What is a frozen shoulder?

 

If your shoulder is painful and becoming increasingly stiff – and for no obvious reason – you may have a condition called frozen shoulder. Known as adhesive capsulitis of the shoulder or shoulder contracture in the medical world, frozen shoulder usually affects just one shoulder – typically the non-dominant one (that is, your left shoulder if you’re right-handed). However around 14 per cent of people with the condition experience symptoms in both shoulders (i). Thankfully it’s very rare to have the condition more than once in the same shoulder.
 
The term frozen shoulder has nothing to do with your shoulder feeling chilly. Rather it’s because your shoulder feels so stiff you can hardly move it, and eventually it can become completely ‘frozen’. Usually the pain and stiffness start and get worse gradually over time, but occasionally frozen shoulder can happen suddenly – for instance, it can be triggered by having an injury to your shoulder.
 
According to the NHS, estimates suggest up to one in 20 people in the UK experience frozen shoulder at some point or other (ii), though experts at Patient claim it affects slightly fewer of us (around three per cent of adults (iii)). You can get frozen shoulder at any age but it’s most likely to affect you between the ages of 40 and 60, with women more likely to develop the condition than men.
 

Frozen shoulder symptoms

The severity of frozen shoulder tends to vary from one person to another. You could, for instance, have a mild case that doesn’t affect your day-to-day life that much. But if you have severe pain and stiffness in your shoulder you may find even the simplest things a challenge, including:
 

• Dressing
• Showering and bathing
• Driving
• Sleeping comfortably
• Scratching your back
• Reaching into your back pocket

 
… or indeed anything that involves movement of your arm and shoulder joint. Even passive shoulder movements – that is, when someone moves your shoulder joint or arm for you (your doctor or a physiotherapist, for instance) – will trigger pain and stiffness.
 
The good news is frozen shoulder is a self-limiting condition, which means it will usually get better even without any treatment. The bad news is recovery can take a long time. According to the NHS, the symptoms of frozen shoulder can last at least 18 – 24 months, with some people not seeing much or any improvement for five years or more (v). But if you see your GP and are diagnosed with frozen shoulder as early as possible, getting the right treatment quickly could help you recover faster.

 

What are the three stages of frozen shoulder?

Frozen shoulder symptoms usually change over time and can be separated into three different stages:
 
Stage one: this is usually when you experience the most pain and is often called the freezing stage or the painful stage. Lasting anything from two to nine months, it’s when your shoulder starts to ache and becomes increasingly painful, especially when you reach out for things. Stiffness and limited movement in your shoulder joint will gradually make an appearance too, with both becoming worse over time. During this stage you may find the pain is worse at night, particularly if you sleep on your affected side.
 
Stage two: Known as the frozen stage or stiffness stage, this is when your shoulder becomes more and more stiff. This stage typically lasts for four to 12 months, and the good news is that the pain doesn’t usually get any worse – in fact it should gradually ease a little. The stiffness, however, remains and can often become more severe, and you may find it difficult to move your shoulder or arm in any direction (though the most severely affected movement tends to be the outward rotation of the arm – imagine bending your arm at the elbow and then moving your lower arm and hand out to the side while keeping your elbow still). In this stage your muscles may become weaker and start to waste slightly, as you may not be using them very much.
 
Stage three: The last stage of frozen shoulder is known as the thawing stage or resolution stage, and it can last anything from six months to several years. At this point the pain and stiffness start to ease and your movement gradually returns to normal (or close to normal). During this time you should be able to do more things more easily. Some people, however, never regain complete movement in their shoulder joint.
 
However according to the National Institute of Health and Clinical Excellence (NICE), since there is an overlap between these three stages, frozen shoulder has been more recently classified into two  – namely pain predominant and stiffness predominant stages (vi).
 

What causes frozen shoulder?

Several bones are found in the shoulder joint including the humerus (the upper arm bone) and the scapula (the shoulder blade). The main shoulder joint is called the glenohumeral joint – it’s found where the socket of the scapula (the glenoid) and the head of the humerus (the ball of the shoulder’s ball and socket joint) come together.
 
Surrounding the glenohumeral joint are layers of connective tissue that form a structure called the shoulder capsule (or glenohumeral joint capsule). These tissues include ligaments attaching the top of the humerus to the shoulder socket that hold the joint firmly in place. The capsule is usually elastic, which allows your shoulder to move freely. But if the tissues in the shoulder capsule become inflamed, they can become scarred, making the shoulder capsule thicker and stiffer, which in turn causes pain and makes movement more difficult. However experts still don’t know exactly why the inflammation and the scarring happens.
 
To make matters worse if your shoulder is painful you’re less likely to use it, which is thought to make the tissues in the shoulder capsule even thicker and tighter. This, of course, makes your symptoms even worse.
 

What increases my chances of developing frozen shoulder?

While we largely don’t know why anyone develops frozen shoulder, we do know that some of us have a higher risk of being affected than others. Your age and your gender are two common risk factors, since the condition is more common in women than men and in those aged 40 – 60. Other risk factors include:
 
Shoulder injury or surgery   While most cases of frozen shoulder develop for no obvious reason, some affect people who’ve had a shoulder or arm injury – a broken bone, for instance – or in those who’ve had shoulder surgery. Experts think this may happen because you usually have to keep your arm and shoulder still for a long time while recovering from a shoulder injury or surgery (such as when your arm is in plaster after a fracture). And if you don’t use your shoulder, the lack of movement can cause tightening in the shoulder capsule.
 
This means if you injure your shoulder, it’s important not to ignore it and seek medical advice that could help you recover faster if you do go on to develop frozen shoulder. Similarly anything that causes immobility can increase your risk, such as having to spend time in hospital.
 
Shoulder conditions   People can sometimes develop frozen shoulder if they have another type of shoulder condition, such as a rotator cuff tear (the rotator cuff is a group of muscles that control the movement of your shoulder) or calcific tendonitis (this is when tiny deposits of calcium affect the tendons in your shoulder).
 
Diabetes   According to the NHS people with diabetes are twice as likely to develop frozen shoulder than the rest of the population (iv) – though experts haven’t yet figured out why this should be the case. People with diabetes are also more likely to have more severe frozen shoulder symptoms, plus they’re more likely to develop the condition in both shoulders.
 
Besides diabetes a higher risk of developing frozen shoulder is linked with other health conditions, including:
 

• Thyroid disease (overactive or underactive thyroid)

• Heart disease 

• Stroke 

• Lung disease

• Breast cancer

• Dupuytren’s contracture (when small lumps of thickened tissue on your hand cause one or more fingers to bend in towards your palm)

 

What is the fastest way to help heal frozen shoulder?

If you think you may have frozen shoulder it’s important to see your GP sooner rather than later, since early treatment can help prevent long-term problems. Most cases are diagnosed without the need for any special tests, though sometimes other conditions have to be ruled out with x-rays, ultrasound scans or MRI scans. Conditions that have similar symptoms as frozen shoulder include:
 

• Rotator cuff injury (this causes pain when you move your shoulder joint yourself, but not when your doctor moves your arm for you – if it’s frozen shoulder, you’ll feel pain with both types of movement)

• Arthritis (osteoarthritis and rheumatoid arthritis of the shoulder)

• Biceps tendonitis (inflammation of the tendons of the bicep muscles)

• Subacromial bursitis (inflammation of fluid-filled sacs called bursae found under the collarbone)

 
If you’re diagnosed with frozen shoulder, the treatment your doctor may suggest will depend on how severe your symptoms are and what stage of the condition you’re at. You may not need any treatment at all if your symptoms are very mild – though some treatment could help you recover more quickly (experts say the symptoms of untreated frozen shoulder last between two and three years (iii)).
 
There are a few ways of treating frozen shoulder, though some may be more effective for you than others. These include:
 
Painkillers   Doctors usually recommend paracetamol in the first instance to help control the pain of frozen shoulder. These are preferred over anti-inflammatory painkillers such as ibuprofen, as they’re considered safer for long-term use. Anti-inflammatories can cause side effects such as kidney and stomach problems if you take them for prolonged periods. However you may be advised to take ibuprofen or another anti-inflammatory for a short time, usually just a week or two.
 
Both paracetamol and ibuprofen are available without a prescription online and at pharmacies. Other stronger pain relief medicines, however, must be prescribed by a doctor. Always follow your GP’s instructions when taking any painkillers or stick to the dosage instructions carefully on the patient leaflet inside the packaging.
 
Steroid injections   If you don’t get much or any relief by taking painkillers, your doctor or specialist may recommend you have a steroid injection in your shoulder joint to help relieve the inflammation and improve your shoulder mobility. Steroid injections are effective, but they don’t cure frozen shoulder, and your symptoms may come back gradually after a few weeks. They are, however, helpful for anyone who needs a break from severe frozen shoulder pain.
 
Doctors usually recommend a maximum of three steroid injections at least three to four weeks apart, since having too many can actually damage your shoulder.
 
Physiotherapy   Your GP may refer you to a physiotherapist for treatments such as massage, stretching exercises and thermotherapy (using warm or cold packs). A physiotherapist is also the best person to show you exercises that can help with frozen shoulder recovery. They may also try relieving your pain by using a transcutaneous electrical nerve stimulation (TENS) machine.
 
Surgery   It’s highly unlikely you’d be offered surgery for frozen shoulder unless your symptoms are severe and you’ve tried other treatments for at least six months and they haven’t worked. If you are offered surgery, however, you’ll be referred to an orthopaedic surgeon at a hospital. They will discuss your options and recommend a surgical procedure, such as:
 

• Manipulation (this is when a surgeon manipulates your shoulder joint in a controlled way to stretch your shoulder capsule while you’re under general anaesthetic)

• Arthroscopic capsular release (a type of keyhole surgery carried out under general anaesthetic that releases tightness in the shoulder capsule)

• Arthrographic distension (also known as hydrodilation this is not a common procedure but is sometimes recommended for frozen shoulder and performed under local anaesthetic)

 

What exercises are recommended for frozen shoulder?

There are a number of things you can do yourself that can offer some relief from frozen shoulder symptoms. One of the most important things you can do is to try to keep as active as possible. One of the reasons is that exercise in general is thought to release chemicals in the body called endorphins, which are often called the body’s natural painkillers. General physical activity shouldn’t cause you any harm, but try to pace yourself and stop if you feel any pain.
 
Meanwhile there are stretching and strengthening exercises you can do at home that will help specifically with your affected shoulder. Here are a few examples you can try – they may feel a little uncomfortable at first, but if you persevere you’ll reap the benefits in the long term:
 

Exercise #1

1. Stand up straight with your good arm resting on a chair or table at your side, keeping your affected arm hanging and loose.

2. Lean forwards and keep your affected arm hanging straight.

3. Swing your affected arm backwards and forwards 15 times, then side to side 15 times. Then circle the arm clockwise 15 times, then anti-clockwise 15 times.

4. Start with one set of each 15 repetitions, but build up to three sets as you feel stronger.

 

Exercise #2

1. Stand up straight and hold the back of a chair or a table with both hands.

2. Slowly walk backwards, keeping your hands on the surface, until you can feel the stretch in your shoulders.

3. Hold the position for a count of five, then walk back to the starting position. Repeat 15 times, two or three times a day.

 

Exercise #3

1. This time stand further away from the chair or table and hinge forward from your hips, placing your hands flat on the surface.

2. While keeping the same general position, let your upper body slowly lower down until you can feel the stretch in your side and chest muscles,. Keep your arms straight. 

3. Stretch for a count of five and return to the starting position. Repeat 15 times two or three times a day. Gradually increase the length of your stretch as you get stronger.

 

Exercise #4

1. Lie on your back with both hands behind your head and elbows pointed straight up at the ceiling. Try to keep your shoulders relaxed.

2. Slowly and gently, lower your elbows so that your arms are moving away from each other. Lower your elbows as far as you can, hold for a count of five, then slowly raise your elbows to the starting position.

3. Repeat the exercise 15 times, and start to increase the amount of time you keep your elbows to the ground as you get stronger. Do one set of 15 repetitions at first, then gradually build up to three sets a day.

 

Exercise #5

1. Stand up straight with your feet hip-width apart and holding some light weights at shoulder height (If you don’t have any weights, use bottles of water or tins).

2. Raise your hands towards the ceiling, pushing the weights upwards. Go as far as you can comfortably (as you get stronger you’ll be able to go further).

3. Return to the starting position, then repeat 20 times. Rest, then repeat another 20 times.

 

Exercise #6

1. While standing, hold both ends of a towel behind your back – the towel should be about three feet long.

2. With your unaffected arm, pull the towel up towards your shoulder. This will help stretch the affected arm and shoulder. 

3. Return to the starting position and repeat 10 - 20 times.

 

Exercise #7

1. Stand facing a wall about three-quarters of an arm’s length away.

2. With your affected arm, touch the wall at waist level, placing the tips of your index and middle fingers on the wall.

3. Keeping your elbow bent, slowly walk your fingers up the wall until you’ve gone as high as you can without any discomfort.

4. Lower your arm slowly, and repeat 10 - 20 times.

 
If in doubt, ask your GP to refer you to a physiotherapist who can show you more exercises for your shoulder that you can do safely at home.      
 

Other at-home ways to helo relieve frozen shoulder pain

Meanwhile there are more things you can do besides exercise (though keeping your shoulder joint as mobile as possible is arguably the most important). Try one or more of the following:
 

Heat packs: is heat good for frozen shoulder?

Applying some warmth to the affected area can help reduce the pain. Try using a heat pad, a hot water bottle or taking a warm bath or shower. If you’re applying heat directly to your skin, make sure it’s not too hot (use a towel or similar between the heat source and your skin), and keep it in place for 10 - 15 minutes.
 

Ice packs: should you ice a frozen shoulder?

You could also try applying some ice to the affected area. You can buy gel-filled ice packs and wheat bags that you keep in the freezer online and at pharmacies, but a packet of frozen peas or a handful of ice cubes work just as well. Place the ice cubes or frozen peas in a clean towel or tea towel before applying them to the part of your shoulder that hurts the most – never apply ice directly to your skin.
 

TENS: does a TENS unit help frozen shoulder?

Physiotherapists sometimes use TENS units for a frozen shoulder as they may help reduce pain by blocking nerve impulses, but you can use a TENS device at home too. These are widely available online and at pharmacies, and can be mains or battery powered.
 

Massage: is it ok to massage a frozen shoulder?

This is another thing physiotherapists often use on frozen shoulder patients, but again you can do some simple self-massage at home. The easiest technique is to simply use your unaffected hand to gently massage the affected shoulder and arm, focusing on any sensitive areas. If you have a foam roller there are several ways to use it that could help relieve the stiffness in your shoulder. However there is a chance you might cause further injury if you don’t do these moves correctly, so ask a physiotherapist to show you the right techniques.
 
Alternatively you can try getting a massage from a qualified massage therapist – ask your GP or another healthcare professional to recommend a therapist in your local area.
 

Sleep: how do you sleep comfortable with a frozen shoulder?

Getting a good night’s sleep can be a problem if you have frozen shoulder, as the condition may make finding a comfortable sleep position difficult. However sleep is really important when it comes to pain management, so do whatever you can to improve your sleep – find tips and advice in our guide to sleep and insomnia. 
 

Nutritional support

While there’s no evidence that what you eat can either treat or prevent frozen shoulder, there are a few nutritional supplements you may find useful, including:
 
Magnesium   Considered helpful for general muscle health and function, magnesium is also often used to manage chronic and acute pain (vii). Many people, however, may not be getting the level of magnesium in their diet that they need. You can top up your magnesium levels with a good-quality supplement – choose one that’s better absorbed by the body, such as magnesium citrate. Alternatively you could take a daily bath with added Epson salts – which is a form of magnesium – making sure your shoulder gets a good soaking.
 
Turmeric   This well-known curry spice contains a compound called curcumin that’s widely thought to have anti-inflammatory properties. Indeed, studies suggest it may treat pain effectively but without the potential side effects associated with conventional anti-inflammatory painkillers (viii).
 
This means turmeric may be helpful for frozen shoulder in the early stages, when inflammation is present.
 
Ginger   A member of the same Zingiberaceae plant family as turmeric, ginger too is thought to have anti-inflammatory properties, thanks to components found in the plant including gingeral and zingerone. Studies into ginger and its treatment of pain are few and far between, but the authors of one review say there’s tentative support to suggest it may reduce the subjective experience of pain in conditions such as osteoarthritis – though they add that more trials are needed (ix).
 
High-strength fish oils   The omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are found in oily fish such as mackerel, trout, sardines, herring and salmon. These too are widely believed to help reduce inflammation by affecting the body’s natural production of substances called prostaglandins. One study, for instance, describes how more than half of a group of volunteers taking fish oils as well as prescription painkillers for neck and back pain stopped taking their prescription medicines after 75 days, with 88 per cent saying they wanted to keep taking the fish oils (x).
 
These days you can benefit from omega-3 fatty acids found in oily fish even if you’re a vegetarian or vegan by taking supplements whose omega-3s are sourced from marine algae instead of fish.
 
Glucosamine and chondroitin   Compounds naturally found in cartilage – the tissue that cushions your joints – glucosamine and chondroitin are two more nutrients thought to have anti-inflammatory potential (xi). Studies vary as to which of the two is the most effective, which may be why many products provide both compounds together. Most glucosamine and chondroitin supplements are sourced from the cartilage of animals including shellfish, cows and pigs. However there are now supplements available that are suitable for vegetarians and vegans, which are sourced from plants such as corn.
 
PEA    Also known as palmitoylethanolamide, PEA is a type of fatty acid made naturally by the body and found in all cells, tissues and fluids including the brain (it’s also found in foods such as soya beans, peanuts, eggs, flaxseed and milk). Described as an endocannbinoid-like chemical that belongs to a family of fatty acid compounds called amides (xii), PEA is an alternative to CBD, since both substances are thought to have similar properties including the ability to reduce pain and inflammation. However researchers suggest PEA is safer than CBD, since it has been studied more extensively and has a more robust safety profile (xiii) with no known side effects (xii).

Your body naturally increases its production of PEA when your cells are damaged or threatened. This is confirmed by a small-scale study, which found concentrations of PEA and other compounds were significantly higher in muscles of women with chronic neck and shoulder pain compared with women who had no neck or shoulder pain (xiv).

However in certain situations – such as when your body is experiencing chronic inflammation – the level of PEA in your cells drops (xii). When this happens, PEA supplements may be helpful. In fact a review of 16 clinical trials and meta-analysis of PEA suggests it does have analgesic actions – in other words it helps to relieve pain (xv).


Frozen shoulder can be very painful and the stiffness and lack of mobility can make life difficult, to say the least. Not only that, but it could take years before you’re back to normal again. Thankfully, however, most people recover without extreme treatments such as surgery – plus, as this guide shows, there are lots of ways you can help yourself feel better faster. There’s lots more advice on how to manage a wide range of other conditions in our
pharmacy health library – why not take a peek?

References:

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4. Available online: https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/conditions/frozen-shoulder#causes

5. Available online: https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/conditions/frozen-shoulder#treatment

6. Available online: https://cks.nice.org.uk/topics/shoulder-pain/background-information/causes/

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8. xi. Lakhan SE, Ford CT, Tepper D. Zingiberaceae extracts for pain: a systematic review and meta-analysis. Nutr J. 2015 May 14;14:50. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4436156/

9. Terry R et al. The use of ginger (Zingiber officinale) for the treatment of pain: a systematic review of clinical trials. Pain Med. 2011 Dec;12(12):1808-18. Available online: https://pubmed.ncbi.nlm.nih.gov/22054010/

10. Maroon. JC, Bost. JW. Omega-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain. Surg Neurol. 2006 Apr;65(4):326-31. Available online: https://pubmed.ncbi.nlm.nih.gov/16531187/

11. Kantor EG et al. Associations Between Glucosamine and Chondroitin Supplement Use and Biomarkers of Systemic Inflammation. J Altern Complement Med. 2014 Jun 1; 20(6): 479–485. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4048982/

12. Clayton P. et al., Palmitoylethanolamide: A Natural Compound for Health Management. Int J Mol Sci. 2021 May;22(10): 5305. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8157570/

13. Clayton P. et al., Palmitoylethanolamide: A Potential Alternative to Cannabidiol. J Diet Suppl. 2021 Nov;28;1-26. Available online: https://www.tandfonline.com/doi/full/10.1080/19390211.2021.2005733

14. Ghafouri N. et al., High Levels of N-Palmitoylethanolamide and N-Stearoylethanolamide in Microdialysate Samples from Myalgic Trapezius Muscle in Women. PLoS One. 2011;6(11): e27257. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3220690/

15. Gabrielsson . L, Mattsson. S, Fowler. CJ. Palmitoylethanolamide for the treatment of pain: pharmacokinetics, safety and efficacy. Br J Clin Pharmacol. 2016 Oct;82(4): 932–942.Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5094513/

 

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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

 

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