Frozen Shoulder

Frozen shoulder (adhesive capsulitis) is a condition that causes pain, stiffness, and limited mobility in the shoulder. It occurs when the connective tissue around the shoulder joint (capsule) thickens, forming scar-like bands of tissue called adhesions that limit movement.

Frozen shoulder develops gradually and often gets worse before it gets better. While it may resolve on its own over time, early treatment can reduce pain and restore movement faster.

What Causes Frozen Shoulder?

The exact cause of frozen shoulder isn’t always known, but it often develops after:

• Any condition with inflammation in the shoulder where the patient self-immobilizes due to pain. (For example, routine bursitis causes pain, and the patient does not move their shoulder because they fear that will “make it worse”)
• An injury or surgery that keeps the arm immobile for an extended period

Certain health conditions can increase the risk, including:

• Diabetes
• Thyroid disorders
• Parkinson’s disease
• Heart disease

Frozen shoulder is more common in adults between the ages of 40 and 60 and occurs more often in women than men.

What Are the Symptoms of Frozen Shoulder?

Frozen shoulder develops in three main stages, each with different symptoms:

• Freezing stage
  • Increasing pain and stiffness
  • Range of motion becomes limited
• Frozen stage
  • Pain may decrease
  • Stiffness remains
• Thawing stage
  • Shoulder movement slowly improves
  • Full recovery may take up to 2 years

Pain is usually dull or aching and is worse at night or when reaching overhead.

When Should I See a Shoulder Specialist?

You should see an orthopedic specialist if:

• You’re experiencing ongoing shoulder stiffness and pain
• Your lack of mobility limits your daily activities
• Shoulder pain is affecting your sleep

Remember: early treatment can ease discomfort and shorten your recovery time.

How Is Frozen Shoulder Diagnosed?

A healthcare provider will diagnose frozen shoulder based on:

• Medical history and symptom review
• Physical exam to test the range of motion and shoulder strength
• Imaging tests like X-rays or MRI may be used to rule out other causes of shoulder pain, such as arthritis or a torn rotator cuff

It's important to note that the diagnosis is made on a physical exam; the only caveat is if the patient has end-stage arthritis (no cartilage left), or a dislocation of the shoulder.

How Is Frozen Shoulder Treated?

The goal of treatment is to relieve pain and restore shoulder motion. Most people improve with nonoperative options, but in severe cases, surgery may be necessary.

Nonsurgical Treatments

Treatment can significantly shorten the duration of the condition and help prevent further stiffness.

• Anti-inflammatory medications: NSAIDs like ibuprofen can reduce pain and swelling.
• Steroid injections: Cortisone shots may reduce inflammation and allow better movement.
• Physical therapy: Guided stretching and mobility exercises are critically important.
• Shoulder exercises at home: Daily stretching must be performed to improve and maintain the range of motion; if patients do not diligently perform the daily stretching exercises, the shoulder will NOT get better.
• We also recommend bringing a family member to a physical therapy session so they can be instructed on how to safely and reliably stretch their loved one’s shoulder at home.
• Hot or cold therapy: Ice packs or heating pads can help with pain.
• 90% of patients are successfully treated with non-operative management and do NOT require surgery.

Surgical Treatments

Surgery is rare but may be necessary if symptoms don’t improve after a minimum of 4 months of treatment. Options include:

• Arthroscopic capsular release: A minimally invasive procedure releases the adhesions (scar bands described above) to safely recover the full range of motion.
• Shoulder manipulation under anesthesia: The surgeon moves the joint to break up scar tissue.

Surgery is typically followed by a structured rehab program that MUST begin on Post-operative Day 1 and continue at least 3x/week x 3 months.

What Are the Risks for Frozen Shoulder Surgery?

Like any surgery, frozen shoulder surgery carries some risks, including:

• Shoulder dislocation
• Shoulder fracture
• Failure to regain 100% range of motion
• Recurrent frozen shoulder
• Unresolved pain

Complications from surgery are rare, and success rates are high, especially when combined with adherence to your postoperative physical therapy plan.

What Does Recovery Involve?

Recovery from frozen shoulder takes time and commitment to therapy. After starting treatment, most patients gradually regain shoulder movement.

After surgery, physical therapy begins on postoperative day #1 to maintain the range of motion that was regained intraoperatively.

How Long Does Frozen Shoulder Last?

Frozen shoulder can last anywhere from 6 months to 2 years or longer, depending on how early it’s diagnosed and treated. The thawing stage often happens slowly, even with treatment.

What Is the Outlook for Frozen Shoulder?

With consistent treatment and stretching, most people fully recover from frozen shoulder and regain full use of the joint. In rare cases, some stiffness may remain. Early diagnosis and a tailored treatment plan give you the best chance for a full recovery.