If you are experiencing severe shoulder pain and stiffness, you may have frozen shoulder, also known as adhesive capsulitis.
What is frozen shoulder?
The shoulder pivots mainly on a ball-and-socket joint called the glenohumeral joint, which joins the upper arm bone (humerus) to the shoulder blade (glenoid cavity). This joint helps the shoulder move and allows the arm to rotate and extend. The joint is surrounded by strong connective tissue called the shoulder capsule. Synovial fluid lubricates the shoulder capsule and joint, helping the shoulder move more easily.
In frozen shoulder, the smooth tissues of the shoulder capsule become inflamed, thick and stiff, and there is typically less synovial fluid. In fact, the condition is called ‘frozen shoulder’ because the more pain that is felt, the less likely the shoulder will be used. This lack of use causes the shoulder capsule to thicken and tighten, which makes it even more difficult to use, freezing into its position.
What are the symptoms of frozen shoulder?
Shoulder pain and a decrease in range of motion are the two main characteristics of frozen shoulder. The pain is usually located in the outer shoulder area, but sometimes in the upper arm. Reaching overhead or behind the back can cause pain and stiffness to worsen. The symptoms are also more severe early-on, as well as when you move your arm.
The stages of frozen shoulder
Frozen shoulder develops over three stages, each of which can last several months:
- Freezing stage: Movement of your shoulder causes pain, and range of motion in the shoulder starts to become limited
- Frozen stage: Pain in the shoulder may diminish, but it becomes stiffer and more difficult to use.
- Thawing stage: The shoulder’s range of motion begins to improve.
What causes frozen shoulder?
Frozen shoulder typically occurs in people who have sustained an injury or have had their arm still for a long period of time.
“Frozen shoulder is always a later stage issue because people don’t recognize it, but a frozen shoulder is never the primary problem. People ignore the primary problem and develop frozen shoulder,” says Dr. Vladimir Alexander, Founding Partner of Alexander Orthopaedics. “The key to taking care of it is to find the primary reason that causes shoulder pain in the first place. So, when we see frozen shoulder, we understand what it is and we try to get to the bottom of the root cause.”
What are risk factors for frozen shoulder?
Frozen shoulder more commonly occurs between the ages of 40 and 60, and in women. Other risk factors include:
- Diabetes: Frozen shoulder occurs more frequently in people who have diabetes, with research showing that people with diabetes are 2-4 times as likely to develop frozen shoulder. Frozen shoulder occurs in 10-20% of diabetic patients.
- Other diseases: Thyroid disorders, cardiovascular disease, or Parkinson’s disease
- Immobilization: People who are recovering from injuries, such as a rotator cuff injury or a broken arm, or wearing a shoulder sling for a long period of time, can be susceptible to frozen shoulder, as well as someone recovering from a stroke or surgery.
Can frozen shoulder go away on its own?
Even though frozen shoulder may get better after the frozen stage, full recovery can take up to three years. In addition, a study published in The Bone & Joint Journal cites that 40% of patients may experience persistent symptoms. According to American Family Physician, some patients never regain full function of their shoulder if left untreated.
How is frozen shoulder diagnosed?
A physical examination is typically the first step in assessing your range of motion for frozen shoulder. Your doctor will ask you to perform certain movements to measure the range of motion of the shoulder, including:
- Passive range of motion: In this type of assessment, the doctor will move your shoulder in all directions and assess the range of motion and if there is pain with the movement. It is passive because the doctor is moving your arm, not you.
- Active range of motion: In this assessment, you will move your shoulder and the doctor will observe your range of motion.
People with frozen shoulder are limited in their active and passive range of motion.
After a physical examination, imaging tests may be ordered to help your doctor rule out other causes, including:
- X-rays: X-rays can help show other problems in the shoulder, such as shoulder arthritis.
- MRI: An MRI, which shows soft tissues better than an X-ray, can help identify other shoulder problems, such as a torn rotator cuff.
What is the treatment for frozen shoulder?
If another underlying condition is identified that is causing the frozen shoulder, that will be the focus of treatment, according to Dr. Alexander. However, if the cause of frozen shoulder is unclear, the focus of treatment will be on controlling pain and restoring motion and strength in the shoulder.
Nonsurgical, conservative treatment is typically recommended for frozen shoulder to restore motion and manage pain, including:
- Anti-inflammatory medicine: Medications like ibuprofen (Motrin, Advil), Naprosyn, Aleve, and aspirin can help reduce pain.
- Steroid injections: Cortisone can be directly injected into the shoulder joint to help with pain and inflammation.
- Physical therapy: An experienced physical therapist can help you learn specific exercises to help restore motion.
If conservative methods are ineffective, your doctor may recommend shoulder surgery. According to American Family Physician, if pain does not improve and becomes intolerable after 6-12 weeks of nonsurgical treatment, surgery may be recommended. The two surgical procedures for frozen shoulder are:
- Shoulder arthroscopy: Arthroscopic surgery can help loosen the joint capsule so it can move more freely.
- Manipulation under anesthesia: In this procedure, the humerus is manipulated to disrupt adhesions.
Do’s and Don’ts for Frozen Shoulder
If you think you have frozen shoulder, here are some guidelines for recovery and treatment. Before following these guidelines, schedule an appointment with a physician if you have persistent pain and stiffness that interferes with daily activities
Do’s for Frozen Shoulder
- Follow exercises provided from a physical therapist or physician.
- Take medications as recommended by your doctor.
- Maintain an upright posture and keep your shoulders gently back.
- Remember to regularly move your shoulder — keeping it still will make the pain and stiffness worse.
- Use heat and cold packs on your shoulder to help with inflammation.
Don’ts for Frozen Shoulder
- Make up your own exercises or follow what you see on the Internet.
- Slouch when sitting.
- Roll your shoulders and bring your neck forward.
- Engage in activities that involve jerky or jarring movements.
- Sleep on the frozen shoulder.
What is the frozen shoulder recovery process?
Physical therapy and pain medication can speed up frozen shoulder recovery. According to John Hopkins Medicine, supervised physical therapy typically lasts from one to six weeks depending on the frequency of sessions. In physical therapy, you will learn exercises that can be done at home, as well to help with healing.
Early treatment helps frozen shoulder from getting any worse, along with identifying and treating the underlying cause of frozen shoulder. Since frozen shoulder is fairly common in people who have diabetes, properly managing diabetes can help reduce the risk of frozen shoulder.
If you are living with shoulder pain and stiffness, you don’t have to keep suffering. Our orthopedic surgeons and physical therapists are experts in shoulder treatment and surgery, and will work with you to create a treatment plan that addresses the underlying causes of your frozen shoulder to ensure long-term recovery.