What Is Frozen Shoulder? Causes, Symptoms, Stages, and Treatments
Living with frozen shoulder can be difficult. Thankfully, in many cases, this condition can be treated without surgery.
What is frozen shoulder?
Frozen shoulder, or adhesive capsulitis, occurs when the lining of the joint—also called the capsule—sticks to the shoulder, resulting in shoulder pain and reduced range of motion.
Often, there is a lack of synovial fluid in the joint to lubricate the capsule. Also, thick bands of tissue known as adhesions can develop in the area.
Frozen shoulder stages
Frozen shoulder doesn’t happen overnight. Instead, it occurs over time in three distinct stages.
“There typically is an inflammatory stage, which is the initial stage that is very painful,” says Scott Smith, MD, a board-certified orthopedic surgeon at Texas Orthopedics in Austin, Texas.
“There can be a stagnate stage or non-changing stage, where the patient experiences a classic loss of range of motion and discomfort. The third stage is a resolution stage, where the adhesions will go away, and the patient’s shoulder will return to normal.”
Frozen shoulder causes and risk factors
Unfortunately, frozen shoulder causes are largely unknown.
There is no detectable connection between frozen shoulder and arm dominance or occupation that could point to a cause and effect, according to the American Academy of Orthopaedic Surgeons (AAOS).
However, frozen shoulder most commonly affects people between the ages of 40 and 60 years old, according to the AAOS, and it is more common in women than men. There are also other potential risk factors for frozen shoulder, including:
Although the reason is unknown, frozen shoulder often occurs in patients with diabetes. They also tend to experience a greater degree of stiffness that lasts longer before it starts to “thaw.”
If your shoulder is immobilized following surgery or injury, it could lead to frozen shoulder.
There has been some evidence to suggest frozen shoulder is associated with cardiac disease, hypothyroidism, hyperthyroidism, and Parkinson’s disease.
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Frozen shoulder symptoms
The primary frozen shoulder symptoms are pain and loss of range of motion.
The pain typically occurs in the outer shoulder and may extend into the upper arm. These symptoms can vary based on the different frozen shoulder stages.
“The different symptoms are very painful in the first stage and moderately painful in the second stage, and gradually taper off in the resolution phase,” Dr. Smith says.
Diagnosing frozen shoulder
To diagnosis frozen shoulder, you will need to undergo a physical exam with your doctor. That exam will include moving your shoulder in all directions to monitor movement and pinpoint when you experience pain.
Movement is evaluated based on your own movements as well as when the doctor moves your shoulder.
It’s possible your doctor also may have X-rays, an ultrasound, or magnetic resonance imaging (MRI) taken of your shoulder to rule out other causes of your shoulder pain and lack of movement, such as arthritis or a torn rotator cuff.
Frozen shoulder treatment
In most cases, frozen shoulder treatment features rest, time, simple exercises, physical therapy, and medications. The goal of treatment is to reduce pain and restore shoulder motion.
Exercises and physical therapy
Frozen shoulder treatment starts with exercises that help restore motion and strength.
“Exercise, focusing on flexibility, is actually the solution for frozen shoulder,” Dr. Smith says. “The timing and intensity of the exercise varies and should be guided by a physical therapist.”
One example of an exercise for frozen shoulder is a crossover arm stretch. In this exercise, you pull one arm across your chest parallel to the shoulder as far as possible without pain, hold for 30 seconds, relax, and repeat.
- Non-steroidal anti-inflammatory medications: To help alleviate pain and swelling, your doctor may recommend aspirin and/or ibuprofen.
- Steroid injections: Cortisone may be injected into the shoulder joint to reduce inflammation.
- Hydrodilatation: Not exactly a medication, hydrodilatation involves injecting sterile fluid into the shoulder joint to expand and stretch the capsule.
Frozen shoulder surgery
Surgery is rarely a recommendation to release the capsule, according to Dr. Smith.
Still, he adds that recently more orthopedic surgeons are operating on patients who do not respond to nonsurgical treatment in the first several months to speed up the process.
There are two common types of frozen shoulder surgery:
- Manipulation under anesthesia: During this procedure, the doctor forces your shoulder to move, which releases the stiff tissue, increasing your range of motion.
- Shoulder arthroscopy: During this procedure, the doctor actually cuts the tight portions of the capsule to release the tightness and increase range of motion.
Regardless of which treatment (or combination of treatments) you go with, don’t expect quick results.
“Treatment can take a long period of time, sometimes up to a year, for resolution,” Dr. Smith says.
How to reduce your risk of frozen shoulder
Unfortunately, there are no specific steps to take to reduce your risk of frozen shoulder.
“To reduce your risk of frozen shoulder is complicated,” Dr. Smith says. “The source of the problem and the exact mechanism is unknown, therefore risk reduction is problematic.”
While that sounds discouraging, there’s no reason to despair.
“This is not an uncommon condition,” Dr. Smith says. “Most of the time it resolves with activity modification, exercise, and time.”