Understanding Frozen Shoulder: Causes, Symptoms, and Treatment Options
Frozen shoulder, also comes with a range of challenges that can significantly impact daily life. Simple tasks like lifting your arm, sleeping on your side, getting out of bed, putting on a bra, driving or playing with your kids can become painful and difficult. This condition typically starts with sudden shoulder pain and stiffness, which gradually worsens over time. It can persist for months or even years, making it a frustrating and often long-term issue.
What is Frozen Shoulder?
Also known as “adhesive capsulitis,” frozen shoulder affects around 8% of men and 10% of women aged 25–64. However, it becomes more common after the age of 40, especially among those in their 60s. Despite its prevalence, the exact cause of frozen shoulder remains unclear. The tissues surrounding the joint become tight, swollen, and stiff, but the reasons behind these changes are not fully understood.
There are usually three stages to the condition:
- Freezing – Pain gradually worsens, and the shoulder becomes stiff, limiting movement.
- Frozen – Stiffness and pain peak, but some relief may begin to occur.
- Thawing – Pain and stiffness slowly improve, and movement begins to return.
While this staged description suggests a predictable pattern, research indicates that this is not always the case. Recovery times vary from person to person, and some individuals may not fully recover, even with treatment.
A 2020 study followed 215 patients with frozen shoulder. Over 70% reported satisfaction with symptom improvements, but around 40% still experienced some movement restrictions two years later. Another study from 2008 found that over a third of participants had ongoing symptoms, including pain and difficulty sleeping, two to seven years after the condition began.
Who is Most at Risk?
Certain groups are more likely to develop frozen shoulder, including:
- Women, especially during menopause
- People with diabetes
- Older adults
- Those with high cholesterol or thyroid problems
There is some evidence that genetics play a role, as family history increases the risk. However, more high-quality research is needed to fully understand these risk factors.
For example, people with diabetes are around five times more likely to develop frozen shoulder than those without. They also tend to experience worse pain, possibly due to diabetes-related changes in the body such as reduced blood flow and chemical changes from high blood sugar. However, the exact mechanisms are not yet clear, and research is ongoing to determine if better blood sugar control could help prevent or slow the condition.
Similarly, women are 40% more likely to develop frozen shoulder than men. One theory suggests that hormone fluctuations during menopause may be responsible, but there is currently no clear evidence to support this.
How is Frozen Shoulder Treated?
The effectiveness of treatments for frozen shoulder varies, and there is mixed evidence regarding the best approaches. For instance, over-the-counter pain medications like Voltaren may offer some relief, but their effectiveness is not well established.
Oral Steroids
A review of the evidence suggests that oral steroids, such as prednisolone, can provide short-term pain relief and improve shoulder movement compared to doing nothing or taking a placebo. However, these benefits do not last beyond six weeks, and the evidence comes from small studies. These medications require a prescription.
Injections
High-quality evidence shows that corticosteroid injections can provide short-term relief compared to doing nothing. There is also some limited evidence that corticosteroid injections and platelet-rich plasma injections can offer better short-term pain relief compared to over-the-counter pain relief and physiotherapy. However, the studies are small or poorly designed, and the effects are modest, so the evidence should be interpreted with caution.
Physiotherapy
Moderate-quality evidence suggests that physiotherapy can help improve shoulder movement. Benefits are greater when combined with a steroid injection and followed by home exercises. More research is needed to understand how well these treatments work in the long term.
What About Surgery?
There are two main surgical procedures for frozen shoulder, both performed under general anaesthesia:
- Manipulation under anaesthetic – A less invasive procedure where the surgeon stretches the shoulder to loosen tight tissue.
- Arthroscopic capsular release – A keyhole surgery where the surgeon cuts tight tissues inside the shoulder joint to improve movement.
Improvements from these procedures are typically small, and evidence suggests they are not better than non-surgical treatments. For example, one study showed that after one year, patients who had surgery had similar improvements to those who received physiotherapy and a steroid injection.
These procedures also have downsides, including higher costs, additional risks, and longer rehabilitation periods, which can last up to three months.
The Bottom Line
Being physically active and doing exercises can help if you’re experiencing pain and limited movement. However, you don’t have to manage this alone. It’s a good idea to seek advice on managing pain and staying active.
If you suspect you have frozen shoulder, it’s important to see a doctor or physiotherapist to rule out other conditions, such as fractures or arthritis. A health professional can also discuss management options, including the potential benefits, harms, costs, and accessibility of each treatment.
