Frozen Shoulder

Overview

Frozen shoulder, also called adhesive capsulitis, is a condition where the shoulder joint becomes stiff, painful, and difficult to move. The tissue around the shoulder joint thickens and tightens, 'freezing' the shoulder in place.

Frozen shoulder affects about 2 to 5 out of every 100 people. It is a fairly common condition, especially among people in their 40s to 60s.

Frozen shoulder is most common in people between 40 and 60 years old, and it affects women more often than men. It is also more likely in people with diabetes, thyroid problems, or after a shoulder injury or surgery that keeps the arm immobile for a long time.

Symptoms

Common symptoms

• Dull or aching pain deep in the shoulder, often worse at night.
• Stiffness that makes it hard to move the arm in certain directions, like reaching overhead, behind your back, or out to the side.
• Limited range of motion that gradually gets worse over weeks to months.

Symptoms in children

• Frozen shoulder is extremely rare in children. If a child has shoulder pain and stiffness, it is more likely due to another cause, and a doctor should evaluate it.

Symptoms in older adults

• In older adults, frozen shoulder can last longer and may be more stubborn. Pain may be less intense, but stiffness can limit daily activities like dressing or bathing.

Causes

Main causes

• The exact cause is not fully understood, but it involves inflammation and thickening of the shoulder capsule – the tissue that surrounds the shoulder joint and helps it move smoothly.
• The capsule becomes tight and sticky, which limits movement and causes pain.

Risk factors

• Being between 40 and 60 years old.
• Being female.
• Having diabetes – this is a strong risk factor, and frozen shoulder can be more severe and last longer in people with diabetes.
• Having a thyroid condition, like an overactive or underactive thyroid.
• Having an injury or surgery that keeps your arm still for a long time, such as after a fracture, rotator cuff repair, or stroke.

When to see a doctor

See a doctor urgently if:

• If you have shoulder pain and stiffness after a recent fall or injury.
• If you have signs of infection such as fever, redness, warmth, or swelling around the shoulder.

Book a routine appointment if:

• If shoulder pain and stiffness last more than a few weeks and are not improving with rest and gentle movement.
• If you have a condition like diabetes or thyroid disease and develop new shoulder symptoms.

Diagnosis

A doctor will ask about your symptoms and medical history, and perform a physical exam to check your shoulder's range of motion and pain. They will move your shoulder in different directions and may compare it to your other shoulder.

Tests that may be done

• X-rays – to rule out other problems like arthritis or a fracture.
• Ultrasound – can show thickening of the shoulder capsule and rule out rotator cuff tears.
• MRI – may be used if the diagnosis is unclear or if other joint problems are suspected.

What to expect at your appointment

Your doctor will gently move your arm while you are relaxed to see how far it can go. They may also check for tenderness and swelling. The diagnosis is usually made based on the pattern of stiffness and limited motion, especially when the arm is moved by the doctor (passive range of motion is also limited).

Treatment

Treatment focuses on reducing pain and improving shoulder movement. Many people improve with simple self-care, but some need extra help from a doctor or physical therapist. The best approach depends on which phase of frozen shoulder you are in.

Self-care at home

• Apply a warm towel or heating pad to the shoulder for 15 minutes before doing gentle stretches to loosen the joint.
• Use cold packs for 15 minutes after activity if pain increases.
• Take over-the-counter pain relievers, such as paracetamol or ibuprofen, following the package directions and your doctor's advice.
• Do gentle range-of-motion exercises, like pendulum swings (lean forward and let your arm hang, then gently swing it in circles).
• Avoid heavy lifting, overhead reaching, or sharp movements that cause sharp pain.

Medical treatments

If self-care is not enough, a doctor may recommend physical therapy with a trained therapist who can guide you through stretches and exercises. Corticosteroid injections into the shoulder joint can reduce inflammation and pain, often alongside physical therapy. Another option is hydrodilatation, where sterile fluid is injected into the shoulder capsule to gently stretch it. These treatments are tailored to your specific phase and symptoms.

When is surgery considered?

Surgery is usually considered only if symptoms are severe and do not improve after several months of other treatments. The two main types are manipulation under anaesthesia (where the doctor gently moves your shoulder while you are asleep to break up the tight tissue) and arthroscopic capsular release (a keyhole surgery to cut the tight tissue). Most people do not need surgery.

Living with this condition

Living with frozen shoulder means adjusting how you do everyday tasks to avoid pain. Use your other arm more when reaching, dressing, or carrying items. Avoid sleeping on the affected side. Keep moving your arm gently – complete rest can make stiffness worse.

Lifestyle tips

• Use tools that extend your reach, like a long-handled sponge or a grabber.
• Avoid lifting heavy objects above shoulder height.
• If you have diabetes, keep your blood sugar well controlled, as high blood sugar can worsen frozen shoulder.
• Try to stay active with lower-body exercises like walking or stationary cycling while your shoulder heals.

Diet and exercise

A balanced diet with plenty of fruits, vegetables, and anti-inflammatory foods (like salmon, nuts, and berries) may help overall joint health. For exercise, focus on low-impact activities and shoulder stretches prescribed by your doctor or physical therapist. Avoid pushing through sharp pain.

Mental health and emotional wellbeing

Frozen shoulder can be frustrating because it takes a long time to heal and limits daily activities. It is common to feel down or anxious. If you feel overwhelmed, talk to your doctor or a counsellor. Remember that most people recover, and gentle progress is still progress.

Prevention

There is no sure way to prevent frozen shoulder, but you can lower your risk by keeping your shoulder joint moving after an injury or surgery. Gentle range-of-motion exercises as directed by your doctor or physical therapist can help stop stiffness. Managing diabetes and thyroid conditions well may also reduce your risk.

Complications

If left untreated

• Prolonged stiffness that makes daily tasks like dressing, bathing, and driving very difficult.
• Muscle weakness in the shoulder and arm from not using the joint.
• Long-term loss of some shoulder movement, though most people regain most of their motion.

Long-term outlook

The outlook for frozen shoulder is very good. With proper care, most people see steady improvement over time, often within 6 months to 2 years. Even without treatment, the condition tends to get better on its own, though it may take longer. Some people may have a small amount of stiffness that never fully goes away, but this rarely causes major problems. Stay patient, follow your treatment plan, and know that movement will come back gradually.

Find support

International organisations

• Arthritis Foundation ↗
• Versus Arthritis (UK) ↗

Local organisations

• NHS Choices – Frozen Shoulder ↗ · United Kingdom

Helplines

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