Worsening shoulder and upper-arm pain and reduced movement may indicate a frozen shoulder. People with diabetes are more at risk for this complication. Treatment may involve physical therapy, arm exercises, and possibly other options including surgery.
Scott Johnson’s left shoulder was bothering him. Really bothering him.
“I couldn’t remember a specific incident, but was sure it was just a stubborn basketball injury,” said Johnson, a California resident who’s lived with type 1 diabetes for more than four decades since childhood.
But after months of physical therapy with no progress, and even what he describes as “negative progress,” Johnson was diagnosed with adhesive capsulitis, better known by most people as frozen shoulder.
This is one of those lesser-known diabetes complications, one that doesn’t get discussed much in comparison to vision loss, nerve damage, and a host of other common complications. But people with diabetes are three to five times more likely to develop this type of upper limb complication, and the risk increases with age and longer durations of diabetes.
But frozen shouder is a diabetes complication that can be painful and life-altering, and isn’t always easy to recognize when we might just equate it to “the wonders of getting older.”
Surrounding your shoulder joint is a bundle of heavy-duty connective tissue called the shoulder capsule. For reasons that
It’s a
Frozen shoulder materializes in
- Freezing. There’s a gradual onset of shoulder pain at rest, with sharp pain at extremes of motion. It typically lasts about 2 to 9 months.
- Frozen. Pain is reduced at rest, but there’s a notable loss of shoulder mobility, with pain at the end ranges of motion. It can last anywhere from 4 to 12 months.
- Thawing. The range of motion gradually returns in this stage. It can last about 2 to 42 months.
What frozen shoulder feels like
- Starts slowly, with occasional pain when lifting or moving your shoulder and upper arm.
- A gradual reduction in the ability to raise your arm and move the shoulder joint, as it’s “frozen” or stuck in place. May present as difficulty reaching something on the top shelf (known as a “loss of passive range of motion”).
- It can become so debilitating that you can’t even dress yourself.
- At times when it might be at its worst; the process often begins to reverse itself. Like the seasons of the year, the natural progression of adhesive capsulitis is often described in stages of freezing, frozen, and then thawing.
Each year in the United States, 200,000 people are diagnosed with frozen shoulder. It’s
People with diabetes are more at risk. This is
Research has found that 10% to 20% of people with diabetes experience frozen shoulder, with this 2023 study putting that number at 13.4% of people with diabetes. Researchers and clinicians also suggest the actual risk may be much higher than what the stats show, as people may not always self-report frozen shoulder — especially if it improves without further treatment.
Symptoms may be worse for those with diabetes compared to those without the condition, according to a 2021 clinical study.
Over the years, researchers studying this complication have also
As it’s a complication that arises more often as people with diabetes age, the medical community has urged more screening and discussion within the scope of broader diabetes care.
Generally, there are a number of ways to treat frozen shoulder without turning to medications or surgical procedures.
The traditional and most common treatment for frozen shoulder is physical therapy to gradually restore some flexibility to the joint capsule, sort of like stretching out a pair of too-tight pants by wearing them for an hour a day.
Your doctor may also suggest other options, including medications that could be in combination with an exercise program:
- anti-inflammatories medications
- cortisone
- steroids
- hyaluronan injections
- hydrodilatation procedure
Beyond those options, it’s important to know that adhesive capsulitis is one of the few health conditions that can actually go away if you ignore it. Frozen shoulder eventually thaws on its own, but it can take 2 to 3 years to completely heal. And during that time, the pain can be staggering.
Johnson was wary of how steroids might affect his blood sugar, so he opted not to pursue that option. That’s when his frozen shoulder progressed to a point where he began considering other options with his doctors.
He opted for a nonsurgical needle procedure in which doctors use a local anesthetic and force the shoulder through a usual range of motion to break the ice of the frozen shoulder.
Johnson said, “Every once in a while, both on the court and around the house, I’d jar my body in such a way as to hurt my shoulder. It was a knee-weakening, breath-taking, seeing-stars type of pain.”
And that knee-weakening, breath-taking, seeing-stars pain got more and more common as time went by for Johnson. His ice wasn’t thawing, so to speak, and it became so painful it was interfering with his daily life.
“I was avoiding basketball instead of looking forward to every opportunity,” he said, noting that new lack of activity trashed his diabetes management and, he says, his mental health.
A relatively new treatment that Johnson decided to undergo is called a Shoulder Joint Capsule Distension, or hydroplasty.
How it works
Under a local anesthesia, the joint capsule is filled with mixture of saline, anesthetics, and a small dose of steroids to stretch it out, much like blowing up a balloon.
Johnson described the procedure as “quick, easy, relatively painless,” and he said it didn’t take longer than 10 minutes.
This procedure is followed up by “intense” physical therapy to break down the adhesions.
Post-procedure physical therapy
For Johnson, physical therapy started immediately after the injection and continued for 1 hour every day for the following 2 weeks, followed by 30 minutes every other day for another week, with additional at-home work.
“That was one meaning of intense, when my orthopedic doctor described the physical therapy requirements,” he said. “It required a real commitment and the ability to manage so many appointments. I listened to my shoulder make unnatural sounds as the therapist moved my arm. All I could do was breathe through the pain.”
After the first intense physical therapy treatment, Johnson was unsure about the course of action he’d signed up for. But two days into the treatment, he was back on the court, playing basketball again with “very little pain and dramatic range of movement.”
He told Healthline that the most challenging part was “convincing my brain to use my left arm again!”
More than a year after that procedure, Johnson said his left shoulder still felt good, and he wondered why hydroplasty isn’t a better-known option for treating frozen shoulder for those with diabetes.
With his left shoulder is back in the game, Johnson said he started to worry about his right shoulder that had started to show some early signs of adhesive capsulitis. If that progresses in the right shoulder, Johnson planned to sign up for another round of hydroplasty with intense physical therapy.
“I would do it again in a heartbeat, as soon as my doctor feels it’s an appropriate treatment,” he said, adding that he’d push his doctor to move more quickly on his right arm. “That is my shooting arm, so I wouldn’t want to wait so long.”
Clinical research notes that for most people, frozen shoulder recovery can take as long as
People with diabetes are more at risk for developing frozen shoulder. This may gradually develop as a long-term diabetes complication.
Symptoms might include limite ability to move the shoulder joint or upper arm, with some pain before that inability to move the shoulder and raise the arm worsens. Eventually, those with frozen should may not be able to lift or move their upper arm.
Physical therapy and arm exercises can help manage frozen shoulder, and a doctor may also recommend a minimally invasive procedure to relieve this complication. It can take 1 to 3 years or more to fully heal from frozen shoulder, along with physical therapy and at-home exercises.