Shoulder · Condition
Frozen Shoulder
The lining of the joint thickens and contracts, so the shoulder becomes genuinely stuck. Painful, slow, and almost always self-limiting.
Does this sound like you?
- “My shoulder has gone stiff”
- “I can't reach behind my back”
- “It's painful and getting tighter”
- “I can't put my arm into a sleeve”
Symptoms
- Progressive stiffness — the defining feature. The shoulder will not move, and nor can someone else move it for you.
- Severe pain in the early months, often worse at night and disturbing sleep badly.
- Loss of outward rotation first: you cannot turn your palm outwards with the elbow at your side.
- Inability to reach behind your back, to fasten a bra, or to get your arm into a sleeve.
- Difficulty reaching overhead or across your body.
- Pain on any sudden movement, which can be sharp enough to make you catch your breath.
- Later, the pain settling considerably while the stiffness remains.
Why it happens
- Often no identifiable cause at all — this is the commonest situation, and it is genuinely not your fault.
- Diabetes, which increases the risk several-fold and tends to make it more severe and longer-lasting.
- Thyroid disease.
- A period of immobility — after a fracture, after surgery, or after wearing a sling.
- A minor shoulder injury that led to guarded, reduced movement.
- Previous frozen shoulder on the other side, which affects a meaningful proportion of patients.
- Most often affecting people between forty and sixty, and somewhat more often women.
See someone sooner if…
- The stiffness is progressing quickly, since early treatment shortens the painful stage.
- You have diabetes and a stiff shoulder, which needs closer attention and often a more active approach.
- Pain is severe enough to be preventing sleep for weeks.
- There was a significant injury before the stiffness began, which could mean a fracture or a large cuff tear rather than a frozen shoulder.
- The shoulder is hot, red and you feel unwell — this needs assessment today.
What is actually happening
The shoulder joint sits inside a soft, roomy bag of tissue called the capsule, which is loose enough to allow the huge range of movement the shoulder normally has. In a frozen shoulder, that capsule becomes inflamed, then thickened and fibrotic, and then contracts. The bag shrinks around the joint.
This is why a frozen shoulder is different from every other stiff shoulder. It is not that the muscles are tight or that you are guarding it. The physical container of the joint has become smaller, and the movement is genuinely, mechanically unavailable — to you and to anyone examining you.
The three stages, and how long each lasts
Frozen shoulder follows a recognisable course. Knowing where you are in it is genuinely useful, because it tells you what to expect and which treatment makes sense now.
- 1
Freezing — roughly 2 to 9 months
Pain dominates and worsens, often severely, with stiffness gradually increasing behind it. Nights are bad. This is the hardest stage and the one where injections and pain control matter most. Aggressive stretching here makes things worse, not better.
- 2
Frozen — roughly 4 to 12 months
Pain settles noticeably, which is a real relief. Stiffness is at its worst and daily tasks are genuinely difficult. This is the stage where a structured stretching programme starts to earn its keep.
- 3
Thawing — roughly 5 to 24 months
Movement gradually returns, usually without dramatic intervention. Most people recover most of their range. A minority are left with some permanent restriction, most often in reaching behind the back.
What helps, and what makes it worse
| Helps | Makes it worse |
|---|---|
| A corticosteroid injection into the joint during the painful freezing stage | Aggressive stretching while the shoulder is still hot and painful |
| Gentle, frequent movement within the range you have | Complete rest and immobility, which accelerate the contracture |
| Physiotherapy matched to your stage — pain relief first, stretching later | A physiotherapist pushing through severe pain in the early phase |
| Good diabetic control, which measurably affects the course | Ignoring an undiagnosed thyroid or diabetic problem |
| Heat before stretching, ice after | Expecting rapid results and giving up |
| Sleeping propped, with the arm supported on a pillow | Repeated injections beyond two or three |
When surgery is considered
Rarely, and not before a reasonable period of proper non-surgical treatment. Where a shoulder remains severely stiff and disabling after twelve months or more — most often in diabetic patients — two options exist.
- Hydrodilatation: the joint is distended under imaging with fluid and steroid, physically stretching the contracted capsule. Not surgery, and often effective.
- Arthroscopic capsular release: keyhole surgery to divide the thickened capsule under direct vision, releasing the contracture. Followed immediately by intensive physiotherapy, which is essential — the range gained in theatre must be kept.
Manipulation under anaesthesia alone is used less than it once was, since a controlled arthroscopic release is more precise and carries less risk of fracturing the bone or tearing the cuff.
First, without surgery
What to try before an operation
This list comes first on purpose. For most people reading this page, it is the whole treatment — and where it is not, having genuinely worked through it makes the decision to operate a much clearer one.
- A corticosteroid injection into the joint during the painful stage — the intervention with the best evidence for shortening the misery.
- Physiotherapy staged to match the phase: pain relief and gentle movement first, progressive stretching once the pain settles.
- Regular gentle movement within your available range, several times a day rather than one long session.
- Simple analgesia and anti-inflammatories, with something at night if sleep is being lost.
- Heat before exercises and ice afterwards.
- Checking and optimising blood sugar and thyroid function, both of which genuinely affect the course.
- Practical adaptations while it lasts: front-fastening clothes, a long-handled sponge, moving frequently used items to waist height.
- Hydrodilatation where pain and stiffness are not responding to injection and physiotherapy.
If surgery is needed
And when it genuinely is
Each option below says when it applies, not just what it is. If your situation does not match, that is a good reason to ask more questions.
Questions patients ask
The questions people most often ask about frozen shoulder.
Related conditions and treatments
- ConditionRotator Cuff TearA tear in the tendon sheet that grips the ball of your shoulder. The night pain is the giveaway.
- ConditionShoulder Dislocation & InstabilityOnce a shoulder has dislocated, the rim that holds it in place is usually torn — and it tends to happen again more easily.
- TreatmentShoulder Arthroscopy & Rotator Cuff RepairReattaching the torn tendon on top of your shoulder to the bone with anchors, through three small keyhole incisions.
- TreatmentShoulder ReplacementResurfacing a worn or collapsed shoulder joint — including the reverse design, which works even when the rotator cuff cannot be repaired.
Bring your scans. Get a straight answer.
A consultation means your imaging on the screen, a plain explanation of what is actually wrong, and an honest opinion on whether you need surgery — including when the answer is no.