Frozen shoulder

Frozen shoulder typically develops slowly. The pain is mild to begin with. Later on the pain becomes more severe and may disrupt sleep. As time progresses the shoulder becomes so stiff that it can barely be moved. Frozen shoulder generally clears up by itself.

At a glance

  • Frozen shoulder typically develops slowly: the pain is mild to begin with, but becomes increasingly severe and may disrupt sleep.
  • The shoulder becomes stiffer and almost immobile over time.
  • Frozen shoulder normally clears up without treatment.
  • Frozen shoulder is a process in which excessive scar tissue (adhesions) form in the joint capsule.

Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.

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What does the term frozen shoulder mean?

The term “frozen shoulder” refers to gradual stiffness and pain in the shoulder that starts for no apparent reason, mostly at the age of around 50.

Frozen shoulder generally clears up without treatment. It may take several months for the shoulder to stop hurting. It takes much longer for it to regain full mobility.

Medication and physiotherapy can alleviate the symptoms and improve mobility. Surgery is very rarely an option as it involves risks and the benefit is questionable.

What are the symptoms of frozen shoulder?

Frozen shoulder typically develops slowly. Most people only have mild symptoms at the outset. The pain becomes more severe over a number of months. At that point it often disrupts people’s sleep. The pain is frequently described as dull or deep-seated. It may radiate out to the biceps. The affected shoulder also becomes increasingly stiff: it becomes more and more difficult to move the respective arm up and back. 

Important: Over time, frozen shoulder can lead to the arm barely being able to move. It feels “frozen”. Hence the name frozen shoulder. Doctors refer to the condition as “adhesive capsulitis” or “periarthritis”. 

Frozen shoulder can be very distressing and make many activities very difficult. Dressing, cooking, cleaning, reaching into your back pocket or changing gear whilst driving can all become challenging or even impossible. Some people are no longer able to do their job, particular if they frequently work above head height.

Another distressing aspect is that other people do not always fully appreciate the problem. The complaints are often difficult for outsiders to understand, since no injuries or external symptoms are visible. Frozen shoulder also often goes undiagnosed until the later stages.

What are the causes of frozen shoulder?

Joints are the connections between two bones. In the shoulder joint, the round top of the humerus fits into the rounded socket of the scapula (shoulder blade) like a ball. A solid layer of fiber called the joint capsule surrounds this ball joint.

Frozen shoulder is a process in which excessive scar tissue (adhesions) form in the joint capsule. This tightens the tissue and the capsule shrinks. Inflammation is likely to be a key factor here. However the exact reasons for this are still not known. As a result the cause of frozen shoulder is also unclear in many cases.

In rare cases, the condition occurs following inflammation or accidents. Frozen shoulder may also occur, for example, when the shoulder is immobilized after surgery. Doctors refer to this as secondary frozen shoulder.

How common is frozen shoulder?

Around 2 to 5 percent of the population is affected by frozen shoulder at one time or another in their lives.

In most cases, frozen shoulder begins between the ages of 40 and 60. It is estimated that it affects about 2 to 5% of the population at some point in their lives; women are slightly more likely to be affected than men. People with diabetes are particularly likely to have frozen shoulder. This is true of 10 to 20% of people with diabetes. The reason for this is not yet clear.

How does a frozen shoulder progress?

Frozen shoulder generally clears up by itself. However it may take a long time.

Frozen shoulder develops in three stages, which overlap:

  • It starts with mild pain which then becomes increasingly severe. The shoulder may also hurt at night-time and even when it is not being moved.
  • The shoulder becomes increasingly immobile over time and “freezes”. The pain subsides as it becomes increasingly immobile.
  • Eventually the frozen shoulder gradually clears up and mobility returns. People with frozen shoulder often find the symptoms improve considerably after a few months.

The progression of frozen shoulder cannot be predicted precisely. Many people have virtually no symptoms after a year or two. But it may be much longer before it clears up in other people. One study showed that around 6% of those affected continued to have severe symptoms even after 4 years.

Frozen shoulder normally only occurs once in people’s lives. However some of those affected go on to develop it in their other shoulder within the next 5 years. This is true of 6 to 17%.

How is frozen shoulder diagnosed?

Shoulder problems are not always an indication of frozen shoulder. Doctors can determine whether frozen shoulder is involved from a description of the symptoms and examination of the shoulder. This involves them palpating the joint and testing the range of motion of the arm and shoulder. The doctor stands behind the patient and observes how the shoulder moves when both arms are stretched out sideways to shoulder height. If it is frozen shoulder the shoulder blade on the affected side will lift throughout the entire movement. This is not the case in a healthy shoulder.

Sometimes a shoulder X-ray is taken, or an MRI (magnetic resonance imaging) scan of the inside of the shoulder, to rule out other conditions such as arthritis. This can provide pointers to the possible cause if it is difficult to determine.

How is frozen shoulder treated?

It can take a while for a frozen shoulder to heal completely. However treatment can alleviate the pain. Mobility can also be improved. Initial treatment aims to alleviate pain. Later on the goal is to restore the shoulder’s mobility.

Treatment is generally conservative, i.e. excluding surgery.

Effective treatments include, for example:

  • cortisone tablets or cortisone injections into the shoulder joint to treat the pain
  • stretching exercises and physiotherapy to improve mobility and strength
  • application of heat and cold, which some people find pleasant

Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen in the form of tablets or creams are unlikely to be much help.

Exercises need to be started gently, particularly in the early stages of the condition. Otherwise they may make the pain worse. During exercises people should make sure they do not force the movements and cause severe pain.

Frozen shoulder heals on its own in most cases. So surgery is not normally required. That’s also because there is no evidence that surgery brings decisive benefits. Surgical intervention also entails risks related to the operation itself and also to anesthesia.

However doctors will sometimes advise patients to have surgery if symptoms persist for several months following conservative treatment. The doctor must then inform the patient that he or she has the right to obtain a second medical opinion.

The decision aid from can help you choose an appropriate treatment for a frozen shoulder.

In cooperation with the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen) (IQWiG).

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