Frozen Shoulder :: Midlands Partnership University NHS Foundation Trust

Drawing of the shoulder labelling the location of various soft tissues and bones. Frozen shoulder is a condition where the shoulder joint becomes stiff. The shoulder joint is covered by a capsule of soft tissues and in this condition the capsule contracts, limiting movement, and the joint becomes flooded with chemicals that cause pain.

Frozen shoulder is a progressive condition which can last anywhere from months to years depending on various factors about the onset of the condition and general health.

It is not fully known why this condition occurs and often has no apparent reason.
Sometimes it occurs after an injury, surgery or other conditions affecting the shoulder.
It is a problem affecting 1% of the adult population at some point in their life.
Most commonly occurs in people aged between 40 and 65 years.
It is more common in people who have diabetes and hyperthyroid disease.

Frozen shoulder is commonly associated with severe and often relentless pain and restriction in movement. This can cause great difficulty with everyday tasks, such as, dressing, brushing teeth, and washing.

The main feature is significant restriction to movement in certain directions, specifically a lack of external rotation (reaching out to the side) and elevation (reaching above your head) at the shoulder (as shown below). Pain can often lead to weakness and reduced function of the affected shoulder.

Someone showing an example of Shoulder External rotation by bending their elbows and turning the arms out to the side.

Frozen shoulder is described as having 3 overlapping phases:

Phase one—”freezing”

First symptom is pain but movement may remain good initially. Limitation to movement gradually builds up.

Phase two—”frozen”

Pain gradually eases but stiffness remains or gets worse.

Phase three—”thawing”

Pain levels reduce and movement is gradually restored.

Diagnosis is usually made from a consultation with your Health Care Professional, involving a detailed history of the onset of symptoms, current pattern of symptoms and your current functional ability.

It is difficult to make a diagnosis of frozen shoulder with X-ray, MRI or ultrasound scan. Therefore one is not normally required.

Frozen shoulder can often resolve itself with no intervention.

The primary aim of treatment is to help manage your pain. This allows you to move more and help you return to normal activities sooner.

Pain more than stiffness.

Treatment therefore is aimed at pain control. This might involve pain medication, or the use of heat or cold treatments and keep active with gentle exercises.

Stiffness more than pain

Once pain has subsided treatment is then aimed at restoring range of movement by stretching the shoulder capsule (as shown below). Heat treatment can be used before exercise to help soft tissue flexibility prior to stretching techniques

It is normal to experience some discomfort when doing exercises, and individuals may start at different points. Pain should not increase excessively during or immediately after the activity. Discomfort should return to pre-activity levels 24-48 hours after the activity has finished.

The number (reps) and frequency (sets) of exercises suggested here are a guide, and should be performed to your personal tolerable pain levels. This means repetitions will vary between individuals and you should only go as far as is reasonably comfortable for you.

Here are some simple mobility exercises to help maintain and improve shoulder joint range of movement:

Moving image of someone lying on their back raising their arms above their head. Shoulder flexion in supine - PROM with long lever

Lie on your back with your arms resting on your stomach. Interlock your fingers and then use your unaffected arm to lift your affected arm towards the ceiling whilst keeping your elbows straight. Continue this movement towards the floor behind you ensuring the weight of your affected arm is supported. Hold this position. Return to the start position and repeat.

Moving image of someone sat on a chair with their hands on top of a stick and leaning forwards. Shoulder forward flexion stretch over stick

Start in a seated position with a broom stick upright between your legs. Place your arms on the top of the stick. Steadily stretch your arms out forwards as far as you can, dropping your head down between your shoulders. Your arms should remain floppy and relaxed throughout and be careful not to tense your shoulders. Hold this position

Moving image of someone standing with a stick in their hands and using the stick to push their arm out to the side. Shoulder External Rotation stretch in standing with stick

Stand up straight holding a stick. Hold the handle of the stick on the side you would like to stretch. Take the rest of the stick in your other hand, holding it horizontally across your body. Both elbows should be bent to around 90 degrees. Keeping your back straight, shoulder blades relaxed and your gaze directly ahead, rotate your forearm on your affected side outwards. Use your other arm to generate this movement, keeping your affected shoulder as relaxed as possible. Your elbow on your affected arm should remain by your side throughout. Hold this position when you feel a stretch across your shoulder and chest.

Moving image of someone standing with a stick in their hands and using the stick to push their arm up to the side and above their head. Shoulder abduction with stick

Hold a stick in both hands and hold it in front of you. Push across your body with one arm, lifting your other arm out to the side. Be careful not to hunch your shoulders up or twist your body around. Control the movement back down carefully. Repeat to the other side

Here are some basic strengthening exercises to help maintain and improve shoulder muscle strength and power:

Moving image of someone with their elbow bent, facing a wall. They are pushing their hand forwards against the wall. Isometric shoulder flexion

Sit or stand up straight facing a wall. Keep your affected arm by your side and bend your elbow to 90 degrees. Place your fist against the wall. Without moving your body, press your fist into the wall. Hold this position and then relax.

Moving image of someone with their elbow bent, side on to a wall. They are pushing their hand out to the side against the wall Isometric shoulder external rotation

Sit or stand up straight next to a wall. Keep your affected arm by your side and bend your elbow to 90 degrees. Place the back of your wrist against the wall. Without moving your body, press your wrist into the wall as if turning your forearm outwards. Hold this position and then relax.

Moving image of someone with their elbow bent, side on to a wall. They are pushing their elbow out to the side against the wall

Isometric shoulder abduction

Sit or stand up straight next to a wall. Keep your affected arm by your side and bend your elbow to 90 degrees. Place the outside of your elbow against the wall. Without moving your body, press your elbow into the wall. Hold this position and then relax.

Unless you have a serious injury or have sudden continuous severe pain, you can usually treat your shoulder pain without having to see your doctor. If after 2 weeks of treating yourself you feel the pain isn’t any better or is worsening, you should see a Health Care Professional

You should also see a Health Care Professional if you:

Have pain that doesn’t show any signs of improvement, within a couple of weeks of self help
Have pain that has rapidly deteriorated or suddenly worsened despite self help
Have pain, tingling, numbness or weakness in your face or arms
Develop sudden stiffness in the shoulders and/or neck resulting in a lack of movement
Are experiencing double vision, dizziness, nausea or sudden fainting
Are noticing changes with your speech and/or difficulty swallowing
Are noticing changes to your balance or walking pattern
Are feeling clumsy or are falling more often
Have a history of inflammatory arthritis, immuno-suppression, cancer, Tuberculosis (TB), drug abuse, AIDS or other infection
Feel unwell, have a fever, or unexplained weight loss
Are experiencing significant and regular changes to your usual sleeping pattern
Have a history of recent injury (e.g. from a road traffic accident or a fall) or a history of shoulder surgery
Have a new and visible deformed or misshapen shoulder