Frozen Shoulder Causes and Treatment

Frozen shoulder, or adhesive capsulitis, is a disorder characterized by pain and stiffness in the shoulder joint. The symptoms generally begin gradually but worsen over time. As more time passes, the shoulder becomes very difficult to move. Around 2% of the general population is affected with this condition, and it typically occurs more often in women between the ages of 40 and 60.

The shoulder is a ball-and-socket joint that consists of the upper arm bone (humerus), the shoulder blade (scapula), and the collarbone (clavicle). With frozen shoulder, the shoulder capsule thickens and gets tight due to stiff bands of tissue called adhesions.

To diagnose this condition, the orthopedic specialist will perform a complete physical examination and take an extensive medical history. Tests that will help the doctor rule out other shoulder disorders include X-rays, MRI, and ultrasound.

What are the stages of frozen shoulder?

Frozen shoulder develops in three stages: freezing, frozen, and thawing. The “freezing” stage occurs slowly and pain worsens gradually. With this stage, you lose range of motion of the shoulder joint, and it typically lasts from 6 weeks to 9 months. In the “frozen” stage, the painful symptoms actually improve – only the stiffness remains. This stage lasts around 4 to 6 months, and daily activities are troublesome during this time. The “thawing” stage is where shoulder motion slowly returns to normal. This stage lasts around 6 months to 2 years.

What are the symptoms of frozen shoulder?

During the “freezing” stage, the shoulder joint becomes quite painful. Any movement of the shoulder leads to discomfort during this time. Stiffness occurs in the “frozen” stage and there is decreased range of motion. These symptoms improve during the “thawing” stage.

What causes frozen shoulder?

Experts do not fully understand the causes of frozen shoulder. There is no distinct connection to arm dominance or occupation. With this condition, the capsule that encases the shoulder joint becomes thickened and tightens, restricting movement. There are some factors that can put you at risk for developing this condition. These include:

  • Age and Sex: People over the age of 40 are more likely to experience frozen shoulder, and it is more common among women.
  • Diabetes: Frozen shoulder has been found to occur more commonly in the diabetic patient, affecting around 15% of the diabetic population.
  • Other Diseases: There are some additional medical problems associated with frozen shoulder like hyperthyroidism, hypothyroidism, tuberculosis, cardiac disease, and Parkinsons disease.
  • Immobilization: When the shoulder is immobilized for an extended period of time, frozen shoulder can develop. Possible conditions requiring immobilization include a broken arm, a rotator cuff injury, a stroke, or recovery from surgery.

How is frozen shoulder treated?

Frozen shoulder typically resolves with time, although it can take as long as three years. The focus of treatment is to control pain and to restore strength and motion of the shoulder joint. Nonsurgical measures include non-steroidal anti-inflammatory medications (NSAIDS), steroid injections, and physical therapy. The orthopedic specialist can also inject sterile water into the joint capsule to stretch the tissue and enhance movement. This is called “joint distension.”

If these conservative measures do not improve the symptoms, the orthopedic specialist may find it necessary to operate on the shoulder. The surgeon can perform manipulation under anesthesia or shoulder arthroscopy. During the manipulation procedure, the doctor will force your shoulder to move under an anesthetic so it will not be painful to you, making the capsule and scar tissue stretch.

This is done to release the tightening and increase the range of motion. With shoulder arthroscopy, the doctor cuts through tight portions of the joint capsule to increase motion of the shoulder. This can be done with tiny instruments and a small camera.


About Jonathan Franklin

Jonathan Franklin, MD (Retired) Dr. Franklin is a board-certified orthopedic surgeon with a clinical focus in arthroscopic and reconstructive knee surgery, arthroscopic shoulder surgery, as well as knee replacement surgery. Dr. Franklin has a strong background in sports medicine, and treats many high school, as well as recreational and professional athletes for a wide variety of sports injuries.