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Frozen shoulder
Expert reviewer, Elizabeth Morgans, Physiotherapist
Next review due July 2021
Frozen shoulder usually causes pain and stiffness in your shoulder, making it difficult to move. Most cases of frozen shoulder get better without treatment. This can take several months, sometimes, even years. The condition is also known as adhesive capsulitis and sometimes contracted shoulder.
About frozen shoulder
Your shoulder is a type of joint 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 bones within the joint are covered with smooth, slippery cartilage and the joint is lubricated with special fluid. The whole joint is enclosed within a loose, fibrous capsule. Frozen shoulder happens when this capsule becomes thickened, scarred and tighter than it should be. You can get frozen shoulder in just one shoulder or both.
About three 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 conditions, such as diabetes (either type 1 or type 2), lung disease, and heart or neck problems, are more likely to get a frozen shoulder. If you have diabetes, a frozen shoulder may take a bit longer to get better.
Symptoms of frozen shoulder
There are two main symptoms of frozen shoulder.
- A dull or aching pain in your affected shoulder, which is often worse when you move your shoulder joint and at night.
- 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.
Frozen shoulder symptoms may be caused by other problems, such as an infection in your shoulder joint or an injury to your rotator cuff (the tendons and muscles in your shoulder). If you have any of these symptoms, see your GP or physiotherapist for advice.
A frozen shoulder usually develops in several stages, which may overlap.
- Painful or ‘freezing’ phase. This phase can last for two to nine months. You’ll slowly develop pain that’s worse when you move, and can become constant. Your shoulder will become stiffer. Frozen shoulder may be hard to diagnose at this early stage.
- Stiffness or ‘frozen’ phase. This phase can last for up to a year. Your frozen shoulder will probably be less painful, but moving it in any direction will be much harder affecting everyday activity.
- Resolution or ‘thawing’ phase. This recovery phase may take up to several years. You’ll gradually begin to get normal movement back in your shoulder. You may still feel some pain though, until it’s completely better.
Diagnosis of frozen shoulder
If you think you have frozen shoulder, see your GP or a physiotherapist.
Your GP or physiotherapist may ask about your symptoms and medical history. Asking about your medical history will help determine if you’ve had a previous condition or injury that could make you more likely to develop a frozen shoulder.
Your GP or physiotherapist will examine your shoulder to see if it’s tender, or if there’s any creaking (which can be a sign of other conditions, like arthritis). They will usually ask you to move your shoulder in different directions, and compare it with your other shoulder, if it’s not affected.
Your GP may suggest you have an X-ray if they think your symptoms could be caused by something else.
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Looking for physiotherapy?Treatment of frozen shoulder
Frozen shoulder can often get better on its own, but it can sometimes take over a year to fully recover. Treatment for frozen shoulder depends on how bad your symptoms are and what stage your condition has reached. Your GP may also consider your individual circumstances and how your frozen shoulder is affecting your life, particularly if you do a physical job.
Getting treatment early may reduce the length of time you have symptoms. They may suggest further tests, like an X-ray, MRI or CT scan on your shoulder, if your treatment isn’t helping.
Self-help
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.
You could also try a heat pad during the early stage, to help reduce any pain.
During the early stage, your GP or physiotherapist may advise you not to move your shoulder in any way that causes you pain. It’s a good idea to tell your employer you’ve been diagnosed with frozen shoulder so they can adapt your work accordingly. You may also need to cut down on some leisure and sports activities for a while if they’re too painful.
However, it’s important not to stop moving your shoulder completely. Pace yourself and aim for a balance between rest and activity. Your GP or physiotherapist can suggest how you can modify your work and home life so they don’t make your symptoms worse.
Some simple changes may help. For example, it’s easier to get dressed if you wear loose and front-fastening tops, and put your affected arm into the armhole first. In bed at night you could use towels or pillows to support your arm, which will also help you stop rolling onto your frozen shoulder. When you’re sitting, put a pillow or cushion behind your lower back so you don’t lean forwards, which can make the pain worse. You can also support your affected arm on a cushion in your lap.
See our FAQs for more information about ways of moving your body that can reduce frozen shoulder symptoms.
Physiotherapy
Your physiotherapist will show you exercises that you can do at home which aim to improve the function and movement of your frozen shoulder. These may involve stretching. See our FAQs for more information about exercises you can do yourself.
Your physiotherapist may also gently move your shoulder joint to help relieve any pain or stiffness. This is called mobilisation. It can also help restore normal movement
Joint injection
If your frozen shoulder pain is severe, or isn’t getting better after trying other treatments, your doctor may offer you a steroid joint injection. This can help to ease the pain, making physiotherapy more comfortable for you.
Surgery
Most people with frozen shoulder find that the pain gets better and movement improves with self-help and non-surgical treatments. But if they haven’t helped after a few months, your GP may refer you to an orthopaedic surgeon (a doctor who specialises in bones and joints). Your orthopaedic surgeon will probably want to confirm the frozen shoulder diagnosis with a further examination and tests. They may then recommend one of 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. It is often combined with a steroid injection to relieve any pain.
- Arthroscopic capsular release. Arthroscopy is a type of keyhole surgery that 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 the 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. It’s also called ‘distension therapy’ and is usually done under local anaesthesia. This completely blocks pain from your shoulder area and you will stay awake during the procedure.
You normally won’t need to stay in hospital overnight after your surgery. Start taking pain relief as soon as you need it. You’ll probably be offered physiotherapy after any of these procedures, to maintain a range of movement in your treated shoulder. Your orthopaedic surgeon may want to see you for follow-up appointments to check how you’re recovering.
Causes of frozen shoulder
The exact reason why frozen shoulder develops isn’t known at the moment. It’s thought frozen shoulder 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, making it tight and restricting 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. You may also be more likely to get a frozen shoulder if you’ve had to keep your shoulder still, such as in a plaster cast, for a long time. Some medical conditions can increase your risk of getting frozen shoulder, including diabetes (both type 1 and type 2), lung disease, an underactive or overactive thyroid and heart disease. Certain drugs that stop cells breaking down may also contribute to frozen shoulder.
Prevention of frozen shoulder
The best way to prevent frozen shoulder is to avoid keeping your shoulder still 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.
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Can acupuncture help my frozen shoulder?
At the moment there isn't enough evidence to say for sure. None of the small number of studies carried out so far give a clear answer as to whether acupuncture will help reduce your frozen shoulder symptoms.
But acupuncture is sometimes suggested by physiotherapists as a frozen shoulder treatment, especially in the early painful stage. It involves puncturing your skin with fine needles at defined points, including near your shoulder.
If you do decide to have acupuncture, check that your therapist belongs to a recognised professional body. The British Acupuncture Council and the Acupuncture Association of Chartered Physiotherapists (AACP) have lists of members trained to provide acupuncture.
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What exercises can I do?
Regular, gentle exercise and stretching may relieve frozen shoulder symptoms and help you recover. Your physiotherapist will show you various exercises you can do at home. The exercises will help to reduce your pain, while improving the health of the tissues around your shoulder joint. They will also help to get rid of your stiffness and restore the range of movement.
Your physiotherapist might suggest the following stretching exercises, including how many times and how often to do each one. It may be a good idea to warm up your shoulder beforehand with a warm shower or heating pad.
- Pendulum stretch: Stand with your good hand resting on a chair. Let your other arm hang down and gently swing it in a small circle. Then swing it round in the other direction. You can gradually build up the size of your swing.
- Towel stretch: Hold one end of a towel behind your back and grab the opposite end with your other hand. Then use your good arm to pull the affected arm upwards to stretch it.
- Finger walk: Face a wall and, with your elbow slightly bent, slowly ‘walk’ the fingers of your affected arm up it as far as you comfortably can. Start at waist level and let your fingers do the work, not your shoulder. Lower your arm gently.
- Door press: Stand in a doorway and hold onto 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.
- Forward stretch: 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.
- Cross-body reach: Gently use your good arm to lift your affected arm by the elbow and pull it across your chest as far as possible without causing pain. Hold for 15 to 30 seconds then relax. You can sit or stand for this exercise.
- Armpit stretch: Use your good arm to lift the affected one onto a shelf at chest height. Bend your knees slightly to stretch your armpit and then straighten up.
Your physiotherapist may suggest more strengthening exercises as your frozen shoulder symptoms improve. You should warm up and do your stretches before performing these.
There are other things you can do to reduce the strain on a frozen shoulder. For example, when you raise your arm or lift objects, keep your elbow bent and in front of your body, with your palm facing up. When you lower your arm, bend your elbow and bring your hand closer to your body.
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Will swimming help my frozen shoulder?
Swimming and exercising in water can help reduce pain and improve function in a wide range of musculoskeletal conditions such as frozen shoulder. The water holds you up and puts less stress on your joints.
But the effect depends on the individual. You may find swimming really helpful, particularly if it’s an activity you enjoy anyway. Your physiotherapist can advise what movements to avoid and how to build up slowly and gently. Or they may suggest starting with exercises for your frozen shoulder that you can do in the water.
However, swimming a lot can overuse muscles and joints and may make musculoskeletal conditions such as frozen shoulder worse. Some strokes, such as butterfly, can increase any pain. You may need to modify your swimming style, or use swimming aids, to avoid putting stress on your frozen shoulder. Breaststroke is generally least likely to be painful because it avoids lifting your arm over your head.
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Related information
Physiotherapy
Physiotherapy is a treatment that aims to improve the way your joints and muscles work.
Steroid joint injections
If you have a painful joint from an injury or arthritis, for example, your doctor may offer you a joint injection of a corticosteroid (steroid) medicine.
Rotator cuff injury
A rotator cuff injury is when you have inflammation or a tear in the muscles and tendons (connecting tissue) in your shoulder.
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Other helpful websites
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Sources
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- Adhesive capsulitis. BMJ Best Practice. bestpractice.bmj.com, last updated November 2017
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- 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, 2011
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- Shoulder pain. Arthritis Research UK/The Chartered Society of Physiotherapy. www.csp.org.uk, published October 2012
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- Shoulder pain. Brukner & Khan’s Clinical Sports Medicine (5th ed. online). McGraw-Hill Medical. Csm.mhmedical.com, accessed 4 January 2018
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- Shoulder pain. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised April 2017
- Shoulder pain. PatientPlus. www.patient.info/patientplus, last checked June 2015
- 7 stretching & strengthening exercises for a frozen shoulder. Harvard Health Publishing/Harvard Medical School. www.health.harvard.edu, updated November 2017
- Frozen shoulder. OrthInfo. American Academy of Orthopaedic Surgeons. www.orthinfo.aaos.org, last reviewed January 2011
- Health and wellbeing benefits of swimming. Swim England. www.swimming.org, published June 2017
- Barker A, Talevski J, Morello R, et al. 2014. Effectiveness of aquatic exercise for musculoskeletal conditions: a meta-analysis. Arch Phys Med Rehabil 2014; 95:1776–86. doi:10.1016/j.apmr.2014.04.005
- Frozen shoulder. HealingWell.com. wwww.healingwell.com, posted March 2016
- Wanivenhaus F, Fox A, Chaudhury S, et al. Epidemiology of injuries and prevention strategies in competitive swimmers. Sports Health 2012; 4(3):246–51. doi: 10.1177/1941738112442132
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Author information
Reviewed by Dylan Merkett, Bupa Health Content Team, July 2018 Expert reviewer, Elizabeth Morgans, Physiotherapist Next review due July 2021
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