Evidence suggests that frozen shoulder affects 5% of the world’s population. Age, hormone imbalances, diabetes, and even your gender can increase your risk of having this condition. (1)
The good news is that frozen shoulder resolves on its own without treatment. But full recovery may take up to three years. (2)
However, you can cut it down to just a few months! All you need is the right knowledge and guidance on dealing with this condition.
That’s what this article is for. This is what we’ll cover, tap on any link to quickly answer your questions:
- What is frozen shoulder?
- What causes this condition?
- Are you at risk?
- What are its symptoms and stages?
- How to diagnose a frozen shoulder?
- Treatment options for this condition
What is a frozen shoulder?
Frozen shoulder is also called “adhesive capsulitis.” Basically, it’s the insidious onset of pain and stiffness inside your shoulder joint capsule.
The joint capsule surrounds your shoulder joint. It has synovial fluid flowing inside, nourishing your cartilage and allowing smooth shoulder movement.
But in a frozen shoulder, this capsule becomes tight. It starts as mild shoulder pain, but then it progresses to drastically restricting your range of movement, to the point of causing severe pain even at night.
Also, your non-dominant arm is 58% more likely to develop a frozen shoulder. (3)
What causes a frozen shoulder?
There are two main causes of frozen shoulder. They are medically classified as:
A primary frozen shoulder happens spontaneously and does not have a distinct cause. (4)
Secondary frozen shoulder is a consequence of different risk factors, such as (4):
- Tyhroid disorders.
- Hormonal changes, like those in menopause.
- A recent trauma, like falling on your shoulder.
- A rotator cuff tear.
- Shoulder arthritis.
Who is at risk for a frozen shoulder?
People who are more prone to developing a frozen shoulder include (5):
- Individuals between 40 to 60 years of age.
- Having a previous trauma to the shoulder.
- Prolonged upper arm immobilization.
- History of diabetes mellitus and thyroid disorders.
What are the symptoms of a frozen shoulder?
Unlike other medical conditions, frozen shoulder goes through 3 distinct stages. The names of each stage can give you an idea about what your shoulder joint is currently going through. They are:
Freezing stage: Lasts 10 to 36 weeks
This is the first stage of the condition. You’ll feel:
- Shoulder pain at rest.
- Gradual limitation of motion of the shoulder.
- Nagging night pain.
Frozen stage: 4-12 months
In this second phase, the main symptoms include:
- Less intense shoulder pain.
- Sharp pain that is only noticeable at extremes of shoulder motion.
- Progressive increase of shoulder stiffness.
Thawing stage: 12-42 months
This is the final stage and the longest. Its symptoms include:
- Gradual improvement of the shoulder range of motion.
- Minimal pain at end ranges.
- Slow return to normal.
Further reading: Signs that your adhesive capsulitis is starting to thaw
How to diagnose frozen shoulder?
Most doctors will follow these steps to accurately diagnose frozen shoulder:
Ask for the history of your condition
During the physical exam, your doctor will ask you for any events such as trauma on your affected arm or systemic illnesses. It may seem trivial but it’ll help lead your doctor to what started the inflammation process.
Test your range of motion
Pain and stiffness are common findings due to your thickened joint capsule. Among the restricted motions of the shoulder, the most limited are:
- External rotation.
- Internal rotation.
Test your muscle strength
Your limited range can fool you into thinking that your muscles are weaker. But after testing, they may actually be close to normal strength.
Request imaging tests
Your doctor will likely request some imaging tests. The most common are:
- X-rays and MRI: Help rule out other possible shoulder problems.
- Contrast bone scan: Shows how much local inflammation is on your joint.
- Shoulder arthrogram: Provides an accurate measurement of your synovial fluid count.
Treatment options for frozen shoulder
After the diagnosis is made, the medical team handling your case will review the results of each test.
This will give them the “big picture” of your condition, so they can suggest the best treatment course for your needs. There are two big groups of treatment options – conservative and surgical treatments:
Further reading: Top 10 treatments for frozen shoulder
These are non-operative treatments. The most common are:
Best for: Any stage of frozen shoulder.
As a lengthy condition, it’s key you learn how to manage your frozen shoulder symptoms at home. The good news is that there are several easy and cheap strategies you can try to relieve your pain:
This will help: The 6 best home remedies for frozen shoulder (with instructions)
Best for: Any stage of frozen shoulder.
Physical therapy involves assessing and treating your condition based on your goals and what stage you are in.
During earlier stages, your physical therapist will focus on pain management to get you comfortable. Once pain permits, stretching exercises for your upper arm and shoulder blade will be key to your recovery.
Outcomes vary depending on your physical therapist’s experience and how your body reacts to the treatment. Some get better after a few months while others opt for surgery if physical therapy fails.
Related: How to prevent frozen shoulder?
Best for: Freezing phase.
A corticosteroid is a type of anti-inflammatory medication. Your doctor will inject it into your shoulder joint.
For frozen shoulder, research suggests choosing steroid injections early on for pain relief and reducing inflammation. (6) This could shorten the course of the condition, allowing a quicker recovery.
Hydrodilatation (Arthrographic distention)
Best for: Frozen phase.
Hydrodilatation is another form of injection-based treatment. It addresses your range of motion deficits, which are mostly restricted at this stage.
The procedure consists of injecting a combination of saline, steroid, and contrast material. This can stretch your shoulder capsule and restore motion. (7)
Studies are conflicting about the right amount and combination of medications, though. However, hydrodilatation effects may last up to 3 months. (7)
Best for: Any stage of frozen shoulder.
Acupuncture is a form of traditional Chinese medicine. It consists of stimulating specific points of your body to promote healing and well-being. This can be done with needles, laser, or other tools.
Further reading: 5 proven benefits of acupuncture for frozen shoulder
Due to the length of recovery and amount of discomfort, some people choose surgery to get their shoulders fixed right away. It’s important to remember you still need to undergo postoperative physical therapy right after.
Shoulder joint manipulation under anesthesia
Manipulation under anesthesia (MUA) is a noninvasive procedure. It helps increase your shoulder range of motion, with results showing within three months. (6)
While on general anesthesia, your doctor will move your upper arm bone forcibly through end ranges of shoulder motion. This will break down adhesions and scar tissue for your arm to move freely.
Yet, notable risks of this procedure are fractures, joint bleeding, and muscle strains.
Using a small arthroscopic camera as a guide and a probe, orthopedic surgeons cut and remove parts of the contracted capsule. This allows the ball and socket joint to roll and glide naturally with each arm motion.
This minimally-invasive surgery allows for better healing and fewer risks as compared to MUA.
What aggravates frozen shoulder?
Sleeping on your affected arm and moving through extremes of motion.
Will frozen shoulder heal without physical therapy?
Yes, but it can take three years to get better.
Though it may resolve on its own, developing frozen shoulder is extremely frustrating. Enduring the pain and stiffness will inevitably affect your daily life. But it will get better.
But before the pain worsens, seek medical advice. Consult your physical therapist to help treat your condition.
- de la Serna, Daniel et al. “A Comprehensive View of Frozen Shoulder: A Mystery Syndrome.” Frontiers in medicine vol. 8 663703. 11 May. 2021, doi: 10.3389/fmed.2021.663703
- Mezian K, Coffey R, Chang KV. Frozen Shoulder. [Updated 2021 Sep 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK482162/
- Toda, Katsuhiro. “Left and Non-Dominant Shoulders Were More Frequently Affected in Patients with Frozen Shoulder: A Systematic Review and Meta-Analysis”. Orthop Muscular Syst 2018, 7:4. DOI: 10.4172/2161-0533.1000258
- Kelley, Martin J et al. “Frozen shoulder: evidence and a proposed model guiding rehabilitation.” The Journal of orthopaedic and sports physical therapy vol. 39,2 (2009): 135-48. DOI: 10.2519/jospt.2009.2916
- Uppal, Harpal Singh et al. “Frozen shoulder: A systematic review of therapeutic options.” World journal of orthopedics vol. 6,2 263-8. 18 Mar. 2015, doi: 10.5312/wjo.v6.i2.263
- Dias, Richard et al. “Frozen shoulder.” BMJ (Clinical research ed.) vol. 331,7530 (2005): 1453-6. doi: 10.1136/bmj.331.7530.1453
- Rymaruk, S, and C Peach. “Indications for hydrodilatation for frozen shoulder.” EFORT open reviews vol. 2,11 462-468. 22 Nov. 2017, doi: 10.1302/2058-5241.2.160061