Frozen shoulder

Frozen shoulder is a condition that causes pain and stiffness in the shoulder. You may also hear it called adhesive capsulitis or shoulder contracture.

The usual pattern is shoulder pain that gets worse over a number of months. Stiffness then follows and slowly increases.

This stiffness can make everyday activities hard to do. In particularly severe cases, you may not be able to move your shoulder at all.

Frozen shoulder happens when the flexible tissue around the shoulder joint, called the capsule, becomes inflamed and thickened. Doctors don't fully understand why this process starts. It can affect one shoulder or both.

The condition can appear after an injury, after surgery, or if you haven't been able to move your arm for a long time. Sometimes it appears for no apparent reason at all.

Your risk of developing a frozen shoulder can go up if you:

• have a neurological disorder like Parkinson's disease, a stroke or a brain injury
• have Dupuytren's contracture (a condition where small lumps of thickened tissue form in the hands and fingers)
• are peri-menopausal or menopausal
• have other health conditions, such as heart disease, diabetes, high cholesterol or a thyroid problem

Lifestyle factors like smoking, obesity and low levels of physical activity can also raise the risk of frozen shoulder.

Pain and a steady loss of movement, which leaves the shoulder stiff all the time, are the main symptoms of a frozen shoulder. Because of this, it hurts and becomes hard to move the shoulder through its full range of normal movements. Everyday tasks can get difficult too, such as:

• bathing
• dressing
• driving
• sleeping comfortably

Symptoms vary from person to person. In mild cases there's little change to daily activities, while in severe cases your shoulder movements may be difficult and painful.

With a frozen shoulder, the symptoms usually get worse gradually, over a number of months. The condition has two stages, though it can be hard to tell one from the other at times. Symptoms can also differ a great deal from one person to the next.

In frozen shoulder, your shoulder starts to ache and can become very painful, for example when you reach out for things. The pain is often worse at night, and lying on the affected side makes it worse too.

In frozen shoulder, your shoulder may get more and more stiff, but the pain doesn't usually get worse and may even ease off. The stiffness can carry on affecting what you do from day to day.

A doctor has to assess you before a frozen shoulder can be diagnosed. They'll start by asking about the problem with your shoulder, and then they'll examine it. This includes checking how far you can move the shoulder and how strong it is.

Sometimes you may need further tests as well, to rule out other health conditions.

How you treat a frozen shoulder depends on how severe your symptoms are. Most cases get better on their own, but it can take more than 2 years to recover. If you have other health conditions, such as diabetes or thyroid problems, recovery can be slower.

Some people don't recover completely and are left with a little stiffness. This tends not to get in the way of their day to day activities.

Pain medicine can help you move more comfortably, and that in turn can help you manage the symptoms of frozen shoulder.

Using heat or ice on your shoulder can help reduce the symptoms of frozen shoulder. Both help reduce pain, so use whichever feels most helpful for you.

Take care to protect your skin from a heat or ice burn by using a barrier, like a towel. Never place heat or ice directly on your skin. Apply it for no longer than 20 minutes at a time, and leave a few hours between treatments.

How to avoid hot water bottle burns and scalds

If you're treating frozen shoulder with heat or ice, stop as soon as you notice more redness, discolouration or blistering of the skin.

Read more about burns and scalds

If you have any problem with circulation or sensation, you shouldn't use heat or ice as a treatment for shoulder pain.

Targeted shoulder exercises can help with frozen shoulder. Exercises that encourage movement, stretching and strengthening can improve how well you move your arm, and they can ease the pain too.

The British Elbow and Shoulder Society has a video with specific exercises to help with a frozen shoulder.

Stop these exercises if they make your symptoms worse, or if they cause new pain. If your shoulder pain gets worse while you follow this advice, it's a good idea to talk to a doctor about your symptoms.

Corticosteroid Injections

If painkillers aren't helping to control the pain, your doctor may talk with you about having a corticosteroid injection into your shoulder joint. Corticosteroids are medicines that help reduce pain and inflammation. They may also be given with a local anaesthetic.

These injections won't cure your condition or reduce shoulder stiffness. They are used to help with the pain.

Frozen shoulder can sometimes mean you need to take some time off work so you can recover. How long you stay off depends on your condition and on the kind of work you do.

You don't have to be free of symptoms before you think about going back. Carrying on with work, or returning as soon as you're able, will help your recovery.

Getting back to your normal daily activities bit by bit can also help build up your strength and stamina.

If you follow this advice, your frozen shoulder should get better gradually over time.

Talk to a doctor if:

• your symptoms haven't improved within 6 weeks following this advice
• your symptoms get worse

Find out about access to MSK services in your area.

With any health condition, it's also important to look after your mental wellbeing, because this can affect your recovery.

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