linked with it, although the reason is not fully understood.
Risk factors
- Age between about 40 and 70
- Being a woman
- Diabetes
- An overactive or underactive thyroid
- A shoulder injury, fracture or operation
- Surgery on the heart or the breast
- A long period with the arm kept still, for example in a sling
- A disc problem in the neck
Complications
The main problem is a long spell of pain, broken sleep and limited use of the arm, which can affect work, driving and daily tasks. The muscles around the shoulder weaken while it is being used less.
Most people get back full or nearly full movement, but some are left with a small lasting restriction, particularly when stiffness has gone untreated for a long time.
Prevention
Frozen shoulder cannot always be prevented, because many cases have no clear trigger. Keeping the shoulder gently moving after an injury or an operation, within the limits a doctor or physiotherapist sets, lowers the chance of stiffness setting in, and treating stiffness early stops it going further. Keeping diabetes and thyroid conditions well controlled also helps.
Diagnosis
Frozen shoulder is usually diagnosed from the history and the examination. The doctor moves the arm in different directions and compares it with the other side, and the finding that points to frozen shoulder is loss of movement in every direction, including when the doctor moves the arm.
Scans are not usually needed. An X-ray may be taken to rule out arthritis or calcium deposits, and other imaging is used when the picture is unclear. Blood tests may be suggested to look for diabetes or a thyroid problem.
Treatment
Treatment aims to ease the pain and get the movement back. Pain relief such as paracetamol, or an anti-inflammatory medicine such as ibuprofen, is the usual first step, and a heat pack before exercises can help.
If the pain continues, a doctor may prescribe stronger pain relief or offer a steroid injection into the shoulder. Physiotherapy adds a programme of stretching and strengthening, usually over at least six weeks, with advice on posture. The exercises given should be followed as taught rather than added to.
When pain and stiffness do not settle with these measures, a surgeon may release the tightened tissue through keyhole surgery. Movement and function usually return within about a year with exercise and pain relief, and shoulders that are not treated often improve within about two years.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“A frozen shoulder must be rested completely until the pain goes.”What is true?
Fact
Keeping the shoulder gently moving is part of the treatment, along with the exercises a physiotherapist or doctor gives. What is advised against is making up strenuous exercises or using heavy gym equipment, not ordinary gentle movement.
Myth“A strong pull or a hard jerk from someone will free the shoulder in one go.”What is true?
Fact
The treatment that is recommended is gentle guided exercise, pain relief and, if needed, a steroid injection. If movement still does not return, a surgeon can release the tight tissue through keyhole surgery, after a proper assessment, rather than by force.
Myth“A stiff shoulder means a calcium deficiency or a nerve problem in the neck.”What is true?
Fact
Frozen shoulder is inflammation and shrinkage of the tissue around the shoulder joint itself. Most cases have no clear trigger, and it is commoner in people with diabetes or a thyroid problem, and after a shoulder injury or an operation.
Myth“Nothing will help, so it will need an operation sooner or later.”What is true?
Fact
Most people get their movement back with exercises, physiotherapy and pain relief, often within about a year, and shoulders that are left alone often improve within about two years. Surgery is kept for shoulders that do not respond to those treatments.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
Why is my frozen shoulder taking so long to get better?
Frozen shoulder is slow by nature. The capsule around the joint has tightened, and it loosens gradually. Pain usually settles before the movement comes back, so it is common to feel better but still be stiff. Most people recover within about a year with exercises and pain relief, and some take up to two.
I have diabetes. Does that change anything?
Diabetes is one of the clearest links with frozen shoulder, so it is worth having your blood sugar reviewed, and keeping it well controlled. Tell the doctor about your diabetes before any injection is considered, so it can be taken into account. The exercises and physiotherapy are the same.
Should the exercises hurt?
Some discomfort during stretching is expected, but sharp or lasting pain is a sign to ease off. The aim is gentle, regular movement rather than forcing the joint. A physiotherapist can set the right level and adjust it as the shoulder improves.
Can frozen shoulder come back, or affect the other side?
It usually affects one shoulder at a time, and some people develop it in the other shoulder later. Keeping both shoulders moving, and treating stiffness early, is the sensible approach. If pain and stiffness return in a shoulder that had recovered, see a doctor so the cause can be checked rather than assumed.
