Frozen Shoulder and its Treatment

What is Frozen Shoulder?


Frozen shoulder is a painful condition in which the shoulder becomes stiff and inflamed, and movement becomes limited. Frozen shoulder also called adhesive capsulitis. Signs and symptoms typically begin gradually, worsen over time and then resolve, usually within one to three years.

Frozen shoulder occurs when the strong connective tissue surrounding the shoulder joint (called the shoulder joint capsule) become thick, stiff, and inflamed. (The joint capsule contains the ligaments that attach the top of the upper arm bone [humeral head] to the shoulder socket [glenoid], firmly holding the joint in place. This is more commonly known as the “ball and socket” joint.)

Frozen shoulder most commonly affects people between the ages of 40 and 60, and occurs in women more often than men. In addition, people with diabetes are at an increased risk for developing frozen shoulder. Physical therapy, with a focus on shoulder flexibility, is the primary treatment recommendation for frozen shoulder.

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Symptoms of Frozen Shoulder

The main symptoms of a frozen shoulder are pain and stiffness that make it difficult or impossible to move it.

If you have frozen shoulder, you’ll likely feel a dull or achy pain in one shoulder. You might also feel the pain in the shoulder muscles that wrap around the top of your arm. You might feel the same sensation in your upper arm. Your pain could get worse at night, which can make it hard to sleep

You’ll typically go through three phases with a frozen shoulder. Each has its own unique symptoms and timeline.

Symptoms of frozen shoulder are divided into three stages:

1. The “freezing” stage

In this stage, the shoulder becomes stiff and is painful to move. The pain slowly increases. It may worsen at night. Inability to move the shoulder increases. This stage lasts 6 weeks to 9 months.

2.  The “frozen” stage

In this stage, pain may lessen, but the shoulder remains stiff. This makes it more difficult to complete daily tasks and activities. This stage lasts 2 to 6 months.

3.  The “thawing” (recovery) stage

Shoulder motion slowly improves during the “thawing” stage. Complete return to normal or close to normal strength and motion typically takes from 6 months to 2 years.

Diagnosis of Frozen Shoulder

To diagnose frozen shoulder, Our doctor will:

  • Discuss your symptoms and review your medical history.
  • Conduct a physical exam of your arms and shoulders:
    • Our doctor will move your shoulder in all directions to check the range of motion and if there is pain with movement. This type of exam, in which your doctor is moving your arm and not you, is called determining your “passive range of motion.”
    • Our doctor will also watch you move your shoulder to see your “active range of motion.”
    • The two types of motion are compared. People with frozen shoulder have limited range of both active and passive motion.
  • X-rays of the shoulder are also routinely obtained to make sure the cause of the symptoms is not due to another problem with the shoulder, such as arthritis. Advanced imaging tests, such as magnetic resonance imaging (MRI) and ultrasound, are usually not needed to diagnose frozen shoulder. They may be taken to look for other problems, such as a rotator cuff tear.

Treatment of Frozen Shoulder

Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibuprofen can help relieve the pain and inflammation in your shoulder. If they don’t help, your doctor might prescribe a stronger medication.

Your treatment might also include going to a physical therapist for strengthening and stretching exercises to improve your range of motion.

If your symptoms are intense or don’t improve over time, your doctor might recommend other kinds of treatments, including:

  • A corticosteroid injection in your shoulder joint to reduce your pain and improve your range of motion.
  • Joint distension. This means your doctor will inject sterile water into your shoulder capsule to stretch it. This can help you move your shoulder more easily.
  • Physical therapy. Results with this are mixed, and it may be more useful during certain phases of frozen shoulder than others.
  • Surgery. This is very rarely necessary to treat frozen shoulder. But if other treatments haven’t helped, your doctor may suggest surgery. It likely would be an arthroscopic procedure. That means it’s done with lighted, pencil-sized tools that are inserted through tiny cuts in your shoulder.
  • Shoulder manipulation can help loosen up your shoulder tissue, but is very rarely done anymore because arthroscopic surgery has replaced it. Surgeons would forcefully move the shoulder under general anesthesia. With this method, there was an increased risk of complications including fractures.