Frozen Shoulder and Diabetes: Everything You Need to Know

Frozen shoulder is one of those things you might hear about but never really think about — until it happens. Unfortunately, it’s not uncommon for people with diabetes, affecting 10 to 30 percent, by some estimates, compared to 2 to 10 percent of the general population. 

In this post, I’ll cover how to diagnose, prevent, and treat frozen shoulder, along with what to avoid if you have it.

What is frozen shoulder?

Frozen shoulder, also known as “adhesive capsulitis,” develops gradually as the shoulder joint stiffens, eventually becoming “frozen.”

This can make it hard to lift your arm above your head or even to shoulder height, with any movement causing significant pain. Over time, basic tasks like dressing or showering can become difficult. 

Although the exact link between diabetes and frozen shoulder isn’t fully understood, research suggests high blood sugars cause AGEs (advanced glycation end products) to form, which stiffen tendons and ligaments. 

This, combined with impaired circulation, leads to inflammation and immobility. Those aged 40 to 60, especially women, are at higher risk, particularly if they’ve had diabetes for many years.

How to diagnose frozen shoulder

This condition is usually diagnosed based on signs and symptoms. 

A physician will test both your active range of motion (where you move your shoulder) and passive range of motion (where they move your shoulder for you). Limited movement in both cases often confirms the diagnosis.

How to prevent getting a frozen shoulder

Unfortunately, there’s no guaranteed way to prevent adhesive capsulitis. 

However, keeping blood sugars in check can help reduce the formation of AGEs, which contribute to joint stiffness and inflammation. Fewer AGEs mean a lower risk of developing frozen shoulder. 

Read more in: How to Lower Your A1c: The Complete Guide.

Beyond that, maintaining a consistent stretching and physical activity routine is crucial to preserving your shoulder’s range of motion. While you can’t completely control whether you’ll get frozen shoulder, you can set yourself up for the best possible outcome.

Timeline for developing the condition

The early signs can be so subtle that you may not even notice them, so it’s important to stay mindful of any persistent shoulder pain or stiffness. 

While most frozen shoulders do eventually improve on their own, the process is slow and involves different stages of discomfort: freezing, frozen, and thawing.

The freezing stage lasts about 6 weeks to 9 months, with pain and limited motion being the most intense. In the frozen stage, pain decreases but mobility remains severely restricted, typically lasting 4 to 6 months.

Treatment options

Most people will opt for non-operative treatments first, such as physical therapy and non-steroidal anti-inflammatory medications (NSAIDs) like ibuprofen.

Some may also consider steroid injections to reduce joint pain and improve range of motion. 

However, if you have diabetes, it’s important to know that steroid injections can cause significantly elevated blood sugar levels for up to a week. Be sure to consult your care team before pursuing this type of treatment.

These non-operative measures are effective for many people. However, if symptoms do not improve, more intensive options such as open capsular release or arthroscopic surgery, followed by physical therapy, may be recommended.

Exercises and stretches that help treat frozen shoulder

Jenna Peitz, a physical therapist at Accelerated PT & Wellness, offers the following advice: 

Here are two exercises she recommends to help regain your shoulder’s range of motion:

Table slides/table walks

Sit at a table with your palm face down. Lean forward at the waist and slide your hand away from your body. If it’s too painful, start with your thumb pointing up.

McKenzie method of repeated shoulder extension 

Stand facing a table or counter and place your hand on it. Rotate your palm towards the thumb as you turn to face away from your arm. Squat until you feel tightness, then relax and repeat.

These low-intensity exercises can be done in sets of 10-20 reps, four to six times per day. 

Unlike typical exercise, the focus here is on restoring range of motion, so volume and intensity are less important. 

Every case is different, so it’s important to consult a physical therapist for exercises tailored to your situation, says Peitz, but these are a good starting point.

What not to do if you have a frozen shoulder

There are a few things that might seem helpful but could actually make this condition worse:

Don’t use a shoulder sling

It’s tempting to keep your shoulder immobile to reduce pain, but limiting movement can worsen stiffness. Keep using your arm to maintain its range of motion (unless your doctor specifically recommends a sling after surgery).

Don’t stop using your arm completely 

Even though it’s painful, gently moving your arm helps the healing process. Just avoid lifting heavy objects.

Don’t look for a “magic cure”

Frozen shoulder takes time to improve, and while many websites promote quick fixes, most of these remedies are ineffective and potentially harmful.

Taking control: dos and don’ts for frozen shoulder

While frozen shoulders affect many people living with diabetes, you can do a lot to prevent or treat a frozen shoulder.

• Manage your blood sugar levels as well as possible.
• Exercise and stretch your shoulders regularly BEFORE you develop frozen shoulder.
• Treat the pain with anti-inflammatory medication (NSAIDs).
• Work with a physical therapist to strengthen your shoulder and increase range of motion.
• If nothing else works, you can consider surgery.
• Don’t use a shoulder sling or completely stop using your arm.

A frozen shoulder can be painful and limit you in many of your daily activities, but the good news is that the condition almost always goes away eventually if you treat it right.

You got this!

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