Frozen shoulder is a condition where a shoulder becomes very painful and stiff. Movements of the shoulder become reduced, sometimes completley 'frozen'. It is thought to be due to scar-like tissue forming in the shoulder capsule. Without treatment, symptoms usually go but this may take up to 2-3 years. Various treatments are used to ease pain and improve the movement of the shoulder.
Frozen shoulder means your shoulder is painful and stiff for months, sometimes years.
It can be treated with shoulder exercises and painkillers / joint injections.
- See Doctor if:
you have shoulder pain and stiffness that does not go away – pain can be worse at night when sleeping
the pain is so bad it makes it hard to move your arm and shoulder
Broadly, treatment works in 3 main steps:
Pain relief – Use paracetamol or ibuprofen to ease the pain.
Maybe steroid injections in your shoulder to bring down the swelling.
Getting movement back – shoulder exercises.
You may get a mix of these treatments depending on how painful and stiff your shoulder is.
Stronger pain relief is usually only used for a short time because it can cause side effects.
Physiotherapy for frozen shoulder
Physiotherapy can help you get movement back in your shoulder.
Treatments from a physiotherapist include:
good posture advice
pain relief advice
How long frozen shoulder lasts
Frozen shoulder can take at least 1.5 to 2 years to get better. Sometimes it can be up to 5 years.
But the pain and stiffness will usually go away eventually.
How you can ease the pain yourself
follow the exercises
keep an upright posture and your shoulders gently back
move your shoulder – keeping it still will make the pain worse
try heat or cold packs on your shoulder
do not make up your own strenuous exercises – for example, gym equipment can make the pain worse
do not slouch when sitting – do not roll your shoulders and bring your neck forward
Putting heat or cold packs on your shoulder
Causes of frozen shoulder
It's often not clear why people get a frozen shoulder.
Frozen shoulder happens when the tissue around your shoulder joint becomes inflamed.
The tissue then gets tighter and shrinks, which causes pain.
Frozen shoulder can happen because:
injury or surgery
diabetes – regular diabetes check-ups to catch any problems early
What are the symptoms of frozen shoulder?
The typical symptoms are pain, stiffness, and limitation in the range of movement of a shoulder. The symptoms typically have three phases.
Phase one - the 'freezing', painful phase. This typically lasts 2-9 months. The first symptom is usually pain. Stiffness and limitation in movement then also gradually build up. The pain is typically worse at night, and when lying on the affected side.
Phase two - the 'frozen', stiff phase. This typically lasts 4-12 months. Pain gradually eases but stiffness and limitation in movement remain and can get worse. All movements of the shoulder are affected but the movement most severely affected is usually rotation of the arm outwards. The muscles around the shoulder may waste a bit as they are not used.
Phase three - the 'thawing', recovery phase. This typically lasts 5-36 months. The stiffness gradually reduces but may not become normal and stiffness may persist if physiotherapy exercises not done properly.
Symptoms often interfere with everyday tasks such as driving, dressing, or sleeping. Even scratching your back, or putting your hand in a rear pocket may become impossible. Work may be affected in some cases.
There is great variation in the severity and length of symptoms. Untreated, on average the symptoms last 2-3 years in total before going. In some cases it is much less than this. In a minority of cases, symptoms last for several years.
Who gets frozen shoulder?
Frozen shoulder affects about 1 in 50 adults at some stage in their life. It most commonly occurs in people aged between 40 and 60. It is more common in people who have diabetes. Either shoulder can be affected but most commonly it is the non-dominant shoulder. That is, the left shoulder in a right handed person. In about 1 in 5 cases the condition also develops in the other shoulder at some stage. Frozen shoulder is not a form of arthritis, and other joints are not affected.
What causes frozen shoulder?
The cause is not clear. It is thought that some scar tissue forms in the shoulder capsule. The capsule is a thin tissue that covers and protects the shoulder joint. The scar tissue may cause the capsule to thicken, contract, and limit the movement of the shoulder. The reason why the scar tissue forms is not known.
A frozen shoulder occasionally follows a shoulder injury, but this is not usual and most cases occur for no apparent reason.
The aim of treatment is to ease pain and stiffness, and obtain full the range of shoulder movement.
Physiotherapy exercises are key to recovery........ 20 to 30 times each day in divided numbers.
Anti-inflammatory painkillers to ease stiffness
For example, ibuprofen, diclofenac, naproxen, etc. One of these drugs is commonly prescribed to ease pain.
There are many different brands. Therefore, if one does not suit, another may be fine. Side-effects sometimes occur with anti-inflammatory painkillers. Always read the leaflet that comes with the drug packet for a full list of cautions and possible side-effects.
Target & Joint injections for movement gain
Regularly, as instructed by a doctor or physiotherapist.
Many people are referred to a physiotherapist who can give expert advice on the best exercises to use. Also, they may try other pain relieving techniques such as heat, cold, TENS machines, etc.
Anti-inflammatory analgesic target injections
An injection into, or near to, the shoulder joint brings good relief of symptoms for several weeks in some cases. Steroids reduce inflammation. It is not a 'cure' as symptoms tend to gradually return, but many people welcome the relief that a steroid injection can bring.
This is a technique that a specialist may try. This is an injection to block the nerves that send pain messages from the shoulder. Like a steroid injection, it often eases symptoms for a while, but it is not usually a cure.
Again, this is a technique that a specialist may try. This is a procedure where the joint space is expanded (distended) by injecting a liquid. In one study, saline (salt water) mixed with a steroid injected into the painful shoulder improved symptoms in a number of cases.
An operation is sometimes considered if other treatments do not help. Techniques that are used include:
Manipulation. This is a procedure where the shoulder is moved around by the surgeon while you are under under anaesthetic.
Arthroscopic capsular release. This is a relatively small operation done as 'keyhole' surgery. It is often done as a day-case procedure. In this procedure the tight capsule of the joint is released with a special probe. One recent research study showed that this procedure gave about an 8 in 10 chance of greatly improving symptoms. Because of the encouraging results of this research study, it may become a more popular treatment.