Progressive stiffness and severe night pain. It does resolve — but the timescale is measured in years, not weeks.
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Frozen shoulder is a condition in which the capsule surrounding the shoulder joint becomes inflamed, thickened and contracted. The result is genuine loss of movement, not simply pain — the shoulder will not move even when someone else moves it for you.
The defining sign is loss of external rotation: with your elbow tucked into your side, you cannot turn your hand outwards away from your stomach. That single finding distinguishes it from rotator cuff problems, and it is what makes the diagnosis.
Two things you deserve to be told honestly:
1. This takes a long time. The natural course runs in three phases and typically lasts one to three years in total. That is a difficult thing to hear, and it is far better heard at the start than discovered gradually while wondering whether something has gone wrong.
2. Timing changes what helps. In the early, painful phase, aggressive stretching makes things worse — while a steroid injection has its best effect. Later, when stiffness dominates and pain has eased, stretching is exactly what is needed. Getting that the wrong way round is common and genuinely counterproductive.
One thing worth acting on: frozen shoulder is strongly associated with diabetes and thyroid disease, and for some people it is the first sign of either.
1. Freezing — roughly two to nine months
2. Frozen — roughly four to twelve months
3. Thawing — roughly six to twenty-four months
Loss of external rotation. Elbow at your side, forearm turning outwards — blocked. Crucially, it is blocked passively too: someone else cannot move it further either. That is what separates frozen shoulder from a painful but mobile rotator cuff.
In a characteristic order: external rotation first and worst, then reaching overhead, then reaching behind your back.
The joint capsule becomes inflamed and then fibrotic, contracting down around the joint. It is not arthritis, not a tear, and not caused by anything you did.
It is worth raising for three reasons: the association is strong, frozen shoulder in someone not known to be diabetic is a reasonable prompt to test, and people with diabetes tend to have a longer, more stubborn course — which is useful to know in advance rather than experiencing it as an unexplained failure of treatment.
Often it simply arrives, without any trigger at all — which people find hard to accept, and is nonetheless the usual story.
Frozen shoulder is diagnosed clinically, and a video consultation does this well because you can demonstrate the restriction — which is more informative than any description.
Not needed to diagnose it. An X-ray is sometimes done to exclude arthritis or a missed fracture where the picture is unclear — in frozen shoulder it is normal, which is itself useful.
This is what most often goes wrong, and it is worth stating plainly. Aggressive stretching during the painful freezing phase increases inflammation and makes things worse. Stretching belongs in the stiff phase, once the pain has settled.
Expect a longer course, and be aware that a steroid injection will raise your blood glucose for several days — worth planning for and monitoring, rather than being caught out by it.
Seek same-day medical attention for:
Call 999 for: shoulder or arm pain with chest pain, breathlessness, sweating or nausea — which may be cardiac.
Book an appointment for:
It determines everything:
Night pain is, for most people, by far the worst part — and it is manageable:
One to three years from start to finish. That is a hard thing to be told, and it is better than being left to wonder why nothing is working after four months.
Most people regain good function. A minority are left with some permanent restriction — usually not enough to matter day to day, but it is honest to say so rather than promise complete resolution.
And the other shoulder is affected in a meaningful minority of people, so recognising the early pattern next time is genuinely useful.
The most useful thing about frozen shoulder is understanding its natural history, and that costs nothing: it resolves on its own, but slowly — typically over one to three years, through freezing, frozen and thawing phases.
That timescale is the hard part, and knowing it in advance changes how people cope. It also explains why almost any treatment appears to work eventually.
NHS physiotherapy is free and takes self-referral in many areas, and NHS steroid injection and surgery are free where needed.
Where treatment timing genuinely matters is the phase. In the painful freezing phase, aggressive stretching makes things worse, and a corticosteroid injection is most effective early. In the stiff phase, physiotherapy and stretching are what help. Getting that the wrong way round is common and prolongs things.
Where a private consultation earns its fee is speed to injection during the painful phase, when the window for the greatest benefit is measured in months and NHS waits can exceed it.
The other thing worth checking is diabetes. Frozen shoulder is substantially more common in people with diabetes, and it is sometimes the first presentation — an HbA1c is a reasonable test in anyone presenting with it.
Where money is wasted: private MRI, which is rarely needed — frozen shoulder is a clinical diagnosis based on restricted passive external rotation.
NICE Clinical Knowledge Summary, Shoulder pain, is the principal reference and covers adhesive capsulitis — its phases, expected duration, and phase-appropriate management.
CKS recommends analgesia and early corticosteroid injection in the painful phase, with physiotherapy and stretching becoming more useful as pain settles and stiffness dominates.
CKS notes the diagnosis is clinical, based on restriction of passive external rotation, and that imaging is used to exclude other pathology rather than to confirm it.
CKS identifies diabetes as a significant risk factor, with frozen shoulder occurring more frequently and often more severely — the basis for the HbA1c point above.
BESS (British Elbow and Shoulder Society) guidance covers the management pathway, including hydrodilatation, manipulation under anaesthetic and arthroscopic capsular release for cases not settling.
Honestly: one to three years from start to finish, across three phases — painful, stiff, then gradually thawing. That is a difficult thing to hear, and knowing it at the outset is considerably better than discovering it slowly while assuming something has gone wrong. Most people regain good function.
It depends entirely on which phase you are in, and getting this wrong is common. In the early painful phase, aggressive stretching increases inflammation and makes things worse — gentle movement and pain control are what is needed. Once the pain has eased and stiffness dominates, stretching is exactly right and should be done consistently.
Often, yes — and timing matters. An injection has its best evidence early, in the painful freezing phase, where it reduces pain meaningfully and may shorten the overall course. It is less useful once stiffness rather than pain is the main problem. If you have diabetes, expect your glucose to rise for several days afterwards.
External rotation. Tuck your elbow into your side and turn your hand outwards. In frozen shoulder that movement is genuinely blocked — and it stays blocked even when someone else tries to move your arm further. With a rotator cuff problem it hurts, but the movement is available.
Frequently there is no trigger at all, which people find genuinely frustrating. It is not caused by overuse, sleeping awkwardly or anything you did. It is more common in the 40 to 60 age group, in women, after a period of immobilisation, and — substantially — in people with diabetes or thyroid disease.
Because the link is strong: diabetes raises the risk several-fold, and frozen shoulder is sometimes the first sign of diabetes nobody knew about. It also matters practically — people with diabetes tend to have a longer, more stubborn course, which is useful to know in advance rather than experiencing as an unexplained treatment failure.
Three things, all worth doing together: sleep propped slightly upright, support the arm on a pillow across your body so it is not hanging, and put a pillow behind your back to stop you rolling onto it. Time your painkillers for bedtime rather than earlier in the evening. Night pain is the hardest part of the freezing phase, and it does pass.
A meaningful minority of people do, though usually not at the same time. The useful part of knowing that is recognising the pattern early next time — particularly the loss of external rotation — since being seen during the painful phase is when treatment has most to offer.
August 24, 2026
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
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If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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