The 3 Frozen Shoulder Stages And Their Treatments

There are 3 frozen shoulder stages: freezing, frozen, and thawing. Each phase has its own set of challenges and timelines according to what’s happening inside your joint capsule.

Now, if you develop frozen shoulder, there are several things you can do in each stage to make sure the condition resolves as quickly as possible.

Below, we’ll discuss each stage in-depth, along with the best treatments for them. Here’s what we’ll cover – tap on any of the bullets to go to its section:

• Freezing phase and its treatments
• Frozen phase and its treatments
• Thawing phase and its treatments
• 3-step home program for frozen shoulder
• Do you need surgery?
• FAQs

Or read along if you want to learn more.

The first phase: Freezing stage

Frozen shoulder occurs due to an insidious and gradual build-up of inflammation affecting your shoulder capsule.

During the first stage, the levels of inflammation slowly rise, increasingly damaging your shoulder capsule. This process may last for 2 to 6 months, leading to symptoms like (1):

• Moderate to severe shoulder pain.
• Gradual reduction of your range of motion.

Unlike other forms of a shoulder injury like a rotator cuff tear, each symptom gradually worsens as it progresses. (1)

Learn more: All you need to know about frozen shoulder

During the freezing stage, pain control is the primary focus.

However, keep in mind that decreasing your pain level does not mean you are cured of a frozen shoulder. This is to make your daily life tolerable, as you work your way through the next 2 phases.

With that, here are some things you can do in this first phase to help reduce pain:

1) Take pain medications for your shoulder joint

Oral medications and steroid injections are two common types of pain-reducing drugs. They temporarily block or reduce enzymes that produce inflammation and pain. (2, 3)

NSAIDs work for a few hours at a time. Meanwhile, cortisone injected directly into your upper arm bone may last up to 12 weeks. (4)

2) Tools to relieve upper arm pain

You can place a hot pack over your affected arm to temporarily alleviate pain. But if you’re feeling a little techie, you can use Transcutaneous Electrical Nerve Stimulation (TENS) too.

This is a small device with pads that send special electrical currents. This helps temporarily reduce the sensation of pain. (5)

However, follow the directions of your physical therapist (PT) before trying TENS by yourself.

3) Initiate your recovery with physical therapy

The goal with physical therapy is to find deficits and work through them with exercises and manual treatment.

Accordingly, the things you do in rehab also change as you go through each of the stages of frozen shoulder.

So in this first phase, your PT will likely use gentle manual therapy and mobilization exercises to relieve your painful shoulder. (6)

The second phase: Frozen stage

Lasting for 4 to 12 months, this stage marks the decline of inflammation levels. (1)

However, the inflammation is replaced by widespread stiffness, as scar tissue forms around your shoulder joint capsule.

To show this transition, this stage is further divided into two phases (1):

• In the early phase – pain worsens and is the dominant symptom.
• Afterward, pain starts to ease but shoulder stiffness remains.

Treatment here focuses on improving your shoulder motion.

And there are two treatments that can help with this:

1) Give hydrodilatation a try

Hydrodilatation is a form of injectable treatment that uses ultrasound technology as a guide. Here, the injected material is a combination of steroids, saline, and anesthetic solutions. (7)

The goal of this method is to break adhesions and capsular thickening, eventually leading to more shoulder range of motion. (1)

2) Continue with physical therapy

At this stage, your physical therapist may progress to some stretching exercises. They will likely include basic strengthening drills as well.

This will all depend on how well you can tolerate the pain.

So, to maximize each treatment session, your PT may start you with a form of heat therapy – like hot packs. Some might even recommend you to take oral pain meds a few hours before rehab.

The last phase: Thawing stage

This stage keeps the ball rolling from the prior phase – the joint inflammation continues to decrease.

In addition, the scar tissue and adhesions that have previously formed are slowly starting to resolve. This translates into more shoulder movement. (1)

So for the next 6 to 26 months, you will notice gradual improvements in both pain and shoulder range of motion. (1)

Regaining the normal function of your affected arm is the main goal.

As a mainstay treatment in this phase, physical therapy now focuses on quickly gaining back your strength and shoulder movement. (1, 6)

Strengthening and stretching exercises will be progressed from basic static holds to more functional movements that mimic your everyday life.

Learn more: 3 tell-tale signs that your frozen shoulder is starting to thaw

3-step home program for frozen shoulder

To jumpstart your recovery, here are 3 things that you can easily do at home. Do all these steps anywhere between once to thrice daily, depending on your tolerance:

1) Apply hot packs over the shoulder joint

You can use a rubber hot water bag or place a face towel inside a resealable plastic bag and fill it with warm to hot water. This will help ease pain and improve your mobility.

To do it:

• Place the water-filled rubber/plastic bag over your shoulder.
• Let it sit for 20 minutes.
• If it’s too hot, wrap the bag with a thin towel to reduce the heat.

2) Crossover arm stretch

After the heat, your shoulder joint will likely have more range of motion. You can maximize this by doing this stretch. To do it:

• Start by either sitting on a chair or standing with hip-width apart.
• Bring your injured arm across your chest.
• Use your unaffected forearm and hook it over your injured arm’s elbow.
• Finally, gently stretch your shoulder by pulling your unaffected arm towards your body.

Hold this for 15 to 30 seconds and repeat thrice.

Check this out: 14 exercises for a well-rounded treatment of frozen shoulder.

3) Shoulder blade squeeze

This movement is to keep the blood flow going and further improve your shoulder blade range of motion. To do it:

• The starting position is the same as above.
• Relax both your arms and let them hang by your side.
• Slowly pull both your shoulder blades back and squeeze tightly.
• Hold this for 5 to 10 seconds.
• Relax and return to the start position.
• Do this for 10 repetitions.

Learn more: The top 6 home remedies for frozen shoulder

Does surgery help with frozen shoulder?

Like in most joint conditions, the choice of undergoing surgery is on a case-to-case basis.

It’s true that the nature of frozen shoulder is that it resolves on its own. But, you might want to consider surgery if nonsurgical treatments have failed for at least 6 to 9 months. (1)

There are different types of surgeries for frozen shoulder that can help you quickly recover from the condition, such as (1):

• Manipulation under anesthesia. While under general anesthesia, your surgeon moves your shoulder around to break adhesions.
• Shoulder arthroscopy. A surgeon uses tiny surgical tools guided by an equally tiny camera to help scope and “release” any capsular tightness.

FAQs

Conclusion: Frozen shoulder stages timeline

Frozen shoulder goes through 3 stages before it fully recovers on its own.

Each stage has its unique set of problems due to what’s developing and resolving inside your joint capsule.

Identifying what stage you are in and getting the right medical help will lead you to a quicker process of getting better.

Resources

1. Pandey, Vivek, and Sandesh Madi. “Clinical Guidelines in the Management of Frozen Shoulder: An Update!.” Indian journal of orthopaedics vol. 55,2 299-309. 1 Feb. 2021,  doi: 10.1007/s43465-021-00351-3
2. Hodgens A, Sharman T. Corticosteroids. [Updated 2021 Oct 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554612
3. Gunaydin, Caner, and S Sirri Bilge. “Effects of Nonsteroidal Anti-Inflammatory Drugs at the Molecular Level.” The Eurasian journal of medicine vol. 50,2 (2018): 116-121. doi: 10.5152/eurasianjmed.2018.0010
4. Koh, Kim Hwee. “Corticosteroid injection for adhesive capsulitis in primary care: a systematic review of randomised clinical trials.” Singapore medical journal vol. 57,12 (2016): 646-657. doi: 10.11622/smedj.2016146
5. Teoli D, An J. Transcutaneous Electrical Nerve Stimulation. [Updated 2021 Nov 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537188/
6. Chan, Hui Bin Yvonne et al. “Physical therapy in the management of frozen shoulder.” Singapore medical journal vol. 58,12 (2017): 685-689. doi: 10.11622/smedj.2017107
7. Patel, Riki et al. “A Comprehensive Update of Adhesive Capsulitis and Minimally Invasive Treatment Options.” Psychopharmacology bulletin vol. 50,4 Suppl 1 (2020): 91-107. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7901130/