- A dull or aching pain in your affected shoulder, which may become severe. The pain usually comes on gradually, and is often worse when you move your shoulder joint. It may also be worse at night and may stop you sleeping on the affected side.
- Feelings of stiffness around your shoulder joint which may stop you from moving your shoulder through its normal range of motion. This may make it difficult for you to do everyday tasks, such as driving or dressing.
These symptoms may be caused by problems other than frozen shoulder. If you have any of these symptoms, see your GP or physiotherapist for advice.
If you think you have frozen shoulder, see your GP or make an appointment to see a physiotherapist.
Your GP or physiotherapist may ask about your symptoms and about any injuries you’ve had which might have affected your shoulder. They may examine your shoulder to see how far you can move it in each direction and compare with your unaffected shoulder.
Frozen shoulder will usually get better on its own. However, sometimes it can take longer than a year to get better. Treatment for frozen shoulder depends on the stage of your condition. Getting treatment early may reduce the length of time you have symptoms.
If you need pain relief during the first stage of frozen shoulder, you can take over-the-counter painkillers. These include paracetamol and non steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.
During the early, freezing stage, your GP or physiotherapist may advise you not to move your shoulder in any way that causes you discomfort. You may find it helpful to inform your work so they can accommodate your working requirements. You might also need to change your leisure activities for a while if they cause your symptoms to worsen. It’s important, however, to continue moving your shoulder regularly during day-to-day activities and not to stop moving your shoulder completely. You may find that simple adaptations to your daily life, such as wearing front-fastening tops and sleeping with supporting pillows may help.
A physiotherapist is a health professional who specialises in maintaining and improving movement and function. They will show you suitable exercises aimed to improve the function and movement of your shoulder. Your physiotherapist may also gently move your shoulder joint themselves to help restore movement. This is called mobilisation. See below for more information about exercises.
Physiotherapists sometimes use other treatments as well as exercises. These include trans-cutaneous electrical nerve stimulation (TENS) which sends electrical pulses to your tissues to reduce pain.
If your shoulder pain is severe or isn’t getting better after trying other treatments, your GP may offer you a steroid joint injection. This may ease the pain, so allowing you to take part in physiotherapy more comfortably.
Most people with frozen shoulder find that the pain gets better and the movement improves with self-help and nonsurgical treatments. But if these haven’t helped, your doctor may refer you to an orthopaedic surgeon (a doctor who specialises in bones and joints). Your orthopaedic surgeon may recommend surgery which might include the following procedures.
- Shoulder manipulation. This procedure is done while you are under general anaesthesia, which means you’ll be asleep. Your surgeon will move your shoulder around to stretch the tightened capsule and loosen up any scar tissues.
- Arthroscopic capsular release. Arthroscopy is a type of keyhole surgery, which can be used to look inside and treat a joint. Your surgeon will look inside your shoulder joint and use special instruments to cut through tight parts of your capsule to loosen it. This is usually done under general anaesthesia.
- Arthroscopic hydrodilation. In this procedure your surgeon fills your shoulder joint with fluid to break up scar tissue and free up the joint. This is usually done under local anaesthesia. This completely blocks pain from your shoulder area and you will stay awake during the procedure.
The exact reason why frozen shoulder develops is not known at the moment. It’s thought it may be caused by inflammation of your shoulder joint and its surrounding capsule. This may lead to thick scar-like tissue forming in the capsule which makes it tight and restricts the movement of the joint.
Frozen shoulder can sometimes develop if you’ve had a shoulder injury, such as a fracture, or if you’ve had surgery on your shoulder. Some medical conditions can increase your risk of getting frozen shoulder, including diabetes, thyroid disease and heart disease.
The best way to prevent frozen shoulder is to avoid keeping your shoulder immobilised for a long time, for example in a sling. And get treatment as early as possible if you injure your shoulder or develop shoulder pain that limits your range of movement.
At the moment there isn't enough evidence to say whether acupuncture helps a frozen shoulder or not.
If you have acupuncture, your therapist will puncture your skin with fine needles, at defined points, to relieve symptoms such as pain. It’s sometimes used by physiotherapists to treat frozen shoulder – especially in the early painful stage.
There have only been a small number of studies investigating whether acupuncture works for frozen shoulder. But none of these studies are strong enough to give a clear answer as to whether acupuncture can help reduce your symptoms or not. We’re still waiting for a study which really tests whether having acupuncture can work as a treatment for frozen shoulder.
In the meantime, if you do decide to have acupuncture, check that your therapist belongs to a recognised professional body.
If you have frozen shoulder, you should keep your shoulder moving as normally as possible but avoid actions which make the pain worse. Your physiotherapist will show you safe and helpful exercises.
Regular, gentle exercise and stretching is important for your shoulder joint if you have frozen shoulder. Your physiotherapist can show you some exercises and stretches you can do to improve the stiffness and range of movement in your shoulder.
The following exercises may help your frozen shoulder.
- Stand in a doorway and hold on to the doorframe with your injured arm bent at 90 degrees. Rotate your body away from the doorway until you feel a gentle stretch. Hold for 30 seconds then relax, and repeat.
- Lie on your back with your legs straight and flat on the floor. Use your unaffected arm to raise your injured arm overhead until you feel a gentle stretch. Hold for 15 seconds then relax, and repeat.
- Gently pull your injured arm across your chest just below your chin as far as possible without causing pain. Hold for 30 seconds then relax, and repeat.
Your physiotherapist may recommend different exercises depending on whether your frozen shoulder is at the early painful stage or the later stiff and immobile stage.
Remember, it may take a long time for your frozen shoulder to recover. Follow your physiotherapist’s advice, keep up with your exercises and your shoulder should eventually improve.
- The Chartered Society of Physiotherapy
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- Adhesive capsulitis. Medscape. www.emedicine.medscape.com, published 20 December 2013
- Adhesive capsulitis of the shoulder. PatientPlus. www.patient.co.uk/patientplus.asp, published 25 October 2012
- Frozen shoulder. OrthInfo. American Academy of Orthopaedic Surgeons. www.orthoinfo.aaos.org, published January 2011
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- Map of Medicine. Shoulder pain. International View. London: Map of Medicine; 2013 (Issue 1)
- Buchbinder R, Green S, Youd JM, et al. Arthrographic distension for adhesive capsulitis (frozen shoulder). Cochrane Database of Systematic Reviews 2008, Issue 1. doi: 10.1002/14651858.CD007005
- Green S, Buchbinder R, Hetrick SE. Acupuncture for shoulder pain. Cochrane Database of Systematic Reviews 2005, Issue 2. doi:10.1002/14651858.CD005319
- Hanchard N, Goodchild L, Thompson J, et al. Evidence-based guidelines for the diagnosis, assessment and physiotherapy management of contracted (frozen) shoulder v 1.7 ‘standard physiotherapy’. Endorsed by the Chartered Society of Physiotherapy. www.csp.org.uk, 2010
- Vastamaki H, Kettunen J and Vastamaki M. The natural history of idiopathic frozen shoulder: A 2- to 27-year follow up study. Clin Orthop Relat Res 2012; 470(4):1133–43. doi: 10.1007/s11999-011-2176-4
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- The Chartered Society of Physiotherapy
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