It starts out insidiously, with shoulder pain that gradually turns into pain and stiffness. Over the weeks or months, as the mobility in your shoulder decreases, you use it less and less. Pretty soon, it's impossible to even zip up a dress or button a shirt—so you head to the doctor, where you receive a diagnosis of adhesive capsulitis, or frozen shoulder.

Nearly 20 percent of individuals with diabetes are affected by frozen shoulder (as compared to about 5 percent of the rest of the population.)

While medical experts aren't sure exactly why having diabetes puts you at risk for this condition, it's theorized that glucose (sugar) molecules may attach to collagen, which is a large part of the ligaments that hold bones together. This may in turn be responsible for the formation of abnormal deposits of collagen in the shoulder's cartilage and tendons, according to the American Diabetes Association. Ultimately, it may be this buildup of collagen that causes the shoulder to grow stiff.

"Diabetes is one of the known independent risk factors for getting frozen shoulder," says Konrad Gruson, MD, an orthopedic surgeon specializing in the shoulder at Montefiore Medical Center in New York City. "And it's kind of a Catch 22. The more you don't move your shoulder the stiffer it becomes."

There are actually three phases of the condition, says Marc S. Kowalsky, MD, an orthopedic surgeon at Lenox Hill Hospital in New York City who has a subspecialty fellowship training in shoulder and elbow surgery, and sports medicine.

  1. The first phase is characterized by pain and general aching, with the pain worsening at night.
  2. The second phase, in which the shoulder joint capsule thickens and stops stretching, is the stiffening stage. An individual loses mobility, and this phase goes on from two to six months.
  3. The third phase, the thawing or recovery phase, is when the shoulder gradually improves. This phase can last anywhere from one to nine months.

"Frozen shoulder is a self limited condition that gets better eventually on its own but there are things you can do to accelerate recovery," Kowalsky says.

How to Speed Recovery

If your shoulder is becoming stiff and sore, see your primary care provider. You may be told to try an anti-inflammatory medication, and to start physical therapy, Gruson explains. These measures are generally very helpful, but don't expect your frozen shoulder to disappear overnight.

You also may be given an injection of corticosteroids directly into the shoulder. This can be done in the doctor's office or by a radiologist. "It has been shown to significantly reduce pain and to allow the person to participate in physical therapy in a more aggressive fashion," Gruson says. 

A small number of patients don't get better and may require a procedure in the operating room to release the scar tissue, Kowalsky says.

But generally, frozen shoulder clears up on its own. "It's important to be patient," Kowalsky says. "It can take months for it to resolve." Some cases of frozen shoulder take from 9 to 17 months or more, and some individuals have had a frozen shoulder last for two years.

Generally, once you've had frozen shoulder in one shoulder, it's rare to get it in that shoulder again. However, it's not uncommon for it to develop it in the other shoulder, Kowalsky says.

Marc S. Kowalsky, MD, reviewed this article.




Frozen Shoulder. American Diabetes Association.