Frozen shoulder, also called adhesive capsulitis, is a condition in which the shoulder becomes painful and progressively stiff, especially when turning the arm outwards or reaching overhead. It is thought to affect between 2% and 5% of people during their lives, most often those aged 40 to 60, and it is more common in women and in people with diabetes. It usually improves over time, but that can take a long while, and the pain can be severe in the meantime. Treatment aims to reduce pain, keep movement going and shorten the difficult phase where possible.
What is frozen shoulder?
The shoulder joint is surrounded by a capsule of tissue. In frozen shoulder, this capsule becomes inflamed, thickened and tight, which limits movement in every direction. Unlike a rotator cuff tear, where you may be unable to lift the arm but can be moved by someone else, in frozen shoulder both your own movement and passive movement are limited.
Sometimes there is a clear trigger such as an injury, surgery or a period of immobility, but often there is not. Diabetes and thyroid conditions raise the risk, and the shoulder can be more resistant to treatment in people with poorly controlled diabetes.
The three stages of frozen shoulder
- Freezing. Pain builds and is often worst at night, and movement starts to reduce. This stage can last a few months.
- Frozen. Pain often eases, but stiffness is at its greatest. Everyday tasks such as dressing, washing your hair or reaching a seat belt become difficult.
- Thawing. Movement slowly returns. Full recovery commonly takes one to three years from the beginning, although some people are left with mild stiffness.
Knowing which stage you are in helps guide treatment. Injections and pain-directed treatments tend to be most helpful in the painful freezing stage. Stretching and mobility work matter more as pain settles.
How we diagnose frozen shoulder
Dr Poply examines the range of movement in both the active and passive directions, looks for the typical loss of external rotation, and checks your neck and nerves, since neck pain problems can refer pain to the shoulder. Blood tests such as glucose or thyroid function are sometimes suggested. An X-ray or ultrasound may be recommended to rule out arthritis, a rotator cuff tear or calcific tendinitis. Where your pain does not fit the typical pattern, we look further rather than assuming frozen shoulder.
Treatment options
Pain relief and self-care
Simple measures include heat, changing sleeping position, appropriate pain relief and gentle movement within comfort. Avoiding the arm completely usually makes stiffness worse, so the balance is regular, gentle movement without forcing through severe pain.
Physiotherapy
Physiotherapy helps maintain movement and guides progression through the stages. It is most effective when pain is controlled well enough to allow stretching.
Corticosteroid injection
A steroid injection into or around the shoulder joint can reduce pain and improve movement, and it tends to be most useful in the early, painful phase. The benefit is often short to medium term, and it is a way to make physiotherapy possible rather than a cure.
Hydrodilatation
Hydrodilatation, or hydrodistension, involves injecting fluid into the joint capsule under image guidance to stretch it. Systematic reviews suggest it improves disability and passive external rotation at least in the short term, although how long the benefit lasts is debated.
Suprascapular nerve block
The suprascapular nerve supplies much of the sensation of the shoulder joint. Blocking it with local anaesthetic, with or without steroid, can reduce pain and allow better movement. A systematic review and meta-analysis published in JBJS Reviews in 2021 examined suprascapular nerve treatments in frozen shoulder. Where pain remains a barrier, longer-acting options such as pulsed radiofrequency to the nerve may be considered, although the evidence for this is more limited and we explain this in advance.
Peripheral nerve stimulation
Peripheral nerve stimulation is used in selected people with persistent shoulder pain that has not responded to other treatments. Evidence for its use specifically in frozen shoulder is limited, so it is not a routine option, and we would discuss it only where simpler approaches have not helped.
Manipulation or surgery
For a small number of people with severe stiffness that does not improve, manipulation under anaesthetic or arthroscopic capsular release may be considered, usually with an orthopaedic shoulder surgeon. We can refer you if this seems appropriate.
If you have diabetes
Frozen shoulder is more frequent in people with diabetes and can be slower to recover. Good glucose control helps overall health, and steroid injections can temporarily raise blood sugar, so let us know if you have diabetes, and monitor your levels for a few days after any injection. We discuss this before treatment.
About your specialist
Dr Kavita Poply is a Consultant in Pain Medicine and Neuromodulation at St Bartholomew’s Hospital, London, and a Reader at Queen Mary University of London. Her clinical interests include rotator cuff syndrome and frozen shoulder, and her procedures include peripheral nerve blocks and radiofrequency treatments.
Frequently asked questions
Q.1 How long does frozen shoulder last?
Ans. Frozen shoulder commonly lasts between one and three years from start to finish, moving through freezing, frozen and thawing stages. Pain is usually worst early on. Most people recover most of their movement, but some are left with mild stiffness. Treatment does not always shorten the whole course, but it can make the painful phase more manageable.
Q.2 What is the fastest way to treat frozen shoulder?
Ans. There is no guaranteed quick fix. Early, well-controlled pain, an injection in the painful stage and regular guided movement give many people the smoothest recovery. Hydrodilatation and nerve blocks are options for persistent pain. The best approach depends on which stage you are in, so an assessment matters more than a single treatment.
Q.3 Is a steroid injection worth having for frozen shoulder?
Ans. For many people, yes, especially in the early painful stage. A steroid injection can reduce pain and make physiotherapy easier, though the effect often wears off and it does not cure the condition. People with diabetes should monitor blood sugar afterwards, as steroids can raise it for a few days.
Q.4 Can frozen shoulder come back?
Ans. Frozen shoulder rarely returns in the same shoulder, but it can develop in the other shoulder in a proportion of people, particularly those with diabetes. If you have had it on one side, mention this early if the other shoulder becomes stiff or painful so it can be assessed promptly.
Q.5 How do I know if it’s frozen shoulder or a rotator cuff problem?
Ans. In frozen shoulder, movement is limited even when someone else moves your arm, and turning the arm outwards is especially restricted. In a rotator cuff problem, you may struggle to lift the arm yourself, but passive movement is usually preserved. Examination, and sometimes ultrasound or X-ray, separates the two.