Frozen Shoulder : The Complete Guide to Pain Relief and Movement Recovery
What Exactly Is Frozen Shoulder?
Frozen shoulder is a condition where the shoulder joint becomes progressively painful and stiff. The main tissue affected is the joint capsule, which is a sleeve of connective tissue that surrounds the shoulder joint and helps keep everything in place. In a normal shoulder, the capsule is loose and flexible in order to allow the huge range of movement available in the shoulder. But in frozen shoulder the capsule becomes inflamed and angry and then contracts and adheses itself to the underlying joint, almost like shrink wrap. So this is where it gets its medical name of adhesive capsulitis.
The Three Stages of Frozen Shoulder
Frozen shoulder will typically progress through 3 distinct stages. Understanding the timeline of the condition is crucial because treatment is tailored to the specific stage you are in.
Stage 1: The 'Freezing' Stage (The Painful Phase) The defining symptom of this initial stage is pain. The shoulder becomes increasingly painful with movement, and the pain can be severe, especially at night, often disrupting sleep. This intense pain is due to active inflammation in the joint capsule. While the name "frozen shoulder" might sound minor, the pain during this phase can be one of the most significant in musculoskeletal medicine. This stage can last anywhere from one to six months.
Stage 2: The 'Frozen' Stage (The Stiff Phase) During this stage, the intense pain begins to subside, which is often a significant relief. However, as the inflammation settles, the capsule becomes fibrotic and tight, leading to profound stiffness. You'll likely find it difficult to lift your arm away from your body, raise it overhead, or reach behind your back. Everyday tasks like combing your hair, fastening a bra, or tucking in a shirt can become challenging. This is typically the longest stage, lasting an average of six to twelve months.
Stage 3: The 'Thawing' Stage (The Recovery Phase) Finally, in the thawing stage, the stiffness gradually begins to resolve, and your range of motion starts to return. While this phase can take several months (or longer), most people experience a significant, if not complete, recovery over time.
The entire journey of a frozen shoulder can take between one and three years. The good news is that it is a self-limiting condition for most, meaning it will eventually get better.
Why Did I Get It? Understanding the Causes and Risks
While the exact trigger for frozen shoulder is often unclear, several factors are known to increase your risk:
- Age: It most commonly affects individuals between 40 and 60 years old.
- Sex: Women are slightly more likely to develop frozen shoulder than men.
- Medical Conditions: People with diabetes or thyroid disorders have a significantly higher risk. The link is particularly strong with poorly controlled diabetes.
- Immobility: The condition can sometimes be triggered by a shoulder injury or surgery, especially if the arm has been immobilised for a long period.
Crucially, frozen shoulder is a medical condition, not something you’ve caused through poor posture, sleeping awkwardly, or lifting a heavy object. It is usually not your fault. It's also worth noting that if you've had a frozen shoulder on one side, there is a roughly 20% chance of developing it in the other shoulder within five years.
How is Frozen Shoulder Diagnosed?
A diagnosis of frozen shoulder is usually "clinical," meaning it's based on your specific symptoms and a physical examination. An X-ray might be ordered to rule out other problems that can mimic a frozen shoulder, such as arthritis or a fracture, but the X-ray itself will typically be normal in a case of frozen shoulder.
The most telling clinical sign is a significant loss of passive external rotation. This is the outward rotating movement of your shoulder. You can check this by tucking your elbows into your sides, bending them to 90 degrees, and then rotating your forearms outwards. An unaffected shoulder can typically rotate 70-90 degrees, whereas a frozen shoulder will be severely restricted, often moving only a few degrees.
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| A Typical Right Sided Frozen Shoulder |
What Are My Treatment Options?
Treatment focuses on two main goals: managing pain and then improving movement. The right approach depends on your stage. For some with mild symptoms, simply understanding the condition and its natural history is enough reassurance to let time be the main healer. For those with more severe symptoms, a more active approach is needed.
Managing the 'Freezing' (Painful) Stage
If you are in the early, painful stage, the priority is pain relief.
- Pain Medication: Over-the-counter painkillers like paracetamol and anti-inflammatories like ibuprofen can be very effective. The key is to take them regularly as directed on the packet (e.g., every 4-6 hours), not just "as needed." This allows a therapeutic level to build up in your system. Always consult a pharmacist or doctor before starting new medication.
- Heat or Ice: Experiment with both Heat Packs and Ice Packs to see which provides more relief. There is no right or wrong choice; it’s about personal preference.
- Cortisone Injection: If your pain is severe and robbing you of sleep, a cortisone injection is often the most effective treatment. It delivers a powerful anti-inflammatory directly into the joint to "put the fire out." This won't fix the stiffness, but it can dramatically reduce pain. If possible, an injection performed under ultrasound guidance is preferable for accuracy.
Managing the Frozen Stage
Once the severe pain is under control, the focus shifts to restoring movement. The principle is "movement is medicine," but it's vital to start gently and not push aggressively into pain. Aim to keep any discomfort during exercises below a 4 or 5 on a 10-point pain scale.
Choose a few exercises that feel right for your stage and aim to do them consistently.
The following exercises can also be seen demonstrated in the video below.
Gentle Mobility Exercises (For early stages with some pain)
- Pendular Swings: Lean forward, supporting yourself with your good arm on a table. Let your affected arm hang down and gently swing it forwards and backwards, side to side, and in small circles, like a pendulum. Using a small weight (e.g., a 1kg dumbbell or a bottle of water) can help relax the shoulder.
- Assisted Elevation: Use your good arm to help lift your affected arm. You can do this by clasping your hands together or by using a stick (like a broom handle) and pushing the affected arm up in front of you.
- Assisted External Rotation: Keep your elbow tucked into your side at a 90-degree angle. Hold a stick and use your good hand to gently push the hand of your affected side outwards, stretching the shoulder into rotation.
- Table Slides: Sit at a table and place the hand of your affected arm on a cloth. Gently slide your hand forwards, sideways, and in circles.
- Pulleys: Use a pulley system (amazon link here) over the top of a door to help elevate your shoulder as high as possible with minimal pain.
More Intensive Stretches (When pain is minimal and stiffness is the main issue)
- Wall Walks: Stand facing a wall and "walk" your fingers up as high as you can without significant pain. Hold for a few seconds, then slide back down. You can also do this standing sideways to the wall to work on abduction (lifting the arm out to the side).
- Doorway Stretch: Stand in a doorway with your elbow bent at 90 degrees and your palm on the doorframe. Keep your elbow tucked in and slowly turn your body away from your arm to stretch the front of the shoulder.
- Hand Behind Back Stretch: Reach your affected hand behind your back as far as is comfortable. Use your good hand to gently pull it further up your back, or use a towel draped over your good shoulder to assist the stretch.
Strengthening Exercises (For the 'Thawing' stage as movement returns)
- Resisted External Rotation: With your elbow at your side, use a Resistance Band to add a challenge to the outward rotation movement.
- Wall Press-ups: Stand facing a wall and perform a press-up motion. To make it harder, move your feet further from the wall.
What if Nothing is Working?
For a small number of people, frozen shoulder can be incredibly stubborn. If your symptoms haven't improved after a significant amount of time (e.g., 3-6 months of severe pain or 2-3 years of stiffness), there are more advanced options:
- Hydrodistention (or Hydrodilatation): In this procedure, a large volume of sterile fluid is injected under pressure into the joint capsule to stretch it from the inside out. It is minimally invasive and can be very effective for persistent stiffness.
- Surgery (Arthroscopic Capsular Release): As a last resort, a surgeon can perform keyhole surgery to carefully cut the tightened sections of the capsule, physically freeing the joint. This is generally preferred over the older technique of "Manipulation Under Anaesthesia (MUA)," which involved forcibly moving the shoulder and carried a higher risk of damaging surrounding tissues.
A Special Note for People with Diabetes
If you have diabetes, managing your frozen shoulder requires an extra layer of diligence. A diabetic frozen shoulder can be more severe and often takes twice as long to get better. Recovery is directly linked to blood sugar control. If your HbA1c levels are high, prioritising your diabetes management is the single most important thing you can do. Other treatments are unlikely to be effective until your blood sugar is under good control.
Final Takeaways
- Be Patient: Frozen shoulder is a marathon, not a sprint. It almost always gets better, but it takes time.
- Find a Balance: Keep the shoulder moving within your pain limits. Don't push through severe pain, but don't stop using the arm completely.
- Manage Pain First: In the early stages, focus on pain relief. An injection can be a game-changer for severe, sleep-disturbing pain.
- Exercise Consistently: Gentle, regular stretching and strengthening will make a difference, especially in the later stages.
- Seek Help: If you are struggling to cope or your symptoms are not improving as expected, consult a physiotherapist or your doctor to discuss your options.
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This article provides general information related to various medical conditions and their treatment. It is intended for informational purposes only and not a substitute for professional advice, diagnosis or treatment provided by a doctor or other qualified health care professional. The information provided does not constitute personal advice or guarantee of outcome and should not be used to diagnose yourself or others. You should never ignore advice provided by a health care professional because of something you have seen or read on this website. You should always consult a doctor or other qualified health care professional for personal medical advice.