Mark Snyder remembers the day that his left shoulder became so painful and stiff that he couldn’t throw a football to his son.  

Snyder, 73, a retired physician in Marin County, California, had a severe case of adhesive capsulitis known as “frozen shoulder.” It can happen to anyone, but those with diabetes, particularly type 1 diabetes (T1D), like Snyder, are more prone to it. 

A few weeks after a steroid injection, his arm mobility returned, helped by yoga and stretching. In the meantime, he taught himself to throw a football with his right arm. That was 15 years ago, and thankfully, it hasn’t returned.  

“The only downside was hyperglycemia for about two days after the steroids,” Snyder said. “Frozen shoulder is not preventable, so I just continue my fitness routine and never think about it.” 

 

What is adhesive capsulitis (frozen shoulder)? 

Adhesive capsulitis is “a pretty serious and common condition in people with diabetes,” said Dr. Steve Edelman, an endocrinologist at the University of California, San Diego. Edelman, who’s also the founder of Taking Control Of Your Diabetes, lives with T1D and has experienced the condition himself.  

“It’s one of the most debilitating things you can have,” he said, recounting his episode during a TCOYD  Facebook Live with Dr. Kenneth Kalunian, a rheumatologist at UCSD, about a host of limb and nerve issues common with diabetes, such as frozen shoulder, stiff hands, and numb feet. Just putting on a shirt was painful, he said.  

“And it gets worse with time,” Edelman said. “Putting on or taking off a bra would be impossible. If I had to put my hand behind my back, it would have been a killer.” 

Physical therapy and sometimes steroid injections are needed to get rid of a frozen shoulder, and it can take many months or even years, according to the Academy of Orthopedic Surgeons. It’s more common in those between 40-60 years old, in women, and in people with diabetes and thyroid conditions. 

 

What are the symptoms? 

Common symptoms include a dull or aching pain in the upper arm and shoulder that develops over time. With swelling and fluid loss in the joint space, it thickens, creating scar tissue (adhesions). In turn, the pain and stiffness cause limited motion, and the shoulder “freezes.” 

“For me, I noticed I could no longer reach the strap on the subway,” said health coach and writer Riva Greenberg, 71, who lives with T1D. “That was a dramatic and a clear indication something was wrong.” Her first frozen shoulder took seeing a variety of doctors and a year for it to finally go away.  

“I ended up going to a chiropractor who worked with me for three months, using heat and adjustments,” Greenberg said. “My second frozen shoulder, which occurred in the other arm 15 years later, needed laparoscopic surgery.” 

It took two years, she said, until she regained full motion. That was about 15 years ago, the same period as between her two bouts. She said she’s hoping it’s not due for a return.  

 

Why is frozen shoulder common with diabetes?  

A 2021 study investigating the connection between diabetes and frozen shoulder found that it may be more severe and more common in people with diabetes — who are as much as five times more likely to develop it. People with diabetes account for almost a third of all frozen shoulder cases, according to the study. 

Frozen shoulder is similar to other joint mobility disorders, such as stiff hand syndrome, which is also common in adults with T1D.  A 2019 study found that almost a third reported a diagnosis of one or more orthopedic conditions, including: 

  • Frozen shoulder (15%) 
  • Trigger finger (15%) 
  • Carpal tunnel (14%) 
  • Dupuytren contracture, or thickening of the skin on the palm (5%) 
  • Multiple joint mobility disorders (15%) 

 

According to the Academy of Orthopedics, the best way to lower your risk of a frozen shoulder and speed up recovery is to keep a healthy fitness routine. With diabetes, meeting time in range goals is an important factor in prevention. 

“The typical answer to try and prevent frozen shoulder is keep your blood sugar managed, eat healthy, exercise, and get good sleep,” Greenberg said. “There’s something about prolonged high blood sugars or having diabetes for a long time that makes us vulnerable to it.” 

 

What are the treatments? 

Pain relievers (such as NSAIDs), acupuncture, physical therapy, and steroid injections can all help to reduce the pain and inflammation of frozen shoulder. While the stiffness and pain will usually go away, it can take some time. 

“Physical therapy can be really effective, especially in the early stages,” Dr. Edelman said. He developed the condition during the pandemic when appointments were limited. By the time he saw a physician, his shoulder was full of adhesions, and the pain was intense.  

After receiving a steroid injection, he began to work with a physical therapist who manipulated his shoulder. Edelman recounted, “I almost passed out because it was so painful, but I walked out five minutes later feeling 90 percent better.”  

Although there’s no fail-proof prevention and the causes are still not perfectly understood, seeking treatment as soon as possible is important. “Being knowledgeable about the early signs and symptoms of conditions like frozen shoulder and trigger finger is extremely important for a much faster and easier recovery,” said Edelman. “Don’t wait to be evaluated.”