Frozen shoulder

Frozen shoulder starts very gradually. The symptoms are typically only mild at first, but get worse over the course of a few months and often make it hard to sleep. Many describe the pain as "dull" or a "deep ache." It can also spread into the biceps muscle in the upper arm. It becomes increasingly difficult to lift your arm up or move it backwards. Over time, the shoulder can become so stiff that you can hardly move your arm anymore, as if “frozen” in place. The medical term for frozen shoulder is “adhesive capsulitis.”

Frozen shoulder can greatly affect your life and make it harder to do many different things. For example, it can become a real challenge (or even impossible) to get dressed, cook, clean, reach a back pocket or shift gears while driving. Sometimes that means you can't do your job for a while – especially if the job often involves reaching up over your head, for instance.

Some people don't take the condition seriously, which can make it harder for those affected. One reason is because the symptoms aren't easy to explain: A frozen shoulder isn't caused by an injury, isn't visible, and often isn't diagnosed right away.

The different bones in our bodies are connected by joints. In the shoulder joint, the rounded end of the bone in the upper arm (humerus) fits into a socket in the shoulder blade (scapula). This "ball and socket" joint is surrounded by a strong fibrous membrane called the joint capsule.

In frozen shoulder, scar-like tissue (adhesions) forms in the joint capsule, causing it to thicken and shrink. Inflammation is believed to play a major role here, but it's not entirely clear what happens. Usually, no underlying cause is found.

In rare cases, frozen shoulder may develop following an accident, an inflammation or immobilization of the shoulder joint, for example after surgery. It is then referred to as “secondary” frozen shoulder.

Frozen shoulder is most common in people between the ages of 40 and 60. It is estimated that 2 to 5% of the population are affected by frozen shoulder at some point, and it is somewhat more common in women than in men. People with diabetes are particularly likely to develop a frozen shoulder: About 10 to 20% of them get it. It is not known why this happens.

Frozen shoulder usually gets better on its own, but it can take quite a while.

It tends to go through various overlapping phases:

• At first, the shoulder starts to hurt and becomes increasingly painful. The pain may also occur when resting and at night, especially if you lie on the affected arm, or if you move your shoulder upwards or backwards.
• Later, the shoulder gradually “freezes.” It becomes more difficult to move the joint, but it hurts less. The shoulder muscles often become weaker due to the lack of movement.
• In the last phase, the stiffness gradually goes away and you can start moving the arm more normally again. The symptoms often already improve a lot within a few months. But it can take longer for the shoulder to become as flexible (or nearly as flexible) as before.

It is hard to accurately predict how frozen shoulder will continue to develop over time: Many people have hardly any problems with their shoulder after one to two years. But the healing process can take a lot longer in some people. In one study, about 6% of the participants still had severe symptoms four years later.

Most people only have frozen shoulder once in their life. But about 6 to 17% of people who have had frozen shoulder get it in their other shoulder within five years.

Shoulder pain can be caused by different things. Doctors diagnose frozen shoulder based on a description of the symptoms and a physical examination of the shoulder. This involves testing the mobility of the shoulder and the arm, and feeling the joint. The doctor watches from behind to see how your shoulder blades move when you raise both arms to the side, level with your shoulders. In frozen shoulder, you can't raise your arm up sideways without lifting the shoulder blade too, which doesn't normally happen.

You might have an x-ray or MRI scan of your shoulder to rule out other possible problems like osteoarthritis, or if it's difficult to determine the cause of your symptoms.

A frozen shoulder needs time to heal. But there are various pain relief options and ways to improve shoulder mobility. At first, the goal of treatment is to relieve the pain. Later, the main aim is to make it easier to move the shoulder more normally again.

Frozen shoulder is usually treated conservatively (without surgery or similar procedures). The following treatments have proven effective:

• Steroid tablets (oral steroids) or steroid injections into the shoulder joint to relieve the pain.
• Stretching exercises and physical therapy to improve joint mobility and strength.

Especially in the early phases, it's important to be careful when doing the exercises because the pain could get worse otherwise. The movements shouldn't be forced or very painful.

Anti-inflammatory painkillers like ibuprofen (tablets or a cream) probably aren't effective enough. Some people like to use heat or cold packs.

• Because frozen shoulder typically goes away on its own, there's usually no need to have surgery or another procedure. These more invasive treatments generally aren't more effective than conservative treatment is. What's more, they are associated with surgical and anesthesia-related risks. Because of this, they are only considered as treatment options if the shoulder is still stiff after several months of conservative treatment. Then the doctor is obliged to inform you that you have a right to get a second medical opinion.

When people are ill or need medical advice, they usually go to see their family doctor first. In our topic "Health care in Germany" you can read about how to find the right doctor – and our list of questions can help you to prepare for your appointment.