Frozen shoulder, or something else
It gets muddled with a rotator cuff problem constantly, and the two want opposite things. There is a test you can do in a mirror that tells them apart.
Get the one-page sheetHow to recognise it
Shoulder pain that came on without an obvious injury, got worse over weeks, and has taken your movement with it. The giveaway is that you cannot turn your arm outwards, and neither can anyone else moving it for you.
It is most common between 45 and 60, and more common in women. The clearest link is with diabetes. Around three in ten people with a frozen shoulder have diabetes, and it tends to be more stubborn and slower to settle in those who do. Night pain is often the worst part of the early months, and it is what brings most people in.
Frozen shoulder or rotator cuff
The guide walks you through a mirror test: both elbows tucked into your sides, both forearms turned outwards like a pair of gates, then the sore arm relaxed and pushed outwards with your other hand.
Pointing towards a frozen shoulder, the sore side travels noticeably less far and stops at a firm, definite end. It feels like it will not go, rather than that it hurts too much to push. Pushing it with the other hand does not unlock it, because the restriction is in the joint itself.
Pointing towards a rotator cuff problem, the arm can still be moved through most of its range when you relax and push it. The pain is more about lifting to a particular height or a particular task.
How it usually runs
The old model splits it into freezing, frozen and thawing. Useful as a story, poor as a set of instructions, because the stages blur into each other. The better question is whether pain or stiffness is the bigger problem today.
While pain leads, roughly the first two to nine months, the job is settling pain and protecting your sleep. Gentle movement inside comfort. This is where an injection into the joint has most to offer, and it works best early and alongside a home programme rather than instead of one.
Once stiffness leads, usually somewhere after four months, range and loading work earn their keep and you can push harder.
How long this takes
Most of it runs somewhere between a year and three. When people are followed up years later, most shoulders are normal or close to it, a good number are left with something mild, and a small minority are left with real ongoing trouble. About one in five get it in the other shoulder at some point.
Nobody can tell you at the first appointment which of those you will be. What we can do is shorten the miserable part and stop you losing the arm through disuse.
Try this first
- Do the mirror test on both arms and note the difference
- Pendulum swings, one minute, several times a day while pain leads
- Sleep with a pillow under the arm to take the stretch off at night
- Keep the elbow, wrist and shoulder blade moving daily, it comes back faster
- If you have never been checked for diabetes, ask your GP
Get it looked at if
- You could not lift the arm at all from the moment of an injury
- The shoulder looks a different shape than the other side
- Fever, unexplained weight loss, or a history of cancer alongside it
- Pins and needles down the arm or into the hand, or a cold pale hand
- Shoulder pain that comes on with exertion and settles with rest
What we would do
First we confirm it is a frozen shoulder rather than a cuff problem, and we measure the external rotation rather than eyeballing it, so there is a number to compare against in six weeks. Then the programme is built around which problem is in front of us today, pain or stiffness, and changed when that changes.
Want this as a one-page sheet?
The version we hand out in clinic. Print it, stick it on the fridge, work through it.
Related: Frozen shoulder treatment · All patient guides · Our blog
This guide is general information about a common problem, not a diagnosis of yours. If something is not settling, or it does not match what is written here, come and get it looked at.