Patient information · Orthopaedics
Frozen shoulder
long, painful, and it does get better
Frozen shoulder is inflammation and then contraction of the capsule around the shoulder joint. It is one of the most painful and prolonged musculoskeletal conditions there is, and the single most useful thing to know at the outset is that it runs in phases, each needing a different approach.
Arrange assessment rather than assuming frozen shoulder if there is
- shoulder pain following a significant injury or fall, particularly with weakness
- an inability to lift the arm at all after trauma — this may be a tendon tear or fracture
- shoulder pain with fever, redness and heat over the joint
- night pain with weight loss, or a history of cancer
- pins and needles or weakness in the hand, or pain spreading below the elbow
- sudden shoulder pain with chest pain, breathlessness or sweating
Referred pain from the heart, gallbladder or lung can present in the shoulder. Genuine frozen shoulder restricts movement in all directions, including when someone else moves the arm for you — that is what distinguishes it from most other shoulder problems.
The three phases
Total duration is commonly one to three years. Most people recover full or near-full movement. Knowing which phase you are in matters, because aggressive stretching during the painful freezing phase makes things worse, while the same exercises during the frozen phase are exactly right.
The signs
- pain deep in the shoulder, often radiating to the upper arm, that is severe at night and makes lying on that side impossible
- progressive loss of movement, particularly reaching behind your back and rotating outwards
- difficulty with bras, seatbelts, hair, coats and reaching into a back pocket
- movement is restricted whether you move it or someone else does — the joint itself will not go further
The diabetes connection
Frozen shoulder is several times more common in people with diabetes, tends to be more severe, lasts longer, and is more likely to affect both shoulders in turn. If you develop frozen shoulder and have not had your blood glucose checked recently, it is worth doing — it is occasionally the presenting feature of undiagnosed diabetes. It is also associated with thyroid disease, Dupuytren's contracture, and periods of shoulder immobilisation.
Treatment by phase
- Freezing phase — control the pain. Regular analgesia, anti-inflammatories if suitable, and sleeping propped with a pillow supporting the arm. Gentle movement within a comfortable range only. Do not force it.
- A corticosteroid injection into the joint is most effective early, during the painful phase. It reduces pain substantially and appears to shorten the overall course. This is the intervention most often left too late.
- Frozen phase — work on range. This is where physiotherapy earns its place, with stretching into the restricted directions, held and repeated daily.
- Hydrodilatation — injecting fluid to stretch the capsule under imaging — can improve movement where stiffness persists.
- Surgery or manipulation under anaesthetic for the minority who remain significantly restricted after a year or more of proper treatment.
Living with it
Helps
- Heat before exercises — a shower or heat pack
- Little and often: short stretch sessions several times a day
- Sleeping on the good side with a pillow hugged in front
- Keeping the elbow, wrist and neck moving freely
- Continuing to use the arm within its available range
Avoid
- Forcing the shoulder into pain, particularly early on
- Complete rest and using a sling — this worsens stiffness
- Sudden jerking movements or heavy lifting overhead
- Comparing progress week to week; judge it monthly
- Assuming lack of quick progress means treatment has failed
Book an appointment if shoulder pain is waking you at night, movement is becoming restricted, or you have had symptoms for more than a few weeks. Early injection during the painful phase makes the greatest difference — our orthopaedic and physiotherapy teams see shoulders seven days a week, with ultrasound-guided injection on site.
Ultrasound-guided injection and physiotherapy
Same-day appointments most days, seven days a week, on Whitechapel Road.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.