Frozen shoulder is an informal term for a musculoskeletal condition called adhesive capsulitis. This painful disorder causes the shoulder to feel stiff, stuck, and hard to move. In more severe cases, it can be impossible to move. It’s difficult to say exactly what causes frozen shoulder symptoms. What we do know is how to improve mobility and decrease pain with physical therapy and other conservative treatments.
The human shoulder is a ball and socket joint comprised of three bones: the upper arm bone (humerus), shoulder blade (scapula), and collarbone (clavicle.) The head of the humerus fits into a shallow socket in the scapula.
The shoulder joint capsule is a group of strong, connective ligaments that surround and stabilize the joint. It also contains something called synovial fluid that lubricates the joint and allows for smooth movement.
With frozen shoulder, or adhesive capsulitis, the capsule encasing the shoulder joint becomes so stiff and thick that it’s hard to move. Bands of thick, tough scar tissue called adhesions may form, further impeding proper motion. It’s also possible to have less synovial fluid as well. Without that lubrication, shoulder movement becomes even more difficult.
We don’t know for sure what triggers this process in some people. However, researchers have identified common risk factors for frozen shoulder. They include systemic diseases like thyroid conditions, diabetes, heart disease, and Parkinson’s disease. Previous shoulder surgery or a shoulder injury can also increase your risk of frozen shoulder. Women over 40 also seem to be more prone to this condition, although medical experts still aren’t sure just why.
Frozen shoulder symptoms come on in stages using the analogy of a frozen object:
Any shoulder movement causes severe shoulder pain. As pain increases, shoulder movement becomes more restricted. This stage lasts anywhere from 6 weeks to 9 months.
Pain may lessen slightly during this stage. However, it is still very difficult to move the shoulder. Stiffness may increase making daily activities challenging. This stage lasts 4 to 12 months on average.
Shoulder movement gradually improves, as pain subsides. It can take as long as 1-3 years to regain full strength and mobility.
Adhesive capsulitis pain is described as a dull ache in the shoulder with movement. Some people also experience pain in the muscles that wrap around the top of the arm. For many, pain is worse at night which can make it challenging to get a restful sleep.
Frozen shoulder is a stubborn condition. Symptoms linger for several months to years. Living with limited use of one shoulder can be frustrating and even impact your quality of life. The good news is that frozen shoulder is a condition that naturally resolves over time and there are options to reduce pain and speed up the process of regaining mobility. Conservative, nonsurgical treatments include:
Physical therapy is also beneficial for patients who have had a recent shoulder injury or are recovering from shoulder surgery. Safe and gentle exercise after an injury or procedure is important to avoid shoulder stiffness and to reduce scar tissue that can contribute to frozen shoulder.
If conservative treatments are not working and pain and stiffness persist well beyond the expected time frame, your provider may discuss surgery. This is typically recommended during the second “frozen” stage of the condition. The goal of surgery is to release the tight shoulder capsule to allow for easy, painless movement.
It’s important to continually assess your condition and your symptoms with your physical therapist and healthcare provider to determine the appropriate course of treatment for you. You don’t have to live in pain. Relief is available.
Do you have unexplained shoulder pain that is affecting your daily life? Schedule an evaluation at a physical therapy clinic near you.