Frozen shoulder: once you've had it, is that the end of it? It rarely returns to the same shoulder, but know about the other side

If your other shoulder has started to feel stiff just as your first frozen shoulder is finally loosening up

Key points in 30 seconds

1. In a study that followed 223 people with frozen shoulder for an average of 4.4 years, not a single case returned in the same shoulder.
2. But 1 in 5 (20%) also had frozen shoulder in the other shoulder.
3. It comes to the other side because whole-body conditions, such as blood sugar, are also involved.
4. There's no sure way to prevent it on the other side. Instead, people who've had it once can recognize the early signs, and the milder the first symptoms, the better the course.
5. When the signs come, measure your angles, move within a pain-free range, check your blood sugar, and confirm it really is frozen shoulder.

What we often hear

• "My right arm is finally going up a bit, and now my left shoulder feels stiff."
• "Is this going to come back?"
• "I'm scared I'll have to suffer through another whole year."
• "Isn't there a way to prevent it in the other shoulder?"

You struggled with frozen shoulder in your right shoulder for more than a year, and your arm is finally starting to go up. But lately your left shoulder feels stiff.

Surely not. The moment that thought crosses your mind, a chill runs down your spine. Will you have to go through those nights, that whole year, all over again? People who've already recovered ask something similar: "Is this going to come back?"

Today we'll answer that question with numbers. The bottom line: it almost never comes back in the same shoulder, but it comes to the other shoulder in about 1 in 5 people. And the second time can be handled much better than the first.

Does frozen shoulder come back?

There's a study from Oxford in the UK that followed 223 people with frozen shoulder for an average of 4.4 years after their symptoms began (up to 20 years). Two numbers came out of it.

• Cases where it came back in the same shoulder: 0. A shoulder that had it once and recovered didn't stiffen again, at least in this study. This is a number you can take comfort in.
• Cases where it also came to the other shoulder: 20%. That's why there were 269 shoulders studied among 223 people. At 1 in 5, it's not rare.

It's not a number to fear, but a number to know.

To be honest, in this study patients answered a questionnaire later, so part of it relies on memory, and it includes people who received treatment during the follow-up period. Even so, it's one of the larger studies on the long-term course of frozen shoulder, so its direction is reliable.

Why does it come to the other shoulder?

Frozen shoulder is a condition in which the capsule around the shoulder joint becomes inflamed, thickens and sticks together. But when you look at why it happens only to some people, and why it comes to both shoulders in the same person, you can see that whole-body conditions are involved, not just the one shoulder.

In the study above, 16% of patients had diabetes. We wrote in My shoulder has stiffened. Why are you asking about my blood sugar? that with diabetes, frozen shoulder is about 5 times more likely. Conditions that act on the whole body, like blood sugar, don't pick just one shoulder. That's why someone who had it on one side can get it again on the other.

It's also why, when you're worried about the other side, you need to look at the whole body along with the shoulder.

Can frozen shoulder on the other side be prevented?

To be honest, there's no sure way to prevent it. No method has yet been proven to the point of saying "do this exercise and it won't come to the other side."

So instead of promising prevention, what we can offer is a way to respond better. And here lies the big advantage of a second frozen shoulder.

What's different for people who've been through it once?

You know the early signs.

Think back to your first frozen shoulder. At first, it was probably just a feeling that your shoulder was a bit stiff. Then it started to hurt when you rolled onto that side at night, it got hard to reach behind you to get dressed, and by the time you went to a clinic, your arm already wouldn't go up much at all.

The same follow-up study reached one more conclusion. The more severe the first symptoms, the worse the long-term course. Put the other way, the earlier it's caught, before it gets severe, the more likely the course will be good.

With a second frozen shoulder, you're someone who can recognize that "before it gets severe." If the other shoulder feels stiff, starts to bother you at night, and your hand doesn't reach behind your back as far as it used to, that's the signal. Night pain is covered in If shoulder pain wakes you up at night. Don't wait for months like you did the first time.

What should I do when signs show up on the other side?

First, measure your current angles. Stand facing a wall, walk your fingers up it and note how high you reach, and reach behind your back and note how far up your spine your thumb gets. You need these baseline values to know how fast things are getting worse.

Second, move within a pain-free range. You probably learned this the first time. Don't push through the pain to stretch; move only up to a pulling feeling. The goal at this stage is to move gently so it doesn't stiffen. Detailed methods are in Frozen shoulder exercises: do you have to push through the pain to loosen it?.

Third, check your blood sugar. If you have diabetes, look at how it's been managed recently. If not, check when you last had a blood test. Frozen shoulder on both sides is a reason to look at whole-body conditions.

Fourth, confirm it really is frozen shoulder. Pain on the other side doesn't necessarily mean frozen shoulder. If your arm goes up when someone lifts it for you but you can't raise it on your own, it may be a tendon problem (rotator cuff tear), and if it's numb and weak, it may be a problem coming from the neck (It may not be frozen shoulder after all). Check first, before concluding it's the same condition as the first time.

How we work

First, we look at both sides. We examine whether the other shoulder really is early frozen shoulder, or whether there's another cause. If needed, we check in partnership with the radiology clinic on the 2nd floor of the same building. We measure and record the angles of both shoulders, and also look at whole-body conditions, including blood sugar, with blood tests.

Second, we catch it early. If night pain hasn't gotten severe yet, we manage pain and inflammation with acupuncture and pharmacopuncture (herbal acupuncture), and prescribe exercises that keep movement within a pain-free range to limit how much it stiffens. If you have diabetes, we work alongside your internal medicine care and set a separate expected course.

Third, we check with angles. At set points, we compare against the first measurements to see whether it's getting worse more slowly, or has started to turn around. We don't treat without evidence.

What changes

The first frozen shoulder caught you off guard, but you meet the second one knowing what it is. So you get through the stretch of lost sleep more quickly.

That's what we aim for.

The course differs from person to person, depending on how severe the early symptoms are, other conditions such as diabetes, and when you respond.

Today's takeaway

A shoulder that recovered almost never stiffens again, but the other side is affected in about 1 in 5 people. If signs appear, don't wait for months. Get checked early.

There's just one thing to do today. If you've had frozen shoulder once, measure the current angles of your other shoulder: how high your fingers reach on the wall and where your thumb reaches behind your back, with the date. If nothing happens, it simply stays a record. If signs appear, that record becomes your fastest starting point. We're open until 8:30 p.m. on weekdays, and on weekends and public holidays too.

The course of frozen shoulder and the evidence for treatment, including this follow-up study, are summarized in the director's column Does frozen shoulder really heal on its own? How true is it?.

For questions or appointments, message us in English through the messenger at the bottom right of the page, or call +82-53-716-1175.

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References

Hand C, Clipsham K, Rees JL, Carr AJ. Long-term outcome of frozen shoulder. J Shoulder Elbow Surg. 2008;17(2):231-236. PMID: 17993282