Frozen shoulder
Your health expert: Mr Damian McClelland, Trauma and Orthopaedic Consultant, and Clinical Director for Musculoskeletal Services at Bupa
Content editor review by Pippa Coulter, December 2022
This article and supporting videos were last reviewed in 2020 by Karen Gambardella and Victoria Reboredo, MSK Physiotherapists, Bupa UK
Next review due, December 2025
Frozen shoulder is a condition where your shoulder becomes painful and stiff. Its medical name is ‘adhesive capsulitis’. Taking painkillers and doing exercises can help ease your symptoms. Your doctor or physiotherapist can recommend additional treatments if you need them.
About frozen shoulder
Your shoulder joint is surrounded by a strong capsule, which is covered by tendons and muscles. Frozen shoulder happens when this capsule becomes thickened, tighter and inflamed. This stops your shoulder from being able to move as well. You can get frozen shoulder in just one shoulder or both.
Up to five in 100 people will get frozen shoulder at some point in their life. You’re more likely to get it between the ages of 40 and 70, and it’s slightly more common in women than men. People with certain medical conditions are also more likely to get a frozen shoulder. For more information on this, see our Causes section below.
Frozen shoulder causes
It’s not always exactly clear why some people develop a frozen shoulder. Sometimes there seems to be no underlying cause at all. This is known as primary (or idiopathic) frozen shoulder.
If there is an underlying cause, it’s known as secondary frozen shoulder. This may be due to 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. This may be necessary after a fracture or surgery on your shoulder.
Although doctors aren’t sure why, some medical conditions can also increase your risk of getting frozen shoulder. These include:
- diabetes
- underactive or overactive thyroid
- heart disease or stroke
Frozen shoulder symptoms
There are two main symptoms of frozen shoulder.
- Pain. This comes on gradually and may become severe. Frozen shoulder pain is often worse at night or when you move your shoulder joint.
- Stiffness. This can stop you from moving your shoulder normally. It 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.
Stages of frozen shoulder
Sometimes, three different stages can be used to describe frozen shoulder. These may overlap, so it can be difficult to tell them apart.
- Painful or ‘freezing’ phase. You start to get pain in your shoulder during this phase, and it slowly gets worse. This phase may last from two to nine months.
- Stiffness or ‘frozen’ phase. The pain may get less severe, but it gets harder to move your shoulder. This can affect your day-to-day activities. This phase may last between four months and a year.
- Resolution or ‘thawing’ phase. The stiffness gradually eases and most gradually recover their shoulder function. This phase can sometimes take up to three years or more.
For most people, a frozen shoulder gets better within 18 months to two years. But it can take much longer for some people. If you’re having shoulder pain or stiffness, it’s best to seek medical advice rather than just waiting for it to get better on its own.
Diagnosis of frozen shoulder
Your GP or physiotherapist will ask about your symptoms, including:
- how long you’ve had them
- when you tend to get them
- if anything makes it worse
- whether it affects your usual activities
They’ll also ask you about your medical history. They’ll want to know about any 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. They’ll assess how well you can move your shoulder by performing a range of tests. These may include:
- gently moving your arm for you (‘passive movement’)
- asking you to move your arm yourself into different positions (‘active movement’)
These tests let them see if the range of movement of your shoulder is reduced. Tell your GP or physiotherapist if the exercises feel very uncomfortable for you.
One of the main tests used to diagnose frozen shoulder is whether you can do a movement called ‘passive external rotation’. This movement is demonstrated in the video at the end of this section.
You won’t need a shoulder X-ray to diagnose frozen shoulder. But your GP may suggest you have one to rule out other conditions.
Diagnosing frozen shoulder: passive external rotation
The passive external rotation test | watch in 45 seconds
A healthcare professional may ask to assess your shoulder by performing a passive external rotation test. This is a gentle movement of your arm. This video looks at what happens during the assessment.
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.
Self-help
There is a lot you can do to help yourself if you have a frozen shoulder. Try these tips alongside advice and treatment from your doctor or physiotherapist.
- 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.
- Try heat or cold packs. These may help to reduce stiffness and swelling, and help relieve pain.
- You could also try using a trans electrical nerve stimulation (TENS) machine. These are devices that use electrical current to stimulate your nerves and reduce pain.
- Support your arm with pillows while sleeping or while sitting in a chair. In bed, this can prevent you rolling onto the affected side. A pillow in the small of your back while sitting can improve your posture, which may help.
- Try to keep using your arm as much as you can. It helps to keep your shoulder moving. You may need to stop certain activities that worsen the pain. Aim for a balance between rest and activity.
- If raising your arm is painful, it’s better to avoid this if you can. But if you need to do this, keep your elbow bent and in front of your body.
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 include reducing your pain and improving the movement in your shoulder. It’s best to start treatment as early as possible.
Physiotherapy
Physiotherapy is an important treatment for frozen shoulder. Your GP may refer you to an NHS physiotherapist, or in some areas you can refer yourself. You can also pay to see a physiotherapist privately.
You’ll usually have an initial course of physiotherapy for six weeks. This may go on longer if it’s helping. A physiotherapist can give advice on how to manage your symptoms. This includes how you can modify your usual activities to reduce any pain. Physiotherapy may also involve a wide range of different treatments. These include the following.
- Exercises. Your physiotherapist will show you exercises to do at home. These help to reduce pain and improve the function and movement of your frozen shoulder. See our section below on Exercises for frozen shoulder to find out more.
- Manual therapy (mobilisation). This is when your physiotherapist moves your shoulder joint in a particular way to help relieve any pain or stiffness. It may also help restore normal movement.
- Shortwave diathermy (SWD) or pulsed shortwave diathermy (PSWD). These therapies use radiofrequency to heat up the tissues in your shoulder. This may help with any stiffness or pain.
A physiotherapist may also be able to provide some of the other treatments listed below.
Acupuncture
Acupuncture aims to help with the pain of a frozen shoulder. It’s a complementary therapy that involves inserting needles into your skin. For frozen shoulder, some of these will be near your shoulder. The needles may just be left in your skin for the treatment session. Sometimes they are stimulated either by hand, or with small electrical pulses.
Your physiotherapist may offer acupuncture. There isn’t enough evidence to say whether it does work for frozen shoulder, but some people find it helpful. Ask your physiotherapist more about it to help you decide whether to give it a try.
Joint injection
If your frozen shoulder pain is severe or isn’t getting better after trying other treatments, a steroid joint injection may help. Your GP or physiotherapist may be able to offer this. A steroid joint injection can help to ease the pain. It may also help you to get the most out of your physiotherapy.
Hydrodilation
Your doctor may recommend a treatment called hydrodilation. In this procedure, your doctor uses X-rays or ultrasound to guide an injection of fluid (usually saline and local anaesthetic) directly into your shoulder. The fluid fills your shoulder joint to stretch the capsule and free up the joint.
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. This is a doctor who specialises in bones and joints.
Your orthopaedic surgeon may recommend one of the following procedures.
- Shoulder manipulation under anaesthetic (MUA). In this procedure, your surgeon moves your shoulder into positions that will stretch or tear the tightened capsule. This should increase the movement you have in your shoulder. You will have a general anaesthetic for this procedure, which means you’ll be asleep during the 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 divide parts of the capsule in your shoulder joint. You may have this surgery at the same time as an MUA.
If you’re offered one of these procedures, your surgeon will explain exactly what’s involved, including the risks and benefits. If you decide to go ahead, they will explain how to prepare for your procedure.
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. It’s important to follow their advice.
Examples of exercises for frozen shoulder your physiotherapist may suggest include:
- pendulum
- wall slide
- external rotation
The video below shows how to do these exercises.
Exercises for frozen shoulder
Exercises for frozen shoulder | The pendulum | The wall slide | External rotation stretching | watch in 2 minutes
This video demonstrates three exercises to help with frozen shoulder; the pendulum, the wall slide, and external rotation stretching with a stick.
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.
Physiotherapy services
Our evidence-based physiotherapy services are designed to address a wide range of musculoskeletal conditions, promote recovery, and enhance overall quality of life. Our physiotherapists are specialised in treating orthopaedic, rheumatological, musculoskeletal conditions and sports-related injury by using tools including education and advice, pain management strategies, exercise therapy and manual therapy techniques.
To book or to make an enquiry, call us on 0345 850 8399
Prevention of frozen shoulder
There may be some things you can do to prevent secondary frozen shoulder. This is when there is an underlying cause for your frozen shoulder, like an injury or another condition. If you’ve had a shoulder injury or surgery, it’s important to keep your shoulder as mobile as possible afterwards. Follow advice from your doctor or physiotherapist about wearing a sling and getting your shoulder moving again safely.
If you have diabetes, making sure you keep it under control may help to prevent secondary frozen shoulder.
There are two main signs of frozen shoulder. The first is a dull or aching pain in your affected shoulder. This may feel worse at night or when you move your shoulder joint.
Another symptom is stiffness around your shoulder joint. This can affect your ability to move your shoulder normally. Read our section on Frozen shoulder symptoms to find out more.
There isn't enough evidence to say whether acupuncture can help with frozen shoulder symptoms.
But some physiotherapists do offer it. Ask your physiotherapist more about this therapy and how it might help you. It’s your choice whether to try it. See our Treatment section for more information.
If you have a frozen shoulder, it’s likely to feel stiff and painful. You may have trouble moving it like you normally would. Frozen shoulder can often develop in stages. You might have pain first of all that slowly gets worse. Then the pain may get better, but it feels stiff. You can find out more in our Symptoms section.
Frozen shoulder will get better on its own, but this can take a long time. Physiotherapy can really help with improving your pain and movement. You can also have injections into your joint to reduce pain. If these treatments aren’t helping, surgery can help to fix a frozen shoulder. You can read more in our Treatment section.
If you have a frozen shoulder, it can help to put some pillows under your affected arm. This can help support your arm. It will also prevent you rolling onto the affected shoulder. You can read more tips for managing frozen shoulder symptoms in our Self-help section.
Physiotherapy
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
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This information was published by Bupa's Health Content Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals and deemed accurate on the date of review. Photos are only for illustrative purposes and do not reflect every presentation of a condition.
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