Frozen shoulder

What is frozen shoulder?

The shoulder joint sits inside a soft, flexible lining called the capsule. In frozen shoulder this capsule becomes inflamed, then thickened and tight, so there is less room for the joint to move.

The result is usually pain first, followed by stiffness. Many people notice they can no longer reach behind their back, fasten clothing or lie on the affected side. A typical sign is losing the ability to turn the arm outwards, away from the body, even when someone else tries to move it for you.

Primary (idiopathic)

Comes on without an obvious cause. This is the most common form, and it is more likely in people with certain health conditions such as diabetes.

Secondary

Develops after something else, such as a shoulder injury, an operation, or a period when the arm has been kept still.

Who gets frozen shoulder?

Anyone can develop frozen shoulder, but it is noticeably more common in some groups. Knowing this helps it to be recognised early, rather than put down to something else.

Adults aged about 40 to 60

Frozen shoulder most often appears in middle age. It is uncommon in younger adults unless there has been an injury or operation.

Women more than men

Women are affected more often than men, which is one reason hormonal change is thought to play a part.

Perimenopausal women

Frozen shoulder is particularly common in women around the time of the menopause. Changing hormone levels are thought to contribute, although the exact link is still being studied.

At this stage of life, shoulder pain and poor sleep are easily put down to other things: being busy, ageing, or general aches. As a result, frozen shoulder is often overlooked for a while. If your shoulder is steadily becoming more painful and stiff, it is worth having it properly assessed.

People with diabetes

Frozen shoulder is more common in people with both type 1 and type 2 diabetes. It is more likely to affect both shoulders, either together or one after the other, and can be more stubborn to settle.

Keeping blood sugar well controlled helps the shoulder recover. If you have diabetes, let us know at your consultation, as it affects how some treatments, particularly steroid injections, are planned.

Thyroid disease

Both an overactive and an underactive thyroid are linked with a higher chance of developing frozen shoulder.

After injury, surgery or immobilisation

A fall, a fracture, an operation on the shoulder or elsewhere, or a spell with the arm in a sling can all trigger secondary frozen shoulder.

Other associations

Frozen shoulder is also seen more often in people with some other conditions, including heart disease and Dupuytren's disease, a thickening of tissue in the palm of the hand. Having one of these does not mean you will develop it, but it can be a useful clue when working out the cause of shoulder pain.

The three stages

Frozen shoulder usually follows a recognisable pattern. The stages overlap and vary from person to person, but the overall course is often many months, and sometimes longer.

Graph of frozen shoulder showing pain and stiffness over time — Pain tends to be worst early on, while stiffness builds more slowly and lasts longer. Both usually ease gradually during the thawing stage.

1

Freezing: the painful stage

Pain builds, often aching at rest and sharp with sudden movements. Night pain is common. Movement gradually starts to become restricted.

2

Frozen: the stiff stage

The pain often eases, but the shoulder is now at its stiffest. Everyday tasks such as dressing, washing hair and reaching up can be difficult.

3

Thawing: the recovery stage

Movement slowly returns. Recovery is gradual, and some people are left with a degree of stiffness they may barely notice day to day.

How it is diagnosed

Frozen shoulder is mainly diagnosed from your story and a careful examination. Scans are used to make sure nothing else is causing your symptoms.

1

Consultation

A conversation about when the pain started, how it has changed, how it affects sleep and daily life, and any health conditions such as diabetes or thyroid disease.
2

Examination

Comparing how far you can move the arm yourself (active movement) with how far it can be moved for you (passive movement). In frozen shoulder both are reduced, especially turning the arm outwards.
3

X-ray or ultrasound

Imaging helps rule out other causes of a painful, stiff shoulder, such as arthritis, calcific tendonitis or a rotator cuff tear. In frozen shoulder the X-ray usually looks normal.

Frozen shoulder stretching exercises — Gentle stretches, done within comfort, help keep and regain movement.

Treatment without surgery

Most people are treated without an operation. The aim is to control pain, protect sleep and keep the shoulder moving while it recovers.

Pain relief

Simple painkillers or anti-inflammatory medicines, if they suit you, can make the painful phase more manageable and help you sleep.

Steroid injection

During the painful stage, a steroid injection into the shoulder can calm the inflammation in the capsule and ease pain considerably.

Gentle stretching

Regular, gentle stretches within comfort, often guided by a physiotherapist. Forcing the shoulder through severe pain tends to make things worse.

Activity advice

Practical tips for work, driving, dressing and sleeping positions, so you can stay as active as possible without aggravating the shoulder.

Treatment in focus

Hydrodistension

Hydrodistension is an image-guided injection into the shoulder joint. Local anaesthetic and steroid are given together with a larger volume of sterile saline (salt water), which gently stretches the tight joint capsule from the inside.

Each part has a job: the local anaesthetic numbs the joint, the steroid calms the inflammation in the capsule, and the saline does the stretching. For many people with a stiff frozen shoulder, it offers a way to regain movement without an operation.

Ultrasound or X-ray guidance means the needle is placed accurately inside the joint. You can read more about how image-guided injections work in the imaging and scans guide.

Image-guided injection into the shoulder — Imaging guides the needle precisely into the shoulder joint.

Who it tends to suit

People with a painful, stiff frozen shoulder that has not settled with physiotherapy or a simple steroid injection.

It is not usually the first treatment offered. Your consultation will confirm whether your shoulder is likely to benefit, and whether anything else needs to be ruled out first.

Benefits

No general anaesthetic and no hospital stay: you go home the same day.
It can ease pain, including pain at night, so sleep improves.
It can make the shoulder move more easily, which makes the stretching exercises more comfortable and effective.
For many people, it avoids the need for keyhole surgery.

Risks

A pain flare. The shoulder may ache more for a short time afterwards. This usually settles within a day or two with simple pain relief.
Infection. There is a small risk with any injection into a joint. If the shoulder becomes hot, red and increasingly painful, or you feel feverish, call the practice on 01604 633730 straight away.
Steroid effects. Some people notice facial flushing for a day or so. In people with diabetes, blood sugar can rise for a few days, so check it more often.

Before, during and after hydrodistension

Hydrodistension is a short, straightforward procedure. Knowing what to expect at each step makes the day easier and helps you get the most from it.

1
Before
- There is usually no general anaesthetic, so you can normally eat and drink as usual. The team will confirm this with you.
- Tell the team if you take blood thinners, if you have diabetes, or if you have any allergies.
- Bring someone to drive you home, as the arm may feel numb and heavy afterwards.
2
During
- A short outpatient procedure, carried out while you lie down.
- It is performed by one of Mr Jepson's radiologist colleagues, using imaging to guide a fine needle into the joint.
- The skin is numbed first. As the fluid goes in, most people feel pressure or fullness rather than sharp pain.
3
After
- The shoulder may feel numb or heavy for a few hours while the local anaesthetic wears off.
- An ache afterwards is common, and simple pain relief usually helps.
This matters most: start your stretching exercises and physiotherapy within a few days. Moving the shoulder regularly is what keeps the stretch gained by the injection.

What to expect from hydrodistension

Hydrodistension is one step in your recovery, not the whole of it. Here is an honest picture of how it may go and what happens next.

Will it work?

Many patients notice that the shoulder moves more easily and that night pain eases.

Results vary from person to person. How well the shoulder does depends a great deal on keeping up the stretching exercises and physiotherapy afterwards.

If it does not help enough

Hydrodistension can sometimes be repeated.

If stiffness persists, keyhole surgery may be considered: arthroscopic capsular release and manipulation, which releases the tight capsule directly.

Follow-up with Mr Jepson

You will usually have a review with Mr Jepson some weeks after the procedure.

He will check your movement, pain and progress with physiotherapy, and talk through the next steps with you.

Arthroscopic capsular release and manipulation

When stiffness does not improve despite injections, hydrodistension and physiotherapy, keyhole surgery can release the tight capsule directly.

This keyhole surgery is usually considered when hydrodistension has not helped enough.

Through small incisions, a camera and fine instruments are used to carefully divide the thickened parts of the capsule. The shoulder is then gently moved through its range to free any remaining tightness. This is done under anaesthetic, usually as a day case or with a short stay.

Early physiotherapy, starting very soon after the operation, is what protects the movement gained in theatre, just as it does after hydrodistension.

To see what happens on the day of your operation, from pre-assessment and fasting to the anaesthetic and going home, read the day of surgery guide.

Arthroscopic view of frozen shoulder — The inside of a frozen shoulder seen through the arthroscope during keyhole surgery.

Common questions

Will it get better on its own?

Frozen shoulder often improves gradually by itself, but this usually takes many months and sometimes longer, and some people are left with a little stiffness. Treatment aims to ease pain, help you sleep and speed up recovery of movement, rather than simply waiting.

Is hydrodistension painful?

Local anaesthetic numbs the area first, so most people describe a feeling of pressure or fullness rather than sharp pain while the fluid goes in. The shoulder may ache for a day or two afterwards, and simple pain relief usually helps. The section on what happens before, during and after hydrodistension explains each step.

How is hydrodistension different from a steroid injection?

A simple steroid injection mainly calms inflammation and pain. Hydrodistension uses the same kind of medicines but adds a larger volume of sterile saline, which stretches the tight capsule as well. It is always image-guided, so the fluid goes accurately into the joint. See what hydrodistension is and who it suits.

Will I need time off after hydrodistension?

Plan to take it easy for the rest of the day, and arrange for someone to drive you home. Gentle everyday use of the arm is encouraged, and the stretching exercises should start within a few days. Ask at your consultation how this fits with your own work and driving.

When can I drive after treatment for frozen shoulder?

There is no fixed date. When you can drive again depends on the treatment you have had (hydrodistension or arthroscopic capsular release), whether you are asked to wear a sling, and how quickly you get active movement back. To drive safely you must be able to move your shoulder yourself, without help, and react normally in an emergency.

UK rules expect drivers to steer with both hands unless the DVLA has given specific permission otherwise. You are responsible for being in control of your vehicle at all times, and you should be able to show this if you are stopped by the police.

Do not drive while taking strong painkillers that can make you drowsy, such as opioids, or for at least 24 hours after an anaesthetic. You only need to tell the DVLA if problems affecting safe driving are likely to last more than three months after your procedure.

Before you return to driving, check with Mr Jepson, your physiotherapist and your motor insurer.

In short

You must not drive one-handed.
If you are advised to wear a sling, that time is the minimum before you consider driving.
Return to driving when you can move your shoulder without help and react safely in an emergency.
Telling your insurer is not always essential, but it is sensible.

I have diabetes. Is anything different for me?

Frozen shoulder is more common with diabetes, can affect both shoulders and may take longer to settle. Steroid, used in injections and usually in hydrodistension, can raise blood sugar for a few days, so you may be advised to check it more often afterwards. Good blood sugar control also supports recovery. Please mention your diabetes at your consultation.

Can I use my insurance?

Mr Jepson is recognised by Bupa, AXA Health, Vitality, Cigna and WPA only. Self-funding is also available. It is worth checking your cover and any authorisation with your insurer before your appointment. See the insurance information on the home page.

How do I arrange a consultation?

Call the practice on 01604 633730 or email enquiries@upperlimb.co.uk. Mr Jepson sees patients at private clinics in Northampton and Kettering; see clinic locations for details.

More about Mr Jepson

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