Frozen shoulder: Symptoms, causes and treatments

Your shoulder joint is surrounded by a strong capsule, which is covered by tendons and muscles. Frozen shoulder happens when this capsule becomes thickened, tighter and inflamed. This stops your shoulder from being able to move freely. You can get frozen shoulder in just one shoulder or both.

Up to 5 in 100 people will get frozen shoulder at some point in their lives.¹ You’re more likely to get it between the ages of 40 and 70, and it’s slightly more common in women than men.

It’s not always exactly clear why some people develop a frozen shoulder. Sometimes there seems to be no underlying cause at all. This is known as ‘primary’ (or idiopathic) frozen shoulder.²

If there is an underlying cause, it’s known as ‘secondary’ frozen shoulder. This may be due to a shoulder injury, such as an injury to your rotator cuff (the tendons and muscles in your shoulder), or it might happen if you’ve had to keep your shoulder still for a long time (perhaps after a fracture or surgery on your shoulder).

Although doctors aren’t sure why, some medical conditions can also increase your risk of getting frozen shoulder. These include:

• diabetes
• underactive or overactive thyroid
• heart disease or stroke.³

There are 2 main symptoms of frozen shoulder:

• pain. This comes on gradually and may become severe. Frozen shoulder pain is often worse at night or when you move your shoulder joint
• stiffness. This can stop you from moving your shoulder normally. It can make it difficult to do everyday tasks such as driving or dressing yourself.

If you have any of these symptoms, see a GP or physiotherapist for advice.

There are 3 stages of frozen shoulder, which can overlap and be difficult to tell apart.

• Painful or ‘freezing’ phase: You start to get pain in your shoulder during this phase, and it slowly gets worse. This phase may last from 2 to 9 months.
• Stiffness or ‘frozen’ phase: The pain may get less severe, but it gets harder to move your shoulder. This can affect your day-to-day activities. This phase may last between 4 months and a year.
• Resolution or ‘thawing’ phase: The stiffness gradually eases and most gradually recover their shoulder function. This phase can sometimes take up to 3 years or more.

For most people, a frozen shoulder gets better within 18 months to 2 years. But it can take much longer for some people. If you’re having shoulder pain or stiffness, it’s best to seek advice from your GP or physio rather than just waiting for it to get better on its own.

Your GP or physiotherapist will ask about your symptoms, including:

• how long you’ve had them
• when you tend to get them
• if anything makes it worse
• whether it affects your usual activities.

They’ll also ask you about your medical history to determine if you have any existing conditions which make you more likely to develop frozen shoulder or could impact your recovery.

Your GP or physiotherapist will examine your shoulder to see if it’s tender and assess how well you can move your shoulder by performing a range of tests. These may include:

• gently moving your arm for you (‘passive movement’)
• asking you to move your arm yourself into different positions (‘active movement’).

These tests let them see if the range of movement of your shoulder is reduced. Tell your GP or physio if the exercises feel very uncomfortable for you.

You won’t need a shoulder X-ray to diagnose frozen shoulder, but your GP may suggest you have one to rule out other conditions.

There is a lot you can do to help yourself if you have a frozen shoulder. Try these tips alongside advice and treatment from your GP or physiotherapist:⁴

• If you need pain relief, you can take over-the-counter painkillers like paracetamol or ibuprofen. Talk to your GP or pharmacist if you have any questions about your medication.
• Try heat or cold packs. These may help to reduce stiffness and swelling and relieve pain.
• Support your arm with pillows while sleeping or while sitting in a chair. In bed, this can prevent you rolling onto the affected side. A pillow in the small of your back while sitting can improve your posture, which may help.
• Try to keep using your arm as normally as you can. It helps to keep your shoulder moving. You may need to stop certain activities that worsen the pain. Aim for a balance between rest and activity.

Frozen shoulder can often get better on its own, but if it’s left untreated it might take several years to fully recover.

The aims of any treatment include reducing your pain and improving the movement in your shoulder. It’s best to start treatment as early as possible.

Physiotherapy is an important treatment for frozen shoulder.

You’ll usually have an initial course of physiotherapy for 6 weeks. This may go on longer if it’s helping. Your physio can give advice on how to manage your symptoms, including how you can modify your usual activities to reduce any pain. Physiotherapy may also involve a wide range of different treatments including:

• at home exercises. These help to reduce pain and improve the function and movement of your frozen shoulder
• manual therapy (mobilisation). This is when your physio moves your shoulder joint in a particular way to help relieve any pain or stiffness. It may also help restore normal movement.

Your GP may also recommend a treatment called hydrodilatation. This procedure involves injecting your shoulder with a sterile salt water solution (saline), and is done with the guidance of an X-ray or ultrasound. Sometimes, corticosteroid or local anaesthetic is added. The injection should stretch the shoulder capsule and free up the joint to help improve your movement.

Most people with frozen shoulder find their symptoms improve eventually with self-help and non-surgical treatments. But if these haven’t helped, your GP may refer you to an orthopaedic surgeon, a doctor who specialises in bones and joints.

Your orthopaedic surgeon may recommend one of the following procedures:

• shoulder manipulation under anaesthetic (MUA). In this procedure, your surgeon moves your shoulder into positions that will stretch or tear the tightened capsule. This should increase the movement you have in your shoulder. You will have a general anaesthetic for this procedure, which means you’ll be asleep
• arthroscopic capsular release. Your surgeon uses keyhole surgery to look inside your shoulder joint, usually under general anaesthetic. They use surgical instruments to divide parts of the capsule in your shoulder joint. You may have this surgery at the same time as an MUA.

Regular, gentle exercise and stretching may relieve frozen shoulder symptoms and help you recover. As your shoulder range improves, gentle strengthening exercises will help you get back to your previous level of function. Your physiotherapist will show you various exercises you can do at home. It’s important to follow their advice.

Frozen shoulder cannot be prevented, but early treatment can help relieve your symptoms and reduce the time it takes to recover.

There may be some things you can do to prevent secondary frozen shoulder. This is when there is an underlying cause for your frozen shoulder, like an injury, shoulder surgery or another condition.

If you’ve had a shoulder injury or surgery, it’s important to keep your shoulder as mobile as possible afterwards. Follow advice from your surgeon or physiotherapist about wearing a sling and getting your shoulder moving again safely.

If you have diabetes, making sure it’s well managed may help to prevent secondary frozen shoulder.

This article was originally published on bupa.co.uk and has been amended in line with Australian guidelines.

The Australian Physiotherapy Association can help you find a physio near you.

Chronic Pain Australia provides education and support for those living with chronic pain.

Musculoskeletal Health Australia provides information and support for people living with arthritis and musculoskeletal conditions. Visit their website or call them on 1800 263 265.