Home / Conditions / Frozen shoulder
The lining around the shoulder joint thickens and tightens, making the shoulder painful and then stiff. It usually comes on without an injury, most often between 40 and 60, and is far more common in people with diabetes. It runs a long course — often one to three years — but most people get most of their movement back.
Frozen shoulder symptoms change as it runs its course, and what helps most changes with them. The timings vary a great deal from person to person, and the stages blend into one another rather than switching over.
| Freezing | Frozen | Thawing | |
|---|---|---|---|
| What you notice | Pain, often severe and worse at night; movement starting to shrink | Pain easing, but stiffness at its worst | Movement gradually returning |
| Typically lasts | A few months to nine months | Four months to a year | Six months to two years |
| What helps most | Easing the pain, an injection, gentle movement within comfort | Stretching; a procedure to loosen the joint if it is not improving | Keeping up the exercises, and rebuilding strength |
Frozen shoulder is not urgent, but some shoulder pain is. A shoulder that is hot, swollen and very painful with a fever, or one you cannot move after a fall, needs seeing the same day — call the clinic and come in, or go to an emergency department if we are closed.
The shoulder is a ball-and-socket joint wrapped in a lining called the capsule. Normally the capsule is loose and roomy, with folds that let the arm move freely in every direction.
What a picture cannot show is why every direction is lost. In frozen shoulder the capsule thickens, tightens and shrinks, so there is simply less room for the ball to move — however the arm is moved, and whoever moves it. A rotator cuff problem is different: it hurts to lift the arm yourself, but someone else can usually move it further.
It also explains why it thaws. Over many months the capsule slowly loosens again, which is why movement comes back even without treatment — and why treatment aims mainly to ease the pain and speed that recovery, rather than to force the joint.
Treatment depends on the stage. Early on, the aim is to ease the pain; later, to win back movement. Throughout, gentle exercise helps, and forcing a painful shoulder early on tends to make it worse.
In the painful early stage, easing the pain and moving the shoulder gently within comfort helps more than pushing through. Exercises then build up as the pain settles.
An injection into the joint can ease the pain considerably, and works best early, in the painful stage. It can make the exercises easier to do. In diabetes it can raise blood sugar for a few days.
If the shoulder stays stiff, the capsule can be stretched by injecting fluid into the joint, or the shoulder can be moved gently under anaesthetic to loosen it. Both are followed straight away by exercises to keep the movement gained.
For stiffness that persists despite everything else, the tight capsule can be released through keyhole surgery. It is uncommon, and needs a committed course of exercises afterwards.
Frozen shoulder here is seen by Dr Jeffrey Tan Gek Meng, a Senior Consultant Orthopaedic Surgeon. His subspecialty is foot and ankle, and he also practises across general orthopaedics, which his profile says includes frozen shoulder. He is a Fellow of the Royal College of Surgeons of Edinburgh and consults in English, Mandarin, Malay, Hokkien and Hainanese.
Usually one to three years from start to finish, though it varies a great deal. The painful stage often lasts a few months, the stiff stage up to a year, and the thawing stage can take a year or two more.
Most improve a great deal with time, and most people get most of their movement back. Some are left with a little stiffness. Treatment eases the pain and can speed the recovery.
Yes. It is several times more common in people with diabetes, can affect both shoulders, and often takes longer to settle. It can also be the first sign that someone has diabetes, which is why blood sugar is checked.
Not in the early, painful stage — forcing it tends to make it worse. Gentle movement within comfort is better then. Firmer stretching helps more once the pain has settled and stiffness is the main problem.
Rarely. Most improve with time, an injection and exercise. Surgery is kept for a shoulder that stays stiff despite all of these.
No. Bring any shoulder X-rays or scan reports, and a list of any other conditions you have, such as diabetes.
Tell us whether you have diabetes, and when the pain started. Both help place which stage the shoulder is in.
