Frozen shoulder

Also called Adhesive capsulitis

A shoulder that stiffens, hurts and then slowly frees. It takes one to three years, and knowing that changes how people cope.

What it is

Frozen shoulder affects around 3% of people, most often between 40 and 60, and considerably more often in people with diabetes and thyroid disease.

The capsule around the shoulder joint becomes inflamed, thickens and contracts. Movement is lost in a characteristic pattern, with external rotation affected most.

It runs in three phases: freezing, which is the painful stage and lasts two to nine months; frozen, which is stiff but less painful, four to twelve months; and thawing, when movement gradually returns, five to twenty-four months.

Total duration is commonly one to three years. Being told that at the start is the single most useful thing a clinician can do, because people otherwise assume something is going badly wrong.

Signs you might notice

Shoulder pain, often severe at night and preventing sleep on that side.

Progressive stiffness, with movement lost in all directions, actively and passively.

Difficulty reaching behind the back, doing up a bra, or reaching into a back pocket.

External rotation affected most, which distinguishes it from a rotator cuff problem.

Usually one shoulder, though the other becomes affected in a proportion of people later.

How it can affect day-to-day life

Sleep loss is the worst part of the painful phase and it is under-treated. Months of broken sleep affects mood, work and everything else.

Dressing, washing hair, driving and reaching become difficult, and people with diabetes tend to have longer and more severe courses.

The temptation to stop using the arm entirely makes stiffness worse.

Supporting someone well

Explain the timeline. Knowing this takes one to three years and then resolves prevents a great deal of anxiety.

Treat the pain properly during the freezing phase, including at night. Ask about a steroid injection, which has good evidence early on.

Keep gentle movement going within the pain limit. Do not force through severe pain during the freezing phase, and do stretch during the frozen and thawing phases.

Get physiotherapy, and expect the emphasis to change with the phase.

Optimise diabetes control, which affects the course.

Ask about hydrodilatation or surgery if there is no progress after a long frozen phase.

Where to get help

A GP or physiotherapist; self-referral to physiotherapy is available in many areas.

Arthritis UK have exercise guides.

Sudden shoulder pain after an injury, or pain with fever, needs different assessment.