The shoulder is a ball-and-socket joint wrapped in a flexible capsule. In frozen shoulder this capsule becomes inflamed, then thickens and tightens, so the ball has less room to move. The result is pain first, then stiffness in every direction.
One feature separates it from most other shoulder problems: the shoulder is stiff even when someone else tries to move it for you. With a rotator cuff problem the arm is often painful to lift but can still be moved passively; in frozen shoulder it simply will not go, especially when turning the arm outwards.
The three overlapping stages of frozen shoulder. Timings vary a great deal between people.
Frozen shoulder usually starts without an obvious injury. Typical signs are:
The diagnosis is made mainly by examination: a clinician checks how far the arm moves on its own and when moved for you. The loss of outward rotation is the key finding.
An X-ray is usually normal in frozen shoulder and is used to rule out arthritis or calcium deposits in the tendons. Ultrasound or MRI are needed only if another problem, such as a rotator cuff tear, is suspected. Because diabetes is so closely linked, a blood sugar test is often worthwhile if it has not been checked recently.
Treatment is matched to the stage. The aims are to control pain early, keep as much movement as possible, and restore the rest as the shoulder thaws.
A large UK trial (UK FROST) compared early structured physiotherapy with a steroid injection, manipulation under anaesthesia, and keyhole capsular release. All three groups improved substantially over a year, and the differences between them were small. For most people, therefore, surgery is not the first step.
At VinayakM, a shoulder that is painful and stiff is examined properly before anything else, because frozen shoulder, rotator cuff problems and neck-related pain need different plans.
Most people recover most of their movement, though it can take one to three years. A minority are left with some stiffness. Treatment does not always speed up the whole course, but it makes the painful phase much more bearable and helps keep movement.
Yes, but gently. In the painful phase, move within comfortable limits and avoid forcing the stretch. As pain settles, the stretching can become firmer.
Yes. Some people develop it in the other shoulder later, especially people with diabetes. It rarely comes back in the same shoulder.
Usually, yes, but it can raise blood sugar for a few days. Check your sugar more often after the injection and tell your clinician about your diabetes beforehand.
Usually not. The diagnosis is made by examination, and an X-ray is used to rule out other causes. MRI is kept for cases where another problem is suspected.
Written in our own words. Textbooks were used as background reading and are cited; no text, figures or tables have been reproduced from them.
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