{"id":14444,"date":"2023-03-13T14:57:42","date_gmt":"2023-03-13T14:57:42","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=14444"},"modified":"2026-07-16T11:04:27","modified_gmt":"2026-07-16T10:04:27","slug":"frozen-shoulder","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/musculoskeletalphysiotherapy\/shoulderelbow\/frozen-shoulder\/","title":{"rendered":"Frozen Shoulder"},"content":{"rendered":"\n

Patient resources<\/strong><\/p>\n\n\n\n

NHS Lothian MSK Self Help Resources Webpage<\/a><\/p>\n\n\n\n

Definition<\/strong><\/p>\n\n\n\n

Typically presents as insidious onset shoulder pain and stiffness persisting more than 3 months.  Characterised by fibrosis of the shoulder capsule. Can be either primary (idiopathic) or secondary. Previously known as adhesive capsulitis.<\/p>\n\n\n\n

Typical signs and symptoms <\/strong><\/p>\n\n\n\n

Pain dominant stage: Progressive shoulder pain, particularly at night and with sudden or unexpected movements. Night pain can be a dominant feature. Pain can be diffuse although usually localised to shoulder and upper arm. Progressive global loss of active and passive movement of the shoulder in a capsular pattern.<\/p>\n\n\n\n

Stiff dominant stage: pain typically improves while capsular stiffness persists, especially loss of passive external rotation. Can range from mild to severe restriction.<\/p>\n\n\n\n

Prevalence and risk factors<\/strong><\/p>\n\n\n\n

Lifetime prevalence of frozen shoulder is estimated to be 2-5% general population (8.2% male & 10.1 % female of working age). Up to 60% of people with diabetes may develop a frozen shoulder. The opposite shoulder can become affected within 5 years in up to 20% of patients.<\/p>\n\n\n\n

Risk factors: Metabolic and hormonal changes including: diabetes, stroke, thyroid disorders, shoulder injury\/surgery, Dupuytren\u2019s disease, primary neurological conditions e.g. Parkinson’s disease, cancer, cardiovascular disease, complex regional pain syndrome, smoking, obesity, autoimmune diseases, genetics (ethnicity and family history of frozen shoulder).<\/p>\n\n\n\n

Prognosis\/ risk factors for poor outcome<\/strong><\/p>\n\n\n\n

On average can take 2-4 years (mean 30 months) to reach a satisfactory recovery. Some cases can take longer with 10- 50% of patients reporting residual shoulder stiffness and disability up to 7 years.<\/p>\n\n\n\n

Risks factors for poorer outcomes include diabetes, thyroid and metabolic disorders, inflammatory conditions, obesity, sleep deprivation, multi-site pain, previous pain episodes, anxiety and\/or depression, adverse coping strategies, low social support, low self-efficacy, lifestyle factors e.g. smoking, alcohol, physical activity levels.<\/p>\n\n\n\n

Other considerations<\/strong><\/p>\n\n\n\n

Rare in patients under 40 & over 70 years old.<\/p>\n\n\n\n

Differential diagnoses<\/strong><\/p>\n\n\n\n