Frozen shoulder

Your shoulder is made of three bones, which together form a ball-and-socket joint. They are your:

• Collarbone (clavicle)
• Shoulder blade (scapula)
• Upper arm bone (humerus)

Your shoulder joint is held together by tissue that surrounds it called the shoulder capsule. A special fluid called synovial fluid lubricates your shoulder capsule so your shoulder joint can move easily. 

When you have a frozen shoulder, your shoulder capsule thickens and tightens, making it hard to move your shoulder joint. Scar tissue forms and the amount of synovial fluid in your shoulder joint reduces, which makes movement even harder. 

Frozen shoulder often takes 18-24 months to get better. However, for some people, it can take up to five years.

What are the three stages of frozen shoulder?

Stage 1 (freezing) 

Your shoulder becomes inflamed and very painful when you move it. The pain gradually worsens and your shoulder may hurt more at night. Some movement of your shoulder may be lost. This stage lasts six to nine months.

Stage 2 (frozen) 

The shoulder pain may ease, but movement becomes increasingly difficult, which makes daily activities more challenging. This stage lasts four to 12 months.

Stage 3 (thawing) 

The shoulder pain continues to ease and mobility returns. This usually takes anywhere from six months to two years. 

Frozen shoulder usually affects one shoulder but in about one in five people, it affects both.

It can sometimes be confused with arthritis but is very different.

Symptoms vary from person to person. You may still have flexibility in your shoulder. However, in some cases, your shoulder may be so stiff that movement is practically impossible.

Symptoms of frozen shoulder include:

• Limited movement in your shoulder and arm, making it harder to perform everyday activities
• Pain in your shoulder muscles, which wrap around the top of your arm — in some cases, you may have pain along your upper arm too
• Shoulder pain that gets worse at night 
• Shoulder pain when you move your shoulder — pain can be severe or can feel like a dull ache
• Stiffness in your shoulder that doesn’t go away

If the pain in your shoulder doesn’t go away, you should see your GP. They may be able to diagnose frozen shoulder from a discussion about your symptoms and a physical examination. A physical examination may involve: 

• Checking your active range of movement — your GP will ask you to move your shoulder on your own by following simple exercises
• Checking your passive range of movement — your GP will gently move your shoulder in different directions and check if you experience any pain on movement

Your GP may also arrange a blood test to check for other conditions. An X-ray, MRI scan or ultrasound scan may also be arranged to rule out arthritis or a tendon injury.

Often it is not clear exactly what causes frozen shoulder, although it can result from an injury or an operation. However, you’re more likely to be affected if you:

• Are aged between 40 and 60
• Are a woman — women are affected more than men
• Have an underlying medical condition, specifically: 
• An overactive or underactive thyroid condition
• Diabetes — you are more than twice as likely to develop a frozen shoulder
• Heart disease
• Parkinson’s disease
• Have had a stroke
• Have other shoulder problems such as a rotator cuff injury or tendonitis

A common cause of frozen shoulder is reduced mobility when recovering from a broken arm, shoulder injury or a stroke. 

If you have had a shoulder injury that makes moving your shoulder difficult, your doctor can advise you on exercises to maintain the range of movement in your shoulder — this will reduce your risk of developing a frozen shoulder.

The usual treatment for frozen shoulder is a combination of physiotherapy, including exercises to increase the range of motion in your shoulder, and painkillers, such as ibuprofen. Hot or cold packs can also help.

In some cases, your doctor may advise you to have a joint injection with steroids to reduce the inflammation and improve your symptoms.

In rare cases, your doctor may recommend shoulder arthroscopy, a surgery to loosen your shoulder capsule and improve the movement of your shoulder.

Not everyone wants treatment for frozen shoulder. You may prefer to wait for it to get better by itself. 

Can frozen shoulder get better on its own?

In most cases, frozen shoulder will get better on its own without any treatment; this usually takes six months to two years. However, without treatment, it takes longer for your range of movement to return and you may never get back to a full, normal range of movement.

Exercises you can try that help a frozen shoulder include: 

• Door press 
• External rotations 
• Finger walk 
• Forward flexions 
• Stretches: 
• Armpit stretch
• Cross-body reach
• Crossover arm stretch
• Forward stretch
• Pendulum stretch 
• Towel stretch

Will swimming help my frozen shoulder?

Swimming or exercising in water puts less strain on your joints as the water supports them. This can relieve your shoulder pain and improve your range of movement. However, swimming too much can overuse your muscles and worsen your frozen shoulder.

Can acupuncture help my frozen shoulder?

There is not yet conclusive evidence that acupuncture can help frozen shoulder. However, some physiotherapists do recommend trying it.