Frozen shoulder is a condition where your shoulder becomes painful and stiff. No one is really sure why this happens. Treatment, including painkillers and exercises, can help ease your symptoms.
About frozen shoulder
Your shoulder is what’s called a ‘ball and socket’ joint. The ball at the top of your upper arm bone (humerus) moves in the shallow socket on the edge of your shoulder blade (scapula). The whole joint is enclosed within a strong, fibrous capsule. Frozen shoulder happens when this capsule becomes thickened, contracted and tighter than it should be. For this reason, frozen shoulder is also known by the medical term ‘adhesive capsulitis’. You can get frozen shoulder in just one shoulder or both.
Up to five out of 100 people will get frozen shoulder at some point in their life. You’re more likely to get frozen shoulder if you’re aged between 40 and 60, and it’s slightly more common among women. People with certain medical conditions are more likely to get a frozen shoulder – for more information about this, see our section on causes.
Causes of frozen shoulder
Doctors don’t yet know exactly why frozen shoulder develops. It’s thought that it may be caused by inflammation of your shoulder joint and its surrounding capsule.
Primary (idiopathic) frozen shoulder
Sometimes there seems to be no underlying cause at all for a person getting a frozen shoulder. This is known as primary (or idiopathic) frozen shoulder.
Secondary frozen shoulder
Secondary frozen shoulder is when there is some previous damage to your shoulder, or you have a medical condition which makes a frozen shoulder more likely.
Frozen shoulder can sometimes develop if you have 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. For example, this may be necessary after a fracture or after surgery on your shoulder.
Although doctors aren’t sure why, some medical conditions can increase your risk of getting frozen shoulder. These include:
- an underactive thyroid
- an overactive thyroid
- heart disease
Frozen shoulder symptoms
There are two main symptoms of frozen shoulder.
- A dull or aching pain in your affected shoulder, which is often worse at night or when you move your shoulder joint.
- Stiffness around your shoulder joint that may stop you from moving your shoulder normally. This can make it difficult to do everyday tasks such as driving or dressing yourself.
If you have any of these symptoms, see your physiotherapist for advice.
A frozen shoulder is usually said to develop in several stages, which may overlap.
- Painful or ‘freezing’ phase. You’ll slowly develop pain that’s worse when you move, and your shoulder will become stiffer. This phase may last from two to nine months.
- Stiffness or ‘frozen’ phase. The pain may get less, but moving your shoulder gets harder, affecting your day-to-day activities. This phase may last up to a year.
- Resolution or ‘thawing’ phase. The stiffness gradually eases and most people make a full recovery. This phase may last up to three years.
Some experts think that this pattern doesn’t really describe the experiences of people with frozen shoulder very well. If you think you have a frozen shoulder, it’s best to seek medical advice rather than just waiting for it to get better on its own.
Diagnosis of frozen shoulder
If you think you have frozen shoulder, see your GP or a physiotherapist. They’ll ask about your symptoms and medical history including any previous condition or injury that could make you more likely to develop a frozen shoulder.
They’ll also ask how your symptoms affect your everyday life.
Your physiotherapist will examine your shoulder to see if it’s tender. They’ll assess your shoulder by performing a range of physical tests to find out if it’s frozen shoulder or another condition. These may include both gently moving your arm for you (‘passive movement’), and asking you to move it yourself into different positions. This lets them see if the range of movement of your shoulder is reduced. Tell your physiotherapist if this is very uncomfortable for you.
The shoulder movement most likely to be affected by frozen shoulder is what is known as ‘passive external rotation’. This movement is demonstrated in this video on diagnosing frozen shoulder.
Although a shoulder X-ray can’t confirm a frozen shoulder, your physiotherapist may suggest you have one because it can rule out other conditions. If you’re having treatment that isn’t helping, you may need further tests such as an MRI or CT scan on your shoulder.
Treatment of frozen shoulder
Frozen shoulder can often get better on its own, but be aware that it may take several years to fully recover.
The aims of any treatment are to reduce your pain and increase the movement in your shoulder. Getting treatment early may give the best results.
If you think you have a frozen shoulder, you should see your physiotherapist. But there’s a lot you can do to help yourself as well.
- If you need pain relief, take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist.
- Support your arm with pillows while sleeping or while sitting in a chair. A pillow in the small of your back while sitting can improve your posture, which may help.
- It’s important to continue using your arm to help keep it as mobile as your pain allows. Aim for a balance between rest and activity. This might affect some of your usual daily activities.
- Follow any advice your physiotherapist gives you about moving your shoulder, including any exercises you’re given. Watch the video in our section on exercises for some suggestions.
Physiotherapy is an important treatment for frozen shoulder. Your GP may refer you to a physiotherapist or you may be able to get an appointment directly with one.
Physiotherapy may involve a wide range of different treatments. The two most commonly used are described here.
- Exercises. Your physiotherapist shows you exercises you do at home to improve the function and movement of your frozen shoulder. These may include some like those shown in our video of exercises for frozen shoulder in our section on exercises.
- Manual physiotherapy (mobilisation). This is when your physiotherapist moves your shoulder joint in particular ways to help relieve any pain or stiffness. It may also help restore normal movement.
Prevention of frozen shoulder
To prevent secondary frozen shoulder, it’s important to keep your shoulder as mobile as possible. If you injure your shoulder or develop shoulder pain that limits your range of movement, get treatment as soon as you can. If you have an injury or surgery to your shoulder, follow the advice your doctor or physiotherapist gives you about wearing a sling and getting your shoulder moving again safely.