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Frozen shoulder
Expert reviewers, Karen Gambardella and Victoria Reboredo, Physiotherapists, Bupa UK
Next review due August 2023
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:
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 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 GP or 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 GP or 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 GP or 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 GP 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.
Diagnosing frozen shoulder: passive external rotation
Diagnosing frozen shoulder using the passive external rotation shoulder movement.
Diagnosing frozen shoulder: passive external rotation
Diagnosing frozen shoulder using the passive external rotation shoulder movement.
Diagnosing frozen shoulder: passive external rotation
Victoria Reboredo (Bupa Physiotherapist): "Assessment of a passive external rotation is the most common clinical tests performed when assessing a frozen shoulder. To perform this test a clinician will move your arm into external rotation for you. As they do they serve the assessment to see if the movement remains restricted when moved passively."
Note: face masks are worn in this video as it was filmed in 2020, during the coronavirus pandemic.
Looking for physiotherapy? You can access a range of treatments on a pay as you go basis, including physiotherapy. Find out more >
Looking for physiotherapy?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.
Self-help
If you think you have a frozen shoulder, you should see your GP or a 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 GP or physiotherapist gives you about moving your shoulder, including any exercises you’re given. Watch the video in our section on exercises for some suggestions.
You can get more tips on easing shoulder pain from the organisations listed in our section: Other helpful websites.
Physiotherapy
Physiotherapy is an important treatment for frozen shoulder. Your GP may refer you to an NHS 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 therapy (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.
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.
Hydrodilatation
Your doctor may recommend a treatment called hydrodilatation. In this procedure, your doctor uses X-rays or ultrasound to guide an injection of fluid directly into your shoulder. The fluid fills your shoulder joint to stretch the capsule and free up the joint. It’s usually done under local anaesthesia. You will be awake during the procedure but will not feel any pain.
Surgery
Most people with frozen shoulder find their symptoms improve eventually with self-help and non-surgical treatments. But if these 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 may recommend one of the following procedures.
- Shoulder manipulation under anaesthetic (MUA). While you’re under general anaesthesia, your surgeon forces your shoulder into movements which will stretch the tightened capsule and loosen up any scar tissues. You will be asleep during this procedure.
- Arthroscopic capsular release. Your surgeon uses keyhole surgery (shoulder arthroscopy) to look inside your shoulder joint, usually under general anaesthetic. They use surgical instruments to release tight parts of the capsule to loosen it.
If you have one of these procedures, you’ll be given information about how to prepare, what’s involved, and what to expect afterwards. You should feel free to ask your surgeon about the risks and benefits of any procedure they offer you.
Exercises for frozen shoulder
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 and you should always follow their advice.
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.
The video shows some simple exercises you can try to help relieve shoulder pain.
Exercises for frozen shoulder
Three simple exercises to help relieve shoulder pain caused by frozen shoulder.
Exercises for frozen shoulder
Three simple exercises to help relieve shoulder pain caused by frozen shoulder.
Try these three simple exercises to help you relieve shoulder pain.
Today we're going to demonstrate the three exercises advised for frozen shoulder.
- The Pendulum. Standing in a stride position, lean on to a supportive surface on your good arm and allow the affecting arm to hang freely in front of your body. Rock forwards on to the front leg to allow the arm to move freely forwards and backwards. You could also change the movement into circles. It should never be painful. Repeat for 1 minute, 3 times per day.
- The wall slide. Stand in front of a wall using a piece of paper or cloth to glide the hand of the affected arm smoothly up and down the wall. Go only as far your comfortable. Repeat 10 times, twice a day.
- External rotation stretching with a stick. Sit on a chair making sure you have space available on either side of your body. Hold the stick between both hands, placing your affected hand with the palm at the end of the stick. Glide the stick towards the affected side, allowing the hand to move away from your body while the elbow stays close to your side. Hold for 5 seconds, then return to the start position. This exercise should be comfortable. You may feel a stretch in the affected shoulder but it should never be painful. Repeat 10 times, twice a day.
Note: face masks were worn in this video as it was filmed in 2020, during the coronavirus pandemic.
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.
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Can acupuncture help my frozen shoulder?
At the moment there isn't enough evidence to say with certainty. None of the small number of studies carried out so far gives a clear answer as to whether or not acupuncture will help reduce your frozen shoulder symptoms or the restriction of your movements.
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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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 including frozen shoulder. The water holds you up and puts less stress on your joints.
If you have a frozen shoulder and you like to swim, ask your physiotherapist whether this would be safe for you. They can advise what movements to avoid and how to build up slowly and gently. It’s important to always follow your physiotherapist’s advice.
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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.
Shoulder arthroscopy
Shoulder arthroscopy is a procedure that is commonly used to diagnose and treat shoulder pain, or to clean out an infected shoulder joint.
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Other helpful websites
- Chartered Society of Physiotherapy
www.csp.org.uk - Versus Arthritis (for tips on managing shoulder pain)
0800 5200 520
versusarthritis.org
0800 5200 520
- Chartered Society of Physiotherapy
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Sources
- Adhesive capsulitis. BMJ Best practice. bestpractice.bmj.com, last reviewed May 2020
- Adhesive capsulitis. Medscape. emedicine.medscape.com, updated September 2018
- Shoulder joint anatomy. Medscape. emedicine.medscape.com, updated November 2017
- Frozen shoulder. Patient. patient.info, last edited October 2015
- Shoulder pain. Patient. patient.info/doctor, last edited June 2015
- Shoulder pain. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised April 2017
- Page MJ, Green S, Kramer S, et al. Manual therapy and exercise for adhesive capsulitis (frozen shoulder). Cochrane Database of Systematic Reviews 2014, Issue 8. doi:10.1002/14651858.CD011275
- Frozen shoulder. OrthoInfo. American Academy of Orthopaedic Surgeons. orthoinfo.aaos.org, last reviewed March 2018
- Shoulder pain. Versus Arthritis. versusarthritis.org, accessed July 2020
- Exercise advice for shoulder pain. Chartered Society of Physiotherapy. csp.org.uk, last reviewed May 2017
- Wong CK, Levine WN, Deo K, et al. Natural history of frozen shoulder: fact or fiction? A systematic review. Physiotherapy 2017; 103:40–7. doi10.1016/j.physio.2016.05.009
- 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
- Rangan A, Goodchild L, Gibson J, et al. BESS/BOA patient care pathways: Frozen shoulder. Shoulder & Elbow 2015; 7(4):299–307. doi:10.1177/1758573215601779
- Barker A, Talevski J, Morello R, et al. 2014. Effectiveness of aquatic exercise for musculoskeletal conditions: a meta-analysis. Arch Phys Med Rehabil 2014; 95:1776–786. doi:10.1016/j.apmr.2014.04.005
- Health and wellbeing benefits of swimming, 2017. Swim England. www.swimming.org, accessed July 2020
- Personal communication Karen Gambardella and Victoria Reboredo, Physiotherapists, Bupa UK, July 2020
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Author information
Reviewed by Dr Kristina Routh, Freelance Health Editor, Bupa Health Content Team, July 2020
Expert reviewers, Karen Gambardella and Victoria Reboredo, Physiotherapists, Bupa UK
Next review due August 2023
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