How long does frozen shoulder last, stages and treatment

What are the symptoms of a frozen shoulder?

A frozen shoulder is characterised by two main symptoms: pain and stiffness. Pain is usually the first symptom and happens in the freezing phase. It gradually becomes severe and is often worse at night.

This pain is then followed by stiffness in what’s called the frozen phase. A frozen shoulder has restricted movement in every direction, but mostly in rotation away from the body. The pain might ease a little over time, but the stiffness can make carrying out your normal daily activities much harder, including getting dressed, driving and reaching for things on shelves.

A frozen shoulder can get better without treatment (when it goes into the thawing phase), but the symptoms can last one to two years.

What does frozen shoulder pain feel like?

Frozen shoulder pain usually begins as a deep, dull ache in your shoulder but can become quite severe, sometimes rapidly. It can also travel down your arm, causing pain in your upper arm or even down to your hand. It has a characteristic “jerk pain” when you move suddenly or unexpectedly. 

Pain from a frozen shoulder often gets worse at night, especially if you lie on your affected shoulder.

How do you tell the difference between a frozen shoulder and a rotator cuff injury?

Both a frozen shoulder and a rotator cuff injury can cause shoulder pain but there is a difference in the stiffness they cause. Inflammation in a frozen shoulder restricts both active and passive movement, with neither you nor someone else being able to move the shoulder. 

A rotator cuff injury causes weakness in your shoulder that can restrict your active movement, but your shoulder can still be moved by someone else. 

What are the stages of frozen shoulder?

There are several stages of a frozen shoulder, so it’s important to diagnose it correctly and target treatment appropriately.

1. Freezing phase: In this first phase, your shoulder starts to become painful, but isn’t stiff yet. The pain in the freezing phase happens gradually and can become very acute. This phase usually lasts between two and nine months but is very variable.
2. Frozen — pain predominant phase: The second phase of a frozen shoulder is the frozen phase itself. This can then be divided into two stages. In the pain predominant phase, the acute pain from the freezing phase persists, but the stiffness typical of a frozen shoulder begins to set in, causing a loss of shoulder mobility and difficulty with day-to-day activities.
3. Frozen — stiffness predominant phase: Following a period of both acute pain and worsening stiffness, the pain often begins to resolve. While still noticeable, it changes from an acute pain to a dull ache. However, stiffness still persists, with your shoulder having a very limited range of movement. The overall frozen phase can last for upwards of a year.
4. Thawing phase: After a period of limited movement, your shoulder starts to slowly regain its mobility, and the pain starts to subside. This final thawing phase can take up to six months before the shoulder returns to pain-free movement.

How long does a frozen shoulder last?

Without treatment, a frozen shoulder usually lasts for around one to two years. This duration includes all of the phases, from the initial pain through to the shoulder being frozen and eventually regaining full movement.

Many patients are told that a frozen shoulder will get better on its own. While this is true, the phases can be long and very painful, with even painkillers not offering relief. Seeking the right treatment at the right time can help significantly reduce the overall duration.

What causes a frozen shoulder?

A frozen shoulder is caused by the tissue around the shoulder becoming inflamed. This inflammation causes the tissue to become thicker and tighter around the shoulder joint, becoming painful and reducing the shoulder’s range of movement.

In the majority of cases of frozen shoulder, there’s no clear cause of the inflammation. This is known as primary or idiopathic frozen shoulder. In some cases, a frozen shoulder can be triggered by an injury, trauma or prolonged immobilisation due to the arm being in a sling or recovering after surgery.

Frozen shoulder is more frequent in people aged between 40 and 60 years old and affects women slightly more than men. If you’ve had a frozen shoulder on one side, it’s also more likely you’ll develop it in the other shoulder at a later date.

While there’s often no identifiable cause of a frozen shoulder, a number of risk factors can increase the chances of developing it. People with diabetes are three to four times more likely to develop a frozen shoulder and people with thyroid conditions (both hypothyroidism and hyperthyroidism) are also at an increased risk.

How is frozen shoulder diagnosed?

Frozen shoulder is typically diagnosed by a physical examination and a review of your symptoms by your doctor. They’ll assess your level of pain and where it is, as well as looking at your shoulder’s range of movement. This includes both active movement, which is how far you can move it yourself, and passive movement, where your doctor will move your arm to see how much it can move.

You will usually also have an X-ray to rule out other causes such as a rotator cuff injury or arthritis. A frozen shoulder will look normal on an X-ray, but this helps ensure your pain isn’t caused by something else. If your diagnosis isn’t clear, you might have an ultrasound or MRI scan, which can identify a thickened shoulder capsule.

How is frozen shoulder treated?

The simplest treatment for a frozen shoulder is to simply wait until it resolves itself. Moving your shoulder as much as you’re comfortable with can help speed up the thawing phase and get you back to your normal range of movement. Pain can often be managed with painkillers like ibuprofen or paracetamol. You can also use heat and cold packs to help reduce pain and loosen stiff muscles.

While a frozen shoulder can resolve on its own, it can take a long time to pass and can be very painful, so it’s best to see an expert who can recommend the right treatment for you.

These treatments can range in their invasiveness and overall effectiveness.

What exercises and physiotherapy help frozen shoulder?

Physiotherapy is usually the recommended first-line treatment for a frozen shoulder, helping to improve your range of motion. It’s also recommended for those in the thawing stage as it gets better. A physiotherapist can manually stretch your shoulder to help improve your range of movement, as well as providing you with a personalised stretching plan to help you further improve your condition. As your range improves, strengthening exercises will be introduced to build back your endurance.

The important thing to remember is that your exercises should be guided by your physiotherapist. Follow the plan you’ve been given and avoid doing exercises that could make your condition worse.

What is hydrodistension and how does it treat frozen shoulder?

If the pain is too severe to allow you to do your exercises and the movement is not improving, then hydrodistension is a simple, effective, minimally invasive procedure used to treat a frozen shoulder. It is usually performed by a consultant musculoskeletal radiologist using ultrasound guidance, to inject a mixture of local anaesthetic, steroid and 30 to 40 millilitres of saline solution into the capsule and joint of the frozen shoulder. 

The volume of liquid breaks up the scar tissue, while the steroid helps reduce inflammation, easing pain and helping restore movement in the frozen shoulder. 

After hydrodistension, between two-thirds and three-quarters of patients don’t need any further treatment.

When is surgery needed for a frozen shoulder?

Patients in the earlier stages of a frozen shoulder respond more effectively to physiotherapy, steroid injections and hydrodistension, and these treatments are generally beneficial at all phases. However, in some patients, these treatments aren’t enough and, in these cases, your consultant may recommend arthroscopic capsular release surgery or manipulation under anaesthesia.

Arthroscopic (keyhole) surgery involves making two incisions in the shoulder and inserting an arthroscope with a small camera on the end to evaluate the inflamed joint. The inflamed tissue is then released using radiofrequency waves to cauterise the inflamed tissue. Following this with physiotherapy can help ensure a timely, effective recovery and a return to your full range of movement.

Manipulation under anaesthesia is a non-invasive procedure that can help you regain movement in your shoulder. This involves putting you under a general anaesthetic, and your surgeon then moves your shoulder through its full range of motion. This breaks up the tightened and scarred tissues, helping to improve your shoulder’s mobility. Your shoulder might feel sore afterwards, but most patients recover within four to six weeks, with the help of physiotherapy.