Frozen shoulder: what helps and how long it lasts

A frozen shoulder is a painful, stiff shoulder caused by the lining of the joint becoming inflamed, thick and tight. It usually gets better on its own, but slowly: often over 1 to 3 years. Pain relief, injections and gentle exercises help in the meantime, and a small number of people need a procedure.

What happens inside the shoulder

The shoulder joint sits inside a soft sleeve of tissue called the capsule. In a frozen shoulder this capsule becomes inflamed, then thickens and shrinks. Bands of scar-like tissue form, and the joint has less fluid to move freely. The result is pain and a shoulder that will not move fully, even when someone else tries to move it for you. That last point is what sets it apart from many other shoulder problems.

Who gets it

The cause is often not clear. It is more likely if you:

• have diabetes. Frozen shoulder is much more common in people with diabetes, and it can be stiffer and last longer
• have a thyroid problem, Parkinson’s disease or heart disease
• have had to keep the arm still after an injury, a fracture or surgery

If you have diabetes, keep your regular sugar checks up to date.

The three stages and how long they last

Stage 1: freezing

Pain builds slowly, and the shoulder loses movement as it does. The pain is often a dull ache over the outer shoulder and upper arm, and it is often worse at night. This stage lasts from about 6 weeks to 9 months.

Stage 2: frozen

The pain may ease, but the stiffness stays. Daily tasks such as reaching up to a shelf, putting on a shirt, fastening a bra or reaching a back pocket are hard. This stage lasts about 4 to 6 months.

Stage 3: thawing

Movement slowly comes back. Getting back to normal or close to normal takes from about 6 months to 2 years.

These times vary a lot from person to person. The whole course can take up to about 3 years.

How a doctor confirms it

The doctor asks about your symptoms and health, then moves your shoulder in every direction and compares it with how far you can move it yourself. In a frozen shoulder both are limited. An X-ray helps rule out arthritis. An ultrasound or MRI scan is not always needed, but it can check for other problems such as a rotator cuff tear.

What helps

Treatment works in steps, and you may have a mix of them.

Easing the pain

• Paracetamol taken regularly, or an anti-inflammatory such as ibuprofen if it is safe for you.
• A heat pack wrapped in a towel for up to 20 minutes at a time.
• Stronger pain relief for a short time if needed.
• A steroid injection into the shoulder joint. This can ease pain, especially in the early, painful stage.

Getting movement back

• Gentle stretching exercises at home, little and often.
• Physiotherapy, usually for at least 6 weeks, with stretching, strength work and posture advice.
• Keep using the arm for light tasks. Keeping it completely still makes the pain worse.
• Do not add heavy exercises of your own. Gym machines can make it worse.

Looking after other health conditions

If you have diabetes, better sugar control is part of treatment. The AAOS notes it can help the shoulder recover.

When the shoulder does not improve

If pain and stiffness continue despite these steps, other options include:

• Hydrodilatation. A large volume of sterile fluid is injected into the joint, guided by imaging, to stretch the tight capsule.
• Manipulation under anaesthetic. While you are asleep, the surgeon moves the shoulder to stretch and release the tight capsule.
• Arthroscopic capsular release. In shoulder arthroscopy, the surgeon uses small instruments through small cuts to release the tight parts of the capsule.

Surgery is usually considered in the frozen stage, and physiotherapy afterwards is essential to keep the movement gained.

Living with it day to day

• Sleep propped up a little, with a pillow under the sore arm.
• Wear loose clothes that open at the front.
• Keep things you use often at waist to shoulder height.
• Expect good weeks and bad weeks. Progress is slow but usually steady.

When to see a doctor

See a doctor if shoulder pain and stiffness do not go away, if the pain stops you sleeping, or if it is so bad you cannot move your arm. A frozen shoulder is not an emergency, but other problems can look like it, so it should be checked.

Get urgent help if shoulder pain comes with chest pain, breathlessness or sweating, as this can be a sign of a heart problem: call 998. Go to an emergency department if the shoulder is suddenly hot and swollen with a fever, or after a fall when you cannot lift the arm.