Frozen shoulder is a condition that causes shoulder pain and limits the shoulder’s range of motion. The limitation in movement affects both the active and passive range of motion. That means that your movement is restricted at the shoulder joint when you try to move your arm and when someone else (such as your doctor) tries to move your arm.
Frozen shoulder is also called “adhesive capsulitis,” “painful, stiff shoulder,” and “periarthritis.” We will use the term “frozen shoulder” throughout this article.
Frozen shoulder affects about two percent of the general population. It is most common in women between 40-and 70 years old. It is also associated with several medical problems, including:
- Diabetes
- Thyroid problems
- Changes in your hormones, such as during menopause
- Shoulder injury
- Shoulder surgery
- Open heart surgery
- Cervical disk disease of the neck
What Are the Symptoms of a Frozen Shoulder?
You become aware of a frozen shoulder when it begins to hurt. The pain then causes you to limit your movement. Moving the shoulder less and less increases its stiffness. Before long, you find that you can’t move your shoulder as you once did. Reaching for an item on a high shelf becomes difficult, if not impossible. When it’s severe, you might not be able to do everyday tasks that involve shoulder movement, such as dressing.
Who Is at Risk for a Frozen Shoulder?
The condition is more likely to occur in middle age and is more common in women.
If you have diabetes, your risk for the condition is three times greater.
Others at risk include:
people who must wear a shoulder sling for an extended period after an injury or surgery
people must remain still for long periods due to a recent stroke or surgery
people with thyroid disorders
What Causes a Frozen Shoulder?
If you have a hormonal imbalance, diabetes, or a weakened immune system, you may be prone to joint inflammation. An extended period of inactivity due to an injury, illness, or surgery also makes you more vulnerable to inflammation and adhesions, bands of stiff tissue. In severe cases, scar tissue may form, severely limiting your range of motion. Usually, the condition takes two to nine months to develop.
Shoulder Exercises
You will learn some simple exercises and stretches for your shoulder.
At first, try to do these exercises once every hour, or at least four times a day.
It is more important to do the exercises often than do them for a long time each time.
Use moist heat before the exercises to help lessen pain and increase movement.
The exercises should focus on the stretching of the shoulder and range of motion.
Avoid exercises to strengthen your shoulder until the range of motion has returned.
Some of the exercises are:
Shoulder stretches
Pendulum
Wall crawl
Rope and pulley stretches
Movements to help with internal and external rotation, such as hand behind back
Your doctor or physical therapist will show you how to do these exercises.
The four stages of frozen shoulder
Typically, these particular symptoms will appear in four stages over about 24 months:
Stage 1, months 1-3: Shoulder pain, often worse at night, which causes you to limit your arm movement.
Stage 2, months 4-9: The “freezing” stage of progressive stiffness, where pain continues (although it may lessen), you experience decreased ability to move your shoulder correctly.
Stage 3, months 10-14: The shoulder is stiff in the “frozen” stage but no longer hurts when you are not moving it.
Stage 4, months 15-24: In the “thawing” stage, your ability to move your shoulder gradually returns.
Diagnosing Frozen Shoulder
If you experience pain, stiffness and limited mobility in your shoulder, make an appointment with a Penn orthopedic specialist to determine if you have a frozen shoulder.
A Penn orthopedic specialist will evaluate your symptoms and examine your shoulder and arm to assess your range of motion and pain levels to diagnose a frozen shoulder.
You may require further imaging tests to ensure an accurate diagnosis, such as:
CT scan
MRI
Musculoskeletal ultrasound
X-ray
Musculoskeletal radiologists carefully review imaging to determine the severity of your condition so you can receive the best possible treatment.
What is the treatment for frozen shoulder?
The goal of treatment is to reduce the underlying inflammation and prevent your shoulder from becoming stiff. Nonsurgical treatment is the first option and works well with an early diagnosis. Surgical treatment is a second option appropriate for severe cases or where nonsurgical treatment is unsuccessful.
Nonsurgical treatment is usually a mix of physical therapy and medication. Physical therapy is an essential part of any treatment because progressive stretching is needed to restore lost range of motion. Rehabilitation treatment may include the use of therapeutic ultrasound. At HSS, you will receive a thorough evaluation by a physical therapist and occupational therapist who will create an individualized rehab plan.
An injection is helpful, especially during the early stages of a frozen shoulder and will ease your pain and improve the range of motion in your shoulder. Your doctor may also prescribe oral anti-inflammatories, pain medication, corticosteroid injections, or these remedies. These injections are often done under image guidance using ultrasound or an X-ray to ensure the injection is accurately administered into the shoulder joint.
Exercises to help recovery — Once the initial pain of a frozen shoulder lessens, your health care provider might want you to do specific exercises to improve your shoulder mobility. Depending on your situation, your health care provider might recommend that you see a physical therapist or suggest that you do these exercises independently. Start slow, and do not push yourself too much at first. Let pain be your guide. If an exercise hurts too much, modify it or stop doing it. Later, as your pain subsides and your mobility improves, you can try to push yourself – and your arm and shoulder – further.
How Can Physical Therapy Help Relieve Frozen Shoulder Pain?
Physical therapy for frozen shoulders focuses primarily on pain relief, using modalities, manual therapy, exercises, and at-home treatments. Your therapist’s ultimate goal is to restore mobility and range of motion to the affected shoulder and help you do the things you usually do daily without pain.
Your physical therapist will teach you how to relieve pain with stretching techniques and strengthening exercises, most of which you’ll be able to complete at home to speed up the recovery process.
Most physical therapists recommend that patients with frozen shoulders often rest between appointments to avoid developing scar tissue in the shoulder. On the chance that scar tissue develops, the muscles surrounding the shoulder may eventually freeze up.
