What is frozen shoulder, and how is it treated?

Frozen shoulder is a common and extremely painful condition that can interrupt your daily routine, disturb sleep and leave you at wits’ end.

The good news is that it’s benign, meaning you’ll eventually get better.

Read on to learn more about frozen shoulder and how to get on the road to feeling better.

What is frozen shoulder?

Also known as adhesive capsulitis, frozen shoulder is a condition characterized by inflammation, pain, stiffness and limited mobility in the shoulder.

It affects the shoulder joint capsule – tissue comprised of the shoulder joint ligaments that envelopes the ball and socket joint and connects the upper arm bone to the shoulder socket.

Frozen shoulder can be difficult to diagnose, and some patients may have been told their pain is related to normal aging.

In some cases, if someone is in the early stages of frozen shoulder, the condition may not be obvious. An MRI will look fairly normal, with thickening in the shoulder joint capsule.

General practitioners or family doctors may be unfamiliar with the stages of frozen shoulder and might refer patients to a specialist because they’re not sure what’s going on.

What causes frozen shoulder?

Generally, frozen shoulder is classified as idiopathic, which means we don’t know the cause.

I’ve seen patients develop frozen shoulder after experiencing a minor trauma, like a fall with no serious injury, or their dog jerked on its leash while walking. I’ve seen it in patients who are post-chemotherapy, in those with endocrine problems – insulin-dependent diabetes, in particular – and in people who’ve had a mastectomy.

Lack of movement might trigger the response, or something about a disease process could cause it.

Common risk factors for frozen shoulder

The main risk factor is being female, with frozen shoulder most common in middle-aged women, a group often in menopause.

There’s also a link to endocrine abnormalities, such as thyroid disease and diabetes.

Thus, while we don’t know the exact link when it comes to menopause, it could be due to the sharp decline in estrogen.

Frozen shoulder stages

Frozen shoulder has three distinct phases that eventually resolve.

Phase 1: pain and inflammation

The first phase of frozen shoulder is pain caused by inflammation. Pain may start on the outside of your upper arm, but this is a referral pattern of pain that’s coming from the shoulder.

During the initial phase, try to avoid involuntary motion, like jumping back when startled, which can be painful. Likewise, don’t suddenly reach for things. Your limited motion will cause a hard stop, like running into a brick wall.

Gradually, mobility decreases as inflammatory pain worsens. This phase can last for several months.

As the inflammation worsens, stiffness begins to set in. At this point, we can diagnose your condition as frozen shoulder.

Phase 2: stiffness

The second phase is stiffness. The pain begins to improve. Mobility is limited, but the degree to which it’s limited varies from person to person.

Phase 3: thawing

The third phase is thawing. Patients’ movements gradually improve after the pain is gone.

How long do frozen shoulder stages last?

Some people pass in and out of the phases over the course of a year.

More often, patients regain full mobility in about three years.

Frozen shoulder treatment options

Phase 1 treatment

• Over-the-counter anti-inflammatory pain medications like ibuprofen for pain
• In some cases, a cortisone injection to help reduce inflammation
• Possible massage therapy, which may improve pain by increasing blood flow, helping muscles relax and reducing inflammation

No physical therapy is recommended at this stage, because it’s just too painful.

Later-phase treatment

During the second and third phases, when pain begins to diminish, massage and physical therapy are great tools for getting your mobility back faster.

Surgery

Surgery often won’t resolve the pain and could make the pain worse. It shouldn’t be considered during the first two phases of frozen shoulder.

Surgery also can often be avoided in phase 3 because, once someone comes out of the inflammatory phase, the capsule naturally tends to stretch back out and mobility returns.

However, in extremely rare cases, the capsule around the shoulder remains stiff and surgery is needed to restore mobility.

The procedure is called a capsular release. This is an arthroscopic, minimally invasive surgery through small incisions using a camera. It’s performed only if your pain is completely gone and you can’t get your mobility back. It allows the shoulder to move, and patients then work hard in physical therapy to regain full motion.

Can frozen shoulder be prevented?

Once the syndrome begins, there’s nothing we can do to stop it. Hopefully, if you know what to expect, you can cope better.

Frozen shoulder recovery

These are the best things I can tell you about frozen shoulder: First, you can’t make the disease process worse; second, you’re going to get better.

Sometimes, patients fear that making an inadvertent movement that causes a sudden increase in pain will delay recovery. That’s not the case. The pain hurts, but it doesn’t increase recovery time, and you’ll move through the stages whether you do anything or not.

We intervene with injections, physical therapy and massage just to make you more comfortable and bring back your range of motion a bit sooner.

Once recovered, frozen shoulder never truly comes back on the same side.