Frozen Shoulder Explained: Causes, Symptoms, And Treatments

Most of us probably take our mobility for granted until we start to experience aches and pains that accompany certain movements. It can be frustrating, scary, and have an adverse impact on the quality of our lives. Frozen shoulder is one such condition. Imagine not being able to reach for something in the top cupboard or barely being able to move your arm at all — not exactly a fun thought, right? Unfortunately, frozen shoulder is a pretty common condition; it tends to affect people between the ages of 40 and 60, and women are more prone to this condition than men (via Harvard Health Publishing).

Frozen shoulder is exactly what the name suggests: A shoulder that has become so stiff that movement is extremely restricted (via Cleveland Clinic). This condition is also referred to as adhesive capsulitis. The shoulder joint is nestled in connective tissue, which plays a vital role in the shoulder's mobility. When these tissues start to stiffen and thicken, inflammation follows, and it gradually starts to limit the shoulder's range of movement.

This causes pretty intense pain, and once people experience it, they instinctively start to limit the movement of the afflicted shoulder. The longer the shoulder isn't used, the more the connective tissue starts to thicken and tighten. The result? A shoulder that is incredibly painful with very limited movement, hence the term "frozen shoulder." Read on to learn about the causes of a frozen shoulder, the symptoms that typically accompany it, and the treatment options available.

A myriad of things can cause a frozen shoulder, and in some cases, doctors can't gauge what exactly trigged it, according to the National Health Service (NHS). What doctors do know is that inflammation of the connective tissue surrounding the shoulder joint is responsible for the pain and stiffness people experience, and it's usually triggered by trauma to the area. Previously sustained shoulder injuries like fractures or overuse injuries like tendinitis or bursitis are notorious for triggering inflammation, according to Harvard Health Publishing.

When the soft tissue in the shoulder becomes inflamed, it leads to pain that worsens over time. Mobility becomes limited, and the tissue around the glenohumeral joint (commonly referred to as the joint capsule) continues to thicken. It also gradually starts to contract, losing its flexibility and ability to stretch. The less the patient moves the afflicted shoulder, the more the connective tissue contracts. This leads to increasingly limited space for the humerus to move, leading to a loss of synovial fluid, which helps lubricate the joint. Once a frozen shoulder progresses to this stage, scar tissue might start to form between the humerus and the joint capsule, leading to even more pain and stiffness.

While a frozen shoulder can affect anyone, some people are more prone to this condition than others. Women are more likely to develop this condition, but other factors can also play a part. For starters, people who already experience some form of restriction when moving their shoulder are at a higher risk of developing a frozen shoulder, according to Mayo Clinic. Those who suffered a rotator cuff injury, broke an arm, or had surgery that limits the use of the shoulder are all considered high-risk patients. This is because these injuries usually require them to keep the arm still and in a sling for prolonged periods of time. This lack of movement creates the perfect conditions for a frozen shoulder to develop.

Patients who suffer from Parkinson's disease, hyperthyroidism, hypothyroidism, and cardiovascular disease tend to be more susceptible to developing a frozen shoulder as well. Those who have diabetes are three times more likely to develop this condition, according to Healthline. It's important to check in with your doctor if you suspect you're developing a frozen shoulder. Diagnosing it early enough can help you recover faster.

The best way to prevent a frozen shoulder from wreaking havoc on your life is to know what to look out for so you can get diagnosed early. The symptoms typically show up in three phases, according to the Mayo Clinic. The first phase is referred to as the freezing stage. This is when you'll start noticing pain in your shoulder whenever you're moving it. You'll also notice that you can't move it like you used to. The pain might start suddenly and without warning, according to Mount Sinai, even if you didn't sustain any trauma or injuries to the shoulder recently. People usually notice that the pain intensifies during the night. It can be so intense that it wakes you from sleep.

The pain can continue for up to nine months before the next phase, known as the frozen stage, sets in (per Mayo Clinic). This is when you'll start to lose movement in the shoulder. The pain might start to subside a bit, but mobility will continue to decrease to the point where using the shoulder becomes a real challenge. You might find that you're not able to reach your arm behind you, and reaching overhead might feel impossible. This frozen stage can last anywhere from four to twelve months. The final phase is referred to as the thawing stage, and this is when mobility starts to return to the shoulder. Thawing can last anything from five months to two years.

While the symptoms of a frozen shoulder might seem pretty obvious, it's crucial you make an appointment with your doctor if you suspect you might be developing this condition. Typically, your doctor will ask you about your medical history, after which they will take a thorough look at your shoulder (via OrthoInfo). They'll assess your mobility and ask if you experience any pain when moving your shoulder a certain way. They'll start off by moving your shoulder for you (referred to as passive range of motion) and then ask you to move it on your own (active range of motion). They'll then compare your active and passive ranges of motion. If you are developing a frozen shoulder, both your active and passive range will be fairly limited.

Next, your doctor may order imaging tests to confirm a frozen shoulder diagnosis and rule out any other causes. This typically consists of x-rays, a magnetic resonance imaging test (MRI), and an ultrasound. X-rays will help your doctor take an in-depth look at your shoulder and rule out other causes of pain like arthritis. The MRI and ultrasound will give your doctor a clear picture of your soft tissues. While these tests aren't crucial for a diagnosis, they can help your doctor rule out other issues like a torn rotator cuff. Once all other possible causes of your shoulder pain have been ruled out, your doctor will start treating you for a frozen shoulder.

Popular pain medications like ibuprofen (think brands like Advil), acetaminophen (commonly known as Tylenol), and naproxen (brands like Naprosyn and Aleve), can all help you manage the pain of a frozen shoulder, according to Mount Sinai. However, it's important that you speak to your doctor before you start to take any of these medications regularly, especially if you've previously had internal bleeding or stomach ulcers.

If you have any other diseases like hypertension, kidney disease, or heart disease, you should also consult with your doctor first. Only use these medications as directed. If you find that they don't ease your pain, speak to your doctor about other options. Some patients get regular steroid injections to help manage swelling and intense pain. Typically, your doctor will inject cortisone directly into the affected shoulder joint in these cases (via Cleveland Clinic).

There are also some small adjustments you can make at home to minimize the pain in your shoulder. Using a hot and cold compress can help ease the pain, as well as avoiding movements that aggravate the shoulder. Ask someone to help you rearrange your house so you can reach everything you need without needing to reach above your head or behind you (via Mount Sinai). It's also important that you get someone to help you with other tasks that require shoulder mobility, like cleaning and gardening. You should also refrain from picking up heavy objects or engaging in activities that require the use of your shoulder.

While medication can do wonders for a frozen shoulder, physical therapy is often a crucial part of regaining the mobility you lost. Your physical therapist will provide you with exercises that are geared towards stretching your shoulder joint. Results aren't instant, however, and it can take anything from a couple of weeks to nine months to notice improvement, according to Healthline.

Most of the exercises you'll be provided with will focus on gentle stretching — you should feel some tension, but not pain. Common exercises include armpit stretches, finger walks, towel stretches, cross-body stretches, and a pendulum stretch, according to Harvard Health Publishing. You'll typically start off with the pendulum stretch, which consists of swinging your arm in a small circle while leaning over just slightly, supporting your other hand on a table or chair. This helps you prep your body for the other exercises. You'll typically perform each exercise 10 to 20 times per day. As your mobility starts to improve, your physical therapist will change your program to include exercises that help strengthen your shoulder. These typically require a resistance band and consist of movements like outward rotation and inward rotation to help strengthen the rotator cuff. You'll typically do 10 to 15 reps of each exercise per day. Remember to do your stretching exercises before you move on to the strengthening section of the program. This will ensure that your muscles are warmed up properly.

Sometimes, a frozen shoulder can linger, and if you've tried everything (including physical therapy) without results, surgery is usually your next best option. Typically, surgery is performed during the frozen stage when people have little to no mobility in the affected shoulder, according to the OrthoInfo. If your frozen shoulder is due to an injury, performing surgery as quickly as possible usually yields the best results.

There are two surgeries doctors can perform: shoulder arthroscopy and manipulation under anesthesia. The surgery your doctor suggests will depend on the severity of your frozen shoulder. Both these procedures focus on getting the joint capsule to stretch and release. Sometimes these two procedures are performed together to improve the chances of complete recovery.

A shoulder arthroscopy focuses on removing and/or releasing the scar tissue that's causing a frozen shoulder. This surgery is performed by making a small incision in the shoulder and using an endoscope to manipulate the scar tissue, according to Medical News Today. Manipulation under anesthesia is a less invasive procedure, which consists of forcing the shoulder to move. While this sounds painful, the patient is fast asleep and none the wiser during the procedure. Once anesthesia is administered, the surgeon proceeds to move the shoulder, which serves to break up and stretch the scar tissue, leading to increased mobility (per OrthoInfo). These surgeries have a pretty high success rate, so if your frozen shoulder isn't getting better, they may be worth considering.

Surgery is only the first step to recovery from frozen shoulder, and you'll need to follow your doctor's post-surgery instructions carefully to ensure that the procedure is a success. According to OrthoInfo, you will need to get started with physical therapy soon after surgery to ensure your newfound mobility sticks around. Fair warning: This is a tedious process; recovery can take anything from six weeks to three months, but it's worth it in the end. All you need to do is stick to the exercises your physical therapist provides. This is the only way you're going to be able to get back to doing all the activities you love.

The good news is that, for most people, surgery combined with physical therapy is a raving success, and they get to continue living their lives without intense pain and restricted movement. There are, however, some cases where patients don't regain their original range of motion post-surgery and still deal with some stiffness years later. Patients with diabetes tend to continue struggling with shoulder stiffness post-surgery, and in some rare cases, a frozen shoulder can return. However, it's still worth giving surgery a shot if no other treatments have helped in the past.

Anyone who's ever been diagnosed with a frozen shoulder knows how daunting it can be when you learn that recovery can take some time. No one enjoys pain and limited mobility, and seeking out medical help is the first step toward getting better as quickly as possible.

The good news is that a frozen shoulder can eventually resolve without treatment, but you'll have to deal with the pain and discomfort much longer. Typically, it takes around two years to heal if a doctor doesn't treat it, according to Healthline. If you opt for medical care like pain medications, cortisone injections, and physical therapy, you can regain mobility and live pain-free within a year or even a few months, depending on the severity of the condition, the Cleveland Clinic reports.

Now that you know just how painful a frozen shoulder can be, you're probably eager for tips on how to prevent it from occurring altogether. The truth is that there's only one way to make sure you don't end up with this painful condition, and that is starting physical therapy as early as possible after sustaining any sort of injury or trauma to your shoulders. Acting early can help lessen the severity of a frozen shoulder if it develops or prevent it from occurring altogether.