Frozen Shoulder: Causes & How to Treat It
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What is frozen shoulder?
Frozen shoulder usually comes on slowly and goes through a series of three stages: the freezing stage, the frozen stage, and the thawing stage. During the freezing stage, moving the shoulder becomes painful and range of motion starts to decrease. In the frozen stage, pain is usually less, but stiffness is worse. Finally, in the thawing stage, range of motion slowly begins to improve. —Dr. Ben Schwartz
Adhesive capsulitis—better known as “frozen shoulder”—makes your shoulder joint stiff and very painful. The tissue in the shoulder joint thickens, causing it to tighten up.
It progressively gets worse so that you can barely move your arm. But over the course of 1-3 years, frozen shoulder eventually gets better on its own.
At first, symptoms of frozen shoulder are similar to other shoulder injuries. You should see your primary care doctor if you have pain or stiffness in your shoulder.
Frozen shoulder symptoms
People with frozen shoulder usually go through three phases. You can be in more than one stage at once.
1. Freezing (painful) shoulder (2 to 9 months)
The first symptom is usually severe pain in the shoulder. This typically starts right after an injury. It may be hard to pinpoint where the pain is coming from. The pain is usually worse at night and over-the-counter pain relievers don’t help very much.
2. Frozen (stiff) shoulder (4 to 6 months)
After a few months, the pain starts to get better. But the shoulder becomes stiffer, or “frozen.” When you try to move your shoulder, you don’t have your normal, full range of motion. For exampe, you can’t reach as far back to throw a ball or lift your arms all the way over your head. It might not feel this way all the time. Movement becomes more limited until you have trouble with simple tasks like putting on a jacket, reaching for something, or lifting your arms at all.
3. Thawing (recovery) shoulder (6 to 24 months)
All of your symptoms suddenly, but slowly, begin to improve. It’ll take 6 months to 3 years for it to fully “thaw.”
At first, symptoms of frozen shoulder are similar to other shoulder injuries. You should see your primary care doctor if you feel any of the above symptoms.
What is the main cause of frozen shoulder?
The shoulder is a “ball and socket” joint. Like cupping one hand around your other fist. The rounded arm bone rests in a nook formed by the curved bones of the shoulder. Your body also makes lubrication, called synovial fluid. It sits between the two bones to keep the arm moving smoothly.
We don't know exactly why frozen shoulder happens. But most experts think it's either from scar tissue forming in the shoulder or inflammation in the shoulder.
Either way, this forces the tissue around the shoulder joint to get thicker and tighter. There's less room for movement and less lubrication. So movement becomes stiff and painful.
The shoulder joint normally provides some of the greatest range of motion of any joint in the human body. This allows our arm to go in many different positions to perform typical activities of daily living such as reaching overhead, putting on clothes, brushing our teeth, and washing our hair. —Dr. Schwartz
You’re more likely to have frozen shoulder
Roughly 2% to 5% of people will have frozen shoulder at some point in their life. The cause is unknown. But certain circumstances and diseases can increase your risk.
- Being in your ‘50s and ‘60s
- Being female
- Type 1 diabetes (up to 1/3 of people with Type 1 diabetes will develop frozen shoulder)
- Other illnesses, including autoimmune diseases, hypo- or hyperthyroidism, heart disease, pulmonary disease, tuberculosis, and Parkinson’s disease
- Having a stroke or an injury that keeps you from using your shoulder for a long period of time.
- A previous frozen shoulder in one arm makes you more likely to develop it in the other arm.
Can frozen shoulder go away on its own?
A “frozen shoulder,” can cause a dramatic decrease in shoulder motion. Even more frustrating, symptoms can come on without warning and take up to 2 to 3 years to resolve. Though most cases improve within 12 to 18 months. —Dr. Schwartz
Frozen shoulder does usually heal on its own, with physical therapy and treating the symptoms. But it could take from 1 to 3 years.
What is the best treatment for frozen shoulder?
Your doctor will give you a physical exam. They might send you to an orthopedist for testing, such as an x-ray, ultrasound, or MRI, to diagnose and treat the problem.
Frozen shoulder is usually treated with:
- Pain medications like acetaminophen and nonsteroidal antiinflammatory drugs (NSAIDs) can be tried during the initial painful freezing phase, but they may not provide much relief.
- Ongoing exercise therapy with a physical therapist. This starts with daily gentle exercises to increase range of motion. The exercises get more intense as pain gets better.
- Getting a steroid injection into the shoulder to help unfreeze the shoulder and to relieve pain.
- Lubricating the joint (called distension) with saline injections into the shoulder to help with movement.
In rare cases, when treatments don’t work after 12-18 months, your doctor might try shoulder manipulation. This is typically performed while you’re under general anesthesia. The doctor will move the arm at the shoulder joint with his hands. This helps break up scar tissue and loosen the stiff joint.
Or your doctor might suggest surgery. This should help remove any scar tissue that’s keeping your shoulder from moving. Surgery is rare, though.
In many people, frozen shoulder gets better on its own. However, it can take up to 3 years for a shoulder to recover. It is not uncommon to have some continued tightness or soreness in the shoulder. In some patients, this can be permanent although it usually does not limit their activities.
Follow up regularly with your doctor or orthopedist. Do the recommended exercises. This will make your shoulder’s mobility and strength better.
If your shoulder or arm is injured and you can’t move it for a while, or you have had a stroke and your arm is immobile, talk to your doctor. They can recommend physical therapy exercises to keep your shoulders active.
Jesse Passman is a PGY-1 surgery resident. He graduated from Rice University with a BS in Ecology and Evolutionary Biology and received his MD from the University of Pennsylvania Perelman School of Medicine. During medical school, Jesse performed work in public health and surgery, taking a year-out to pursue an MPH at the University of Pennsylvania and do research in global surgery and the public health implications and clinical outcomes of trauma. In his free time, Jesse likes to travel, hike, backpack, and cycle.