Frozen Shoulder in Older Adults: Home Management

What frozen shoulder is

The shoulder is a ball-and-socket joint surrounded by a capsule. In frozen shoulder, the capsule becomes inflamed, then thickens and tightens, limiting movement in all directions. Typically, both active movement (the person lifts the arm) and passive movement (someone else lifts it) are restricted, particularly turning the arm outward (external rotation), such as reaching behind the head or back. This differs from a torn rotator cuff, in which the person cannot lift the arm but a helper can move it more freely.

Risk factors:

• Age, commonly 40 to 70, and more common in women.
• Diabetes (higher risk, and often longer or more severe), and thyroid disease.
• Immobility of the shoulder, after stroke, fracture, surgery or injury, or pain from heart or lung conditions.
• Previous frozen shoulder in the other arm.
• Other conditions such as Parkinson's disease, heart disease and some autoimmune diseases.

See also whats causing my shoulder pain and shoulder osteoarthritis.

The three stages

1. Freezing (painful) stage: about 2 to 9 months. Pain gradually increases, often worse at night and with movement. The range of motion starts to reduce.

2. Frozen (stiff) stage: about 4 to 12 months. Pain may ease, but the shoulder is very stiff. Everyday tasks such as dressing, washing and reaching are difficult.

3. Thawing (recovery) stage: about 6 months to 2 years. Movement gradually returns. Many recover most movement; some have lasting mild stiffness.

Total duration is variable. Patience and steady care help.

Telling it apart from other problems

Not all shoulder pain is frozen shoulder. Other causes include rotator cuff problems, arthritis, bursitis, neck problems, and referred pain from the heart, lungs or gallbladder. See a doctor if:

• The pain is sudden and severe after a fall or injury, possible fracture or dislocation.
• There is chest pain, breathlessness, sweating, or pain spreading down the left arm: emergency, possible heart attack.
• There is fever, redness, swelling or heat in the joint: possible infection or gout.
• There is weakness, numbness or tingling in the arm or hand, or neck pain, suggesting a nerve problem.
• There is unexplained weight loss, night pain that does not ease, or a history of cancer.
• The arm cannot be lifted at all but moves passively, which suggests a tear.

A doctor can examine the shoulder, order an X-ray or ultrasound or MRI if needed and check for diabetes or thyroid problems.

Home management: the principles

Frozen shoulder needs a balance: keep the shoulder moving gently without provoking severe pain. Too much rest allows stiffness to set; too much force causes pain and inflammation. A physiotherapist can design a programme suited to the stage.

In the painful stage: focus on pain control, avoiding aggravating movements, and very gentle movement within comfort.

In the stiff stage: gentle stretching, held for longer, to maintain and slowly increase range.

In the thawing stage: stretching and strengthening to restore function.

### Gentle exercises (examples; confirm with a physiotherapist)

Always warm the shoulder first with a warm shower or a warm pack for 10 to 15 minutes. Move slowly and stop if pain is sharp. A mild stretch is fine; pain that stays for hours afterwards means you did too much.

• Pendulum swings. Lean forward, supporting yourself with the good arm on a table or chair. Let the sore arm hang loose and gently sway it in small circles, forward and back, and side to side, for a minute. Let gravity do the work.
• Table slide. Sit at a table with the hand on a towel. Slide the hand forward, bending from the hips, as far as comfortable, then return. Repeat 5 to 10 times.
• Wall walk. Stand facing a wall, and walk the fingers up the wall as high as comfortable. Mark the height each day.
• Cross-body stretch. Use the good hand to gently pull the sore arm across the chest, holding for 15 to 30 seconds.
• Stick or towel stretch. Hold a stick or a towel with both hands and use the good arm to help lift the sore arm forward and sideways.
• External rotation with a stick. Lying on the back, holding a stick with elbows by the sides and bent, push the sore arm outward with the good hand.
• Towel stretch behind the back (in the stiffer stage, when advised).
• Shoulder blade squeezes to keep the muscles active.

Do these a few times a day, five to ten repetitions each, as comfortable. See stretching for stiff older bodies and chair exercises for seniors. A resistance band may be introduced later by a physiotherapist.

Avoid forceful stretching, heavy lifting, and activities that cause sharp pain. Avoid prolonged immobilisation or a sling, unless advised.

Pain relief at home

• Heat before exercise: a warm shower or a warm pack, with a cloth, for 10 to 15 minutes. See heat or cold for joint pain and hot pack safety for older skin.
• Cold after activity or when the shoulder is very sore: a cold pack in a cloth for 10 minutes.
• Pacing: alternate activities and rest; avoid prolonged use above shoulder height.
• Posture: sit upright with the arm supported on a pillow or armrest; avoid slumping.
• Medicines: pain relief tablets and creams must be chosen with a doctor or pharmacist, who knows your other conditions and medicines. Older adults are at risk from some common painkillers; see painkillers and older adults. Do not take anti-inflammatory tablets or others on your own if you have kidney, heart, stomach or blood pressure problems, or take blood thinners.
• Injections. A doctor may offer a steroid injection into the shoulder in the painful stage, which can reduce pain and help exercise. Steroid injections can raise blood sugar in people with diabetes for a few days; discuss monitoring.
• TENS. Some find short-term relief, but check with the doctor, especially with a pacemaker; see TENS units for pain.
• Relaxation and mood. Pain and poor sleep sap energy; see chronic pain in older adults.

Sleeping with a frozen shoulder

Night pain is often the worst part.

• Avoid lying on the sore side. Sleep on the good side, with a pillow hugged to the chest to support the sore arm, or sleep on the back with a pillow under the sore arm.
• Raise the head and upper body slightly with a wedge or extra pillows if lying flat hurts; see wedge pillow guide and pillows for side sleepers and shoulder pain.
• Support the arm with a small pillow or rolled towel under the elbow so it is not pulled down.
• Warm the shoulder before bed.
• Plan pain relief with the doctor.
• Avoid sleeping in a recliner with the arm hanging.
• See sleep problems in older adults for general sleep tips.

Dressing, washing and daily tasks

• Dress the sore arm first and undress it last.
• Choose loose, front-opening clothes, with large armholes, and zip or Velcro closures; front-fastening bras and tops. See dressing aid guide.
• Use a long-handled sponge, and bathe seated; see shower chair buying guide.
• Use a reacher for objects on high or low shelves; see reacher grabber guide.
• Keep frequently used items at waist height.
• Avoid carrying heavy bags on the affected side; use a trolley.
• Use the sore arm for light tasks within comfort, such as holding a cup or turning a page, which keeps it moving.
• Hair care: use a long-handled comb or ask for help.
• Cooking and housework: pace; slide, do not lift; see arthritis daily living gadgets and kitchen setup for seniors.
• Driving: be careful if turning the wheel is painful or you cannot look over your shoulder.
• Temple, travel and festivals: avoid long periods carrying luggage and lifting arms in crowds; see mobility aids for temples and weddings.

Diabetes, thyroid and other health factors

If your parent has diabetes or thyroid disease, good control helps overall health, though it may not speed shoulder recovery. Frozen shoulder is more common and may be more persistent in diabetes. Ask the doctor to review. See diabetes at home after 60 and thyroid problems in older adults.

After a stroke or period of arm immobility, protecting the shoulder is important: never pull on a weak arm, support it with pillows and follow the therapist's advice; see stroke recovery at home guide.

Medical treatments

If home care and physiotherapy do not improve things after a few months, or pain is severe, a doctor or specialist may consider:

• Steroid injection into the joint, to ease pain and allow movement.
• Hydrodilatation: injecting fluid to stretch the capsule.
• Manipulation under anaesthetic, and arthroscopic release (key-hole surgery) to free the capsule, for stubborn cases; recovery involves intensive physiotherapy afterwards. Older adults need fitness checks first.
• Shockwave therapy and other treatments are less established.

The decision depends on health, symptoms, preferences and stage.

When to ask a professional

See a doctor for shoulder pain that is severe, sudden, follows an injury, comes with fever or chest pain, or is accompanied by weakness or numbness. See a physiotherapist early, as exercises given at the right stage make a difference. See an orthopaedic or shoulder specialist if there is no improvement after several months or if the pain is severe. An occupational therapist can advise on daily tasks and equipment.