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Treating a frozen shoulder

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What is adhesive capsulitis or frozen shoulder?

Frozen shoulder (adhesive capsulitis) is characterized by pain and loss of motion of the shoulder joint. The exact cause is unknown, even though it affects between two and five percent of people during their lifetimes.

Risk factors for adhesive capsulities include

  • Diabetes 
  • Thyroid disorder
  • History of shoulder trauma
  • Periods of shoulder immobilization

Shoulder Freeze

Females are at higher risk. Occasionally, frozen shoulder develops after shoulder surgery or traumatic injury to the shoulder. It often cannot be traced to any particular injury or event.

How does a frozen shoulder develop?

Research suggests that the process starts with an inflammation of the joint lining within the shoulder.

Gradually this area thickens and the shoulder becomes stiffer and more painful. Patients with frozen shoulder often have significant shoulder pain for several months. During this time, the shoulder joint stiffens and range of motion is lost. This often affects sleep and common daily activities. Gradually, after several weeks or months, the shoulder pain diminishes when the patient is not using his or her arm and is present only with shoulder usage and with stretching. Patients usually experience a dramatic difference in their range of motion between shoulders.

Diagnosing a frozen shoulder

The physician examines the shoulder for range of motion and compares it to the patient's opposite side and to normal values. The diagnosis is usually evident after this examination in combination with the patient's shoulder history. Frozen shoulder does not appear on X-rays. Occasionally an MRI can confirm findings of frozen shoulder but an MRI is most often not needed.

A frozen shoulder typically progresses through three stages

  • The initial "painful stage" where the shoulder is very painful at rest and with use. The shoulder gradually stiffens. This stage typically lasts about four months but may last up to nine months
  • The "frozen stage" occurs when the shoulder is very stiff and painful with movement, but not at rest. This stage can last four to 12 months.
  • During the final "thawing stage," motion slowly and steadily returns over several months. The entire course of a frozen shoulder can take 12 to 24 months to resolve.

Treating a frozen shoulder

Treatment requires tremendous patience, since improvement comes slowly and there are few shortcuts. Treatment during the painful stage may involve medication, including cortisone injections, that may shorten the painful stage. Patients with frozen shoulder should do physical therapy and/or a home stretching program to help limit the loss of shoulder motion that occurs in the early stages.

Helpful stretching exercises include

  • Walking the fingers up the wall
  • Pulling the arm/shoulder across the chest with the opposite arm
  • Rotating the arm with a cane or broomstick
  • Pulling the arm behind the back

Once the shoulder becomes less painful at rest, physical therapy and stretching can help restore lost motion.

Surgery to repair a frozen shoulder

Fortunately, surgery is rarely necessary. In fact, surgery during the early stages should be avoided because the condition often returns. Surgery can be performed after most shoulder pain has resolved, and can improve range of motion if the shoulder's "thawing" is not progressing appropriately. Treatment can include arthroscopy, which releases the thickened lining of the shoulder joint.

This is followed by manipulation of the shoulder to break free the tissue that is restricting the shoulder's motion. Surgery is always followed by more therapy and stretching.