Frozen Shoulder: Diagnosis, and Treatment

Introduction

Frozen shoulder, also known in medical terms as adhesive capsulitis, is a condition that can make simple tasks like reaching for a cup on a high shelf or slipping on a coat sleeve feel daunting, painful, or even impossible. This condition creeps up slowly and can put a strain on daily life for months or even years. Marked by three distinct stages, each with unique challenges, frozen shoulder is a complex journey. Whether you’re experiencing it firsthand, supporting someone who is, or simply want to learn more, understanding frozen shoulder can help you navigate the condition with clarity and hopefully less frustration.

What is Frozen Shoulder?

Frozen shoulder involves the shoulder joint’s capsule—a flexible envelope that surrounds the joint, helping to keep everything stable and moving smoothly. In a healthy shoulder, this capsule moves freely with the joint, allowing for a full range of motion. In frozen shoulder, however, the capsule becomes inflamed, thickens, and tightens up with scar tissue, restricting movement and causing significant pain. The reasons behind this tightening aren’t entirely understood. The body sometimes overreacts to minor injuries or other shoulder conditions, leading the capsule to thicken and limit the shoulder’s natural movement. This is especially true if the shoulder has been immobilized for some time, as after surgery or injury. In other cases, frozen shoulder appears seemingly out of nowhere, adding to the frustration and mystery.

Stages of Frozen Shoulder

Frozen shoulder doesn’t hit all at once. Instead, it progresses through stages that can last for months or even longer. The first stage, often the most painful, typically begins with a dull ache that escalates to searing pain and makes sleeping or using the affected arm difficult. As pain increases, stiffness also sets in, limiting movement. Pain typically peaks before movement restrictions fully settle in. In the next stage, the pain may begin to ease, but stiffness becomes the dominant issue, making it hard to raise the arm or reach behind the back. While pain may decrease, this phase can be equally challenging because of how significantly motion is limited. During the final stage, the shoulder slowly starts to loosen, allowing for a gradual return to movement as pain fades. Progress can be slow, but the eventual outcome is often positive, especially if treatment and exercises are consistent.

Expanded Risk Factors

Several factors make some people more likely to develop this frustrating condition. Immobilization of the shoulder after an injury or surgery is one significant risk, as it leads to a tight capsule and increases the likelihood of scar tissue formation. Some health conditions are also associated with frozen shoulder, including diabetes, which is one of the most common risk factors. High blood sugar levels may affect connective tissues, causing the capsule to thicken or scar more easily. Other health conditions, like thyroid imbalances, cardiovascular disease, and Parkinson’s disease, can also increase the risk. Hormonal shifts and circulation changes can contribute to the development of frozen shoulder, as can a sedentary lifestyle. Limited movement of the shoulder capsule can restrict its flexibility, leading to stiffness over time.

Why Frozen Shoulder Might Develop

The cause of frozen shoulder is usually a combination of factors that lead to stiffness and pain. For some people, the body’s healing response goes into overdrive, causing inflammation and scarring within the shoulder capsule, even in response to a minor injury. Changes in the capsule itself, whether due to aging or extended immobility, can cause it to tighten and restrict movement over time. Hormonal shifts, particularly for those with diabetes or other systemic conditions, can also contribute to a stiffening capsule. When the shoulder has been kept still to protect it after injury, this immobility can quickly lead to further stiffness and restriction.

Other Shoulder Conditions That May Be Confused with Frozen Shoulder

Frozen shoulder shares some symptoms with other shoulder conditions, which can make diagnosis challenging. Rotator cuff injuries often cause pain and restricted movement, but usually still allow a fuller range of motion with assistance. Shoulder arthritis leads to joint changes visible on an X-ray, unlike frozen shoulder, which involves the capsule and surrounding soft tissue rather than the bone itself. Shoulder impingement, another common condition, involves the shoulder blade rubbing against the rotator cuff tendons and typically does not limit passive motion. Bursitis is an inflammation of the fluid-filled sac that cushions the shoulder joint and can make it hard to move, though it often responds well to rest and anti-inflammatories and does not linger like frozen shoulder.

Conservative Treatments

Managing frozen shoulder often involves a mix of treatments to improve mobility, relieve pain, and promote healing. Physical therapy is the foundation of treatment, with a focus on restoring range of motion through controlled, gradual stretching and mobility exercises. Physical therapy may begin with gentle movements to prevent further pain and progress to more active exercises over time. Trigger point therapy is another approach that focuses on “knots” or tight spots in the shoulder and surrounding muscles, which can develop in response to immobility. By applying sustained pressure to these points, therapists can release muscle tightness and improve flexibility. Massage therapy is another effective treatment, particularly in the painful “freezing” phase, helping to alleviate pain, increase circulation, and relax muscles. Cupping therapy, a traditional technique involving suction cups placed on the skin, is sometimes used to increase blood flow and relieve tension in the shoulder and upper back, drawing fresh blood into the tissues and allowing the area to relax. Alternating heat and cold therapy can also help to manage pain and inflammation. Heat helps relax muscles before exercises, while cold numbs pain and reduces inflammation after activity. Electrotherapy options, like TENS or ultrasound therapy, may provide additional relief by blocking pain signals or reducing inflammation. Home exercises, such as pendulum swings and wall walks, are essential for maintaining flexibility between sessions and reinforcing the work done in physical therapy.

Non-Conservative Treatments

Some cases may require non-conservative treatments. Corticosteroid injections are often used during the painful “freezing” stage to reduce inflammation and provide short-term relief. Manipulation under anesthesia may be considered in more severe cases; during this procedure, the surgeon manipulates the shoulder joint while the patient is under anesthesia to break up adhesions. Arthroscopic capsular release is a minimally invasive surgery where a surgeon uses small instruments to release tight sections of the shoulder capsule. This option is generally reserved for cases that do not improve with conservative treatments, and recovery requires a committed rehab program.

Prognosis and Recovery Expectations

Frozen shoulder is often a lengthy journey, but there’s light at the end of the tunnel. Most cases improve significantly over time, especially with consistent treatment. The timeline varies, with some people recovering within a year, while others may take up to three years. One of the silver linings is that recurrence is rare. Although it’s possible to develop frozen shoulder in the opposite shoulder, most people don’t experience it more than once.

Conclusion

Frozen shoulder may be a frustrating condition, but with patience, knowledge, and a well-rounded treatment plan, recovery is within reach. From gentle physical therapy exercises to more advanced treatments like arthroscopic release, there are options to support each stage of the journey. Whether you’re just beginning to experience stiffness or working through the thawing stage, remember that progress may be slow, but it’s possible. Taking it step by step and staying informed can make a real difference in managing this challenging condition.

Medical Disclaimer

This article is for educational purposes only and should not be considered medical advice. Always consult a healthcare provider for questions about medical conditions or treatments. Frozen shoulder and other musculoskeletal conditions vary widely, and treatment options may differ based on personal history and condition stage. Seek professional guidance for an accurate diagnosis and personalized treatment plan.

References

Manske, R. C., & Prohaska, D. (2008). Clinical commentary and literature review: Diagnosis and management of adhesive capsulitis. Journal of Orthopaedic & Sports Physical Therapy. Neviaser, A. S., & Hannafin, J. A. (2010). Adhesive capsulitis: A review of current treatment. The American Journal of Sports Medicine. Bunker, T. D. (2009). Time for a new name for frozen shoulder—contracture of the shoulder. Shoulder & Elbow. Hsieh, L. F., & Lee, W. C. (2016). Application of cupping therapy in musculoskeletal medicine: A systematic review. British Journal of Sports Medicine. Dommerholt, J., & Fernández-de-Las-Peñas, C. (2011). Myofascial Trigger Points: Pathophysiology and Evidence-Informed Diagnosis and Management. Journal of Manual & Manipulative Therapy