Frozen Shoulder

Frozen shoulder, also called adhesive capsulitis, is a condition that causes stiffness, pain and loss of range of motion in your shoulder joint.

The shoulder is a ball-and-socket joint made up of two bones: 

1. The humerus (upper arm bone) - the “ball”
2. The glenoid (part of the shoulder blade) - the “socket”

A joint capsule surrounds the shoulder joint. It is a flexible tissue that allows the shoulder to move smoothly. If you have frozen shoulder, this capsule becomes thick and tight, forming scar tissue called adhesions. This limits shoulder movement, causing the shoulder to feel “frozen.”

Common symptoms of frozen shoulder include:

• Stiffness and limited range of motion: You may find it hard to move your shoulder, especially when lifting or reaching.
• Pain: This can range from a dull ache to a sharp pain in the shoulder area. It may worsen at night or with movement.
• Discomfort in daily activities: Activities as simple as brushing your hair or reaching for objects overhead may become challenging. 

Stages of frozen shoulder

Frozen shoulder usually develops slowly in three stages:

• Freezing stage: This stage can last from six weeks to nine months. You may experience increasing pain and stiffness, making it difficult to move your shoulder.
• Frozen stage: During this stage, your shoulder may feel stiff but the pain may decrease. You will likely have a limited range of motion. This stage lasts four to twelve months.
• Thawing stage: In this stage, your shoulder will slowly begin to regain its normal range of motion. This process can take anywhere from six months to two years.

Causes and risk factors for frozen shoulder

The exact cause of a frozen shoulder is unclear. Common causes and risk factors include: 

• Age and gender: Frozen shoulder tends to happen more often in people between 40 and 60 and it’s slightly more common in women.
• Health conditions: Certain conditions, like diabetes, heart disease or thyroid disorders, can increase your chances of developing frozen shoulder. People with diabetes are more likely to experience the condition.
• Lack of shoulder movement: When you do not use your shoulder much, it can lead to stiffness and pain over time. Restricted movement may be due to a rotator cuff injury, a broken arm or recovery from surgery.

Your health care provider will: 

• Ask about your symptoms. 
• Perform a physical exam to check your shoulder’s range of motion and pain level. 
• Evaluate your passive range of motion by moving your arm for you. 
• Order imaging tests like X-rays or MRI scans to rule out other conditions such as arthritis. 

Frozen shoulder treatment aims to reduce pain and restore movement. The best approach depends on the severity of your injury, symptoms and your overall health. 

Nonsurgical treatments for frozen shoulder

• Avoid heavy lifting: Give your shoulder time to heal by avoiding heavy activities.
• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) or over-the-counter (OTC) pain relievers, such as ibuprofen or acetaminophen, can help reduce pain and inflammation. 
• Ice and heat therapy: Heat can relax the muscles, while cold packs can help reduce swelling and pain.
• Physical therapy: Physical therapy is a cornerstone of treatment. A physical therapist can guide you through exercises to improve your shoulder’s flexibility (range of motion exercises) and strength. 
• Steroid injections: In some cases, your provider may recommend corticosteroid injections to reduce inflammation and pain. 
• Transcutaneous electrical nerve stimulation (TENS): Nerve stimulation uses electrical pulses to help with pain and improve how your shoulder moves. It can make the nerves less sensitive, which helps physical therapy and other treatments work better.
• Stay active: Move your shoulder gently, even if it hurts a little. This can help prevent stiffness as you heal.

Surgical treatments for frozen shoulder

Most cases improve within 12 to 18 months, but if nonsurgical treatments fail, surgery may be recommended: 

• Arthroscopic surgery: This minimally invasive procedure involves making small incisions (cuts) in the shoulder and using a camera to guide the surgery. An orthopedic surgeon will cut through the tight parts of your joint capsule, removing scar tissue to restore movement. 
• Manipulation under anesthesia: In this procedure, an orthopedic surgeon manipulates your shoulder while you are under anesthesia (put to sleep) to help break up scar tissue and improve your range of motion.   

The good news is that a frozen shoulder usually improves with time. While the entire process can take several months to a couple of years, many people regain full or near-full use of their shoulder by the end. 

It’s not always possible to prevent a frozen shoulder, especially if it’s tied to a health condition. But there are things you can do to lower your risk:

• Keep your shoulder moving after an injury or surgery: If you’ve had surgery or an injury like a rotator cuff tear, follow your provider’s advice for keeping your shoulder moving. Gentle exercises and stretches can help prevent stiffness.
• Stay active: Regularly moving and stretching can keep your shoulder flexible and reduce the chance of a frozen shoulder.
• Manage health conditions: If you have diabetes or another condition that raises your risk, work with your provider to manage it well.

If you’re experiencing symptoms of a frozen shoulder, it’s important to start treatment early. Schedule an appointment with a Banner Health orthopedic specialist today. We’re here to help you on your journey to recovery.