Frozen shoulder, also known as adhesive capsulitis, is one of the most common shoulder problems that an orthopedic surgeon treats.  In fact, a shoulder surgeon may see more than 5 patients a week with this condition.

Frozen shoulder can affect both men and women, but it is more common in women, especially those aged 40 – 60 years old. The good news is that once someone has a frozen shoulder, it rarely comes back in the same shoulder again. The bad news is, that 50% of the individuals who get frozen shoulder may be predisposed to getting it in the other shoulder in the future.

What is frozen shoulder?

Frozen shoulder occurs when the flexible tissue that surrounds the shoulder joint, known as the capsule, becomes inflamed and thickened. It is easy to think of the capsule as a balloon – inside is the shoulder joint comprised of bone, ligaments, cartilage, and fluid.  With a frozen shoulder the balloon becomes inflamed and very thick – almost like a leather belt. It can, in fact, be 10 to 15 times the normal thickness and that causes stiffness and pain. With that inflammation and the adhesions, the shoulder is unable to move freely leading to a loss of range of motion, hence the term “frozen” shoulder.

Frozen shoulder usually starts slowly with pain, stiffness, and reduced motion in the shoulder, and it continues to get worse over time. It can be debilitating and for women they have problems clasping their bra, washing or styling their hair or putting on a coat can be exceedingly painful. The pain can be sharp and described as a burning pain with quick movement.  It is also normal to be worse at night. Individuals with frozen shoulder complain of worsening pain at night either getting to sleep or staying asleep.

What Causes Frozen Shoulder?

It’s not fully understood why this process happens. Frozen shoulder often develops without any apparent reason, however, the risk of developing a frozen shoulder can increase if you have any of the following:

  • A previous shoulder injury or shoulder surgery that resulted in a lack of motion in the shoulder joint
  • A history of diabetes or a thyroid problem
  • Genetic predisposition, such as people of Scandinavian descent. They are predisposed to frozen shoulder and Dupuytren’s contracture – a condition where small lumps of thickened tissue form in the hands and fingers 

The Three Phases of Frozen Shoulder

Frozen shoulder typically develops slowly and gets worse over time. There are three distinct stages in the development and recovery from frozen shoulder.

  • Freezing stage – Also known as the inflammatory stage – the shoulder is stiff and becomes very painful. Any movement of the shoulder causes pain, and the shoulder’s ability to move becomes limited. The shoulder starts to ache, and it becomes difficult to reach out for things or reach overhead. The pain is often even worse at night and especially when you lie on the affected side. Many people seek treatment because it is disruptive to their sleep. This stage usually lasts from 2 to 9 months. 
  • Frozen stage – Pain is less during this stage. However, the shoulder becomes stiffer and using it becomes more difficult. This stage can last from 4 to 12 months. 
  • Thawing stage.The shoulder’s ability to move begins to improve and gradually you regain movement in your shoulder. As the inflammation is reduced, the motion is restored and the pain continues to improve. This stage lasts from 6 months to 2 years.

Diagnosing and Treating Frozen Shoulder

Frozen shoulder is often diagnosed after the shoulder has been painful for a long time and is just not getting better.  Unfortunately, frozen shoulder is often mis-diagnosed as a rotator cuff tendon problem. A good surgeon will recognize the subtle distinction between a rotator cuff problem and frozen shoulder. Unlike rotator cuff issues, almost no one with frozen shoulder will need surgery. In fact, it is rare to need an operation. Treatment usually consists of a steroid injection in the joint capsule and a few formal sessions of physical therapy where you will learn the best exercises to stretch and eventually strengthen the shoulder.

Steroids are medicines that help reduce pain and inflammation. They are safe and effective in limiting the sharp and stabbing pain and they can relieve the aching pain at night that disrupts your sleep. Once you have taken the edge off with an injection, it’s time to get to work with therapy to learn how to continuously stretch the shoulder to eventually regain your motion.

Most patients with frozen shoulder are encouraged to continue exercises at home 5- 7 days a week until their range of motion returns. Although frozen shoulder can take up to 2 years to resolve, most people will return to a pain-free life with their full range of motion.

Dr. Mitchell Fagelman is a board-certified Orthopedic Surgeon at OrthoTexas.  He is a specialist in diagnosing and treating shoulder pain and injuries.