Frozen Shoulder

• Pain, often dull or aching within the shoulder joint, which can worsen with activity
• Pain on movement involving lifting the arm, reaching, or rotating can provoke a sharp, acute pain
• Pain may also radiate down the arm or up to the neck
• Pain often develops slowly over weeks or months
• Stiffness, particularly when doing everyday tasks such as putting on a bra or coat, or reaching overhead
• Limited range of motion and difficulty moving the shoulder in various directions, such as lifting, reaching, rotating the arms outwards, or reaching behind the back

“People often first notice frozen shoulder through a gradually worsening inability to do everyday tasks.”
These tasks include:

• Difficulty putting on shirts or coats
• Women may notice pain when putting their hands behind their back to fasten a bra, and often opt for front-fastening bras
• Combing hair
• Driving
• Picking up objects above shoulder height or reaching overhead to change a light bulb
• Household chores like vacuuming or sweeping, or carrying grocery bags

“Frozen shoulder is known as somewhat of a mysterious ailment in medicine, sometimes idiopathic, meaning there is no identifiable underlying cause,” says Dr Markham.
“It also tends to affect a certain age group — the 40–60 group — and is significantly more common in women than men.”
However, in certain cases there is a higher risk.
For instance, people with diabetes have a higher risk of frozen shoulder. “It’s thought that collagen, which holds the bones together, becomes sticky if sugar molecules attach, causing stiffness and adhesions or scarring, a process known as glycosylation.*¹”

Other risk factors and comorbidities for frozen shoulder include:

• Dupuytren’s syndrome
• Thyroid disease (especially hypothyroidism)
• Nephrolithiasis
• Cancer
• Parkinson’s disease
• Smoking
• Heart and neck surgery
• Chronic regional pain syndrome
• Autoimmune conditions such as rheumatoid arthritis or lupus
• Previous rotator cuff injuries

While frozen shoulder affects 2–5% of the population generally, about 85%*² of people with frozen shoulder will have one comorbidity, while 37.5% have three.*²
Increasingly, menopause is also linked to joint pain*³ in women as a result of fluctuating oestrogen levels.
Frozen shoulder is a considerable complaint in this cohort, who also commonly experience neck pain, knee pain, and hand pain.

The incidence of frozen shoulder in people with diabetes is 11–30% compared with 2–10% in patients without diabetes,*⁴ according to the Journal of Clinical Orthopaedic Surgery.
In patients with Type 1 diabetes, the rate increases to 59% of patients who develop frozen shoulder, with about 73% of this group developing it in both shoulders,*⁵ according to a 2017 report in the Archives of Physical Medicine and Rehabilitation.
The good news, however, is that frozen shoulder, whilst debilitating, always eventually thaws, most often even without surgical treatment.

“Initial treatments include ice, heat, and physiotherapy, as well as over-the-counter pain relief and anti-inflammatory medications,” says Dr Markham.
“The other thing I would say here is to use the shoulder as much as possible, without pushing the pain limits too much.
“This is best done with a physiotherapy plan. If you stop using the arm or immobilise it, this will cause the condition to be even more painful.”
He says exercises should not be painful and are not intended to increase the range of movement or push your body to its limit.
“In fact, too aggressive exercise of the shoulder can aggravate the condition and should be avoided.”

One good exercise for frozen shoulder is “walking the wall”:

• Stand facing a wall
• With your fingers, walk up the wall reaching as high as comfortable
• Hold for a moment and walk back down
• Repeat 5 times, a few times a day

“Another good exercise is holding a towel behind your back with one hand, then using the other hand to gently pull the towel upward, stretching the shoulder. Hold for 15 seconds and repeat two or three times.”

“My initial approach for the majority of patients is to review, prescribe medications and physiotherapy, and monitor,” says Dr Markham.
“However, some patients are in so much pain in the initial freezing stage that they are unable to sleep or do their job, which is when we could consider a simple surgical procedure.”
Surgical procedures include arthroscopic capsular release or hydro dilatation.
This is a day procedure performed under radiological guidance to inject a large volume of fluid into the shoulder joint, distending the joint, stretching the capsule, and providing pain relief and improved motion.
“During the procedure the patient is given a local anaesthetic and the radiologist mixes up a cocktail of saline and steroids to stretch out the joint.
“This is followed up with extensive physical therapy to break down the adhesions or scarring that has occurred on the shoulder joint,” says Dr Markham.
“Risks include adverse events from anaesthesia or blood clots, which patients are monitored for. The most common side effect is recurrent stiffness, which is usually prevented with physiotherapy.”
You can generally return to work within a week or two and drive within a week or two.
One study in the GP Journal of Family Practice found that 94% of patients in that study experienced immediate pain relief after surgery, with effects often lasting up to 10 years.
Remember though all results vary.
“Although many patients know frozen shoulder pain will eventually resolve, and tend to grin and bear it. The surgical option is generally used when pain is so bad they can no longer sleep or do their job,” says Dr Markham.

This page was reviewed by Dr Philip Markham, June 2026
AHPRA Registration No. MED0001196569

Disclaimer
This information is for educational purposes only. Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.