What is frozen shoulder?

Frozen shoulder (also known as adhesive capsulitis) is a painful musculoskeletal (muscle and bone) condition that affects the shoulder joint.

Your shoulder joint includes your upper arm bone (humerus) and collarbone (clavicle) and their associated ligaments and tendons. These are contained in a covering or ‘capsule’ of connective tissue.

If you develop frozen shoulder, this capsule becomes thickened and inflamed, leading to pain and stiffness.

What causes frozen shoulder?

Sometimes, frozen shoulder develops after a shoulder or arm injury. It can also develop after certain surgeries on the upper body, including shoulder surgery and open-heart surgery.

Often, there is no clear cause of the condition.

Factors that can increase your risk of developing frozen shoulder include:

• being over 40 years old
• being female
• having diabetes
• medical conditions including thyroid problems, Parkinson’s disease and cardiovascular disease
• recent injury, trauma or surgery, especially if your arm was immobilised

What are the symptoms of frozen shoulder?

Frozen shoulder usually develops gradually, and goes through 3 stages:

• the ‘freezing’ stage
• the ‘frozen’ stage
• the ‘thawing’ stage

‘Freezing’ stage

In this stage, you may experience the gradual build-up of severe pain in your shoulder whenever you move the joint. Many people have difficulty finding a position that feels comfortable, especially when trying to sleep.

This stage is sometimes described in two parts — the first being the ‘painful’ stage, followed by ‘freezing’ or stiffness in the shoulder joint, as the covering of the shoulder joint becomes ‘stuck’ to the bones.

‘Frozen’ stage

In this stage, you may notice that your pain begins to improve, although the stiffness remains.

You may still experience pain with lifting your shoulder and moving your arm backwards away from your body (known as external rotation of the shoulder joint).

‘Thawing’ stage

As the condition begins to resolve, you may notice that the stiffness in your shoulder joint improves.

Untreated, it may take 1 to 3 years for the condition to reach the ‘thawing’ stage.

How is frozen shoulder diagnosed?

Your doctor will ask about your symptoms and examine your shoulder. Special tests, including imaging tests such as x-ray, are not usually needed to diagnose frozen shoulder.

If your doctor diagnoses frozen shoulder, they may check for other conditions associated with frozen shoulder, such as diabetes, high blood pressure and high cholesterol.

How is frozen shoulder treated?

Not much is known about the best way to treat frozen shoulder. However, most people notice an improvement in their symptoms with treatments like:

Pain relief

Frozen shoulder can be very painful. Your doctor will discuss different options for pain relief, including regular paracetamol, with stronger pain-relief medicines for when your pain is severe. Many pain relief medicines have side effects, so make sure to take them exactly as directed, and see your doctor if you experience side effects that worry you.

Other strategies some people find helpful include:

• resting the affected shoulder, especially during the early stages of the condition
• icing the painful area
• acupuncture

During the ‘freezing’ phase, it’s a good idea to minimise driving as much as you can, as this can make your symptoms worse.

Physiotherapy

Physiotherapy can be a very useful treatment for frozen shoulder. Your physiotherapist may suggest different strategies to improve your pain and your shoulder’s mobility. These may vary depending on which stage of frozen shoulder you are currently experiencing.

Your physiotherapist can:

• advise you about positioning, and other strategies to minimise your pain
• give you exercises to improve the movement in your shoulder joint
• use manual release (touch and massage) techniques to improve the mobility in your shoulder joint

Joint injections

Corticosteroids are a type of anti-inflammatory medicine. Your doctor may suggest corticosteroid injections in your shoulder joint to reduce the inflammation in the joint and improve your symptoms. These are considered safe and effective, especially if you have this treatment at an early stage of the condition.

Another technique sometimes used is known as hydrodilatation. This procedure involves injecting your shoulder joint with a sterile saline (salt water) solution. Sometimes, corticosteroid or local anaesthetic is added to this solution. The purpose of this is to ‘stretch’ your joint capsule and improve the ‘freezing’ stage of the condition.

Surgical techniques

Surgery can be used to try to ‘unstick’ the frozen shoulder capsule. This procedure is known as arthroscopy. During arthroscopy, your surgeon will make a few small incisions (cuts) around your shoulder joint to insert a camera and surgical instruments for the procedure. Arthroscopy is usually done under a general anaesthetic.

While you are in surgery, your surgeon may also move and stretch your shoulder joint in specific ways. This is known as ‘manipulation’. This treatment can also help improve your pain and stiffness.

What are the complications of frozen shoulder?

Frozen shoulder can cause long periods of pain and stiffness that affect your day-to-day life. If left untreated, the condition can continue for several years. Even with treatment, it is common to experience symptoms for a long time.

Can frozen shoulder be prevented?

Frozen shoulder can’t be prevented, but early treatment can help relieve your symptoms and reduce the time until it resolves.

Resources and support

• The Australian Physiotherapy Association has information about the role of physiotherapy in the treatment of frozen shoulder.
• PainAustralia has information about pain services and programs in your area.
• Discuss your pain on the Pain Link telephone helpline (1300 340 357), which is staffed by volunteers with personal experience of chronic pain.