Frozen Shoulder
What Is Frozen Shoulder?
Frozen shoulder, medically known as adhesive capsulitis, is a condition in which the capsule surrounding the shoulder joint becomes thickened, inflamed, and tight. This capsule is a flexible envelope of tissue that normally allows the shoulder its wide range of motion. When it becomes stiff and contracted, the joint loses motion in nearly every direction, making even simple tasks like reaching overhead or behind the back increasingly difficult. Unlike many shoulder problems that stem from a specific structural tear, frozen shoulder is a condition of progressive stiffening of the joint’s surrounding soft tissue itself.
What Causes Frozen Shoulder?
The exact cause of frozen shoulder isn’t fully understood, but several factors are associated with a higher risk of developing it:
- A period of shoulder immobilization, such as after surgery, a fracture, or an injury elsewhere in the body that limits arm use
- Diabetes, which is strongly associated with both a higher risk of frozen shoulder and a tendency toward more severe, longer-lasting cases
- Thyroid conditions
- Being in the 40 to 60 age range, and occurring more frequently in women than men
- In some cases, no clear triggering event or risk factor can be identified at all
What Are the Symptoms of Frozen Shoulder?
Frozen shoulder typically progresses through three distinct phases, each lasting several months:
- Freezing stage — gradually worsening pain, with progressively decreasing range of motion, often the most painful phase
- Frozen stage — pain may begin to ease, but stiffness remains significant, with motion severely limited in multiple directions
- Thawing stage — motion gradually improves over time, often slowly returning toward normal
Throughout these stages, common symptoms include a deep, aching pain, significant difficulty reaching overhead or behind the back, and stiffness that limits motion even when someone else tries to gently move the arm for you.
How Is Frozen Shoulder Different From Other Shoulder Problems?
One of the most distinctive features of frozen shoulder is that it affects both active motion (moving the arm yourself) and passive motion (someone else moving your arm for you) fairly equally. Many other shoulder conditions, such as a rotator cuff tear, primarily limit active motion due to weakness or pain, while passive motion often remains relatively preserved. In frozen shoulder, the stiffness comes from the capsule itself, so even a gentle, assisted attempt to move the joint is met with significant resistance — a finding that helps distinguish it from other causes of shoulder pain and limited motion during a physical exam.
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Treatment Options for Frozen Shoulder
The good news is that frozen shoulder, while frustrating and often slow to resolve, tends to improve over time — the entire process, however, can take anywhere from several months to a couple of years to fully run its course.
Nonsurgical treatment is the mainstay of care and includes:
- Physical therapy focused on gentle stretching to preserve and gradually improve motion, particularly important during the freezing and frozen stages
- Anti-inflammatory medication to help manage pain, particularly during the more painful freezing stage
- Corticosteroid injections into the joint, which can be especially helpful in reducing pain and improving motion during the earlier, more inflamed stages
Additional treatment may be considered when symptoms are severe or particularly slow to improve:
- Manipulation under anesthesia, in which the shoulder is gently moved through a full range of motion while the patient is under anesthesia, breaking up the tightened capsule
- Arthroscopic capsular release, a surgical procedure that uses small instruments to carefully release the thickened, contracted portions of the capsule, reserved for cases that haven’t improved with other measures
Most patients, especially with consistent physical therapy participation, eventually regain the large majority of their shoulder motion, even though the process often requires patience over many months.
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Dr. Palsis specializes in the treatment of knee, shoulder, and sports injuries.