Frozen Shoulder (in everyday language)

Understanding Frozen Shoulder: Causes, Symptoms, and What to Do About It

Have you ever heard of frozen shoulder? It sounds like something that happens in the cold, but it’s actually a medical condition where the shoulder becomes stiff and painful, making it hard to move. This condition, also known as adhesive capsulitis, is surprisingly common and can significantly affect daily life. Let’s break it down to understand what frozen shoulder is, what causes it, how it progresses, and what can be done to manage it.

---

What Is Frozen Shoulder?

Frozen shoulder happens when the tissues around the shoulder joint (the capsule) become inflamed and tight. This inflammation causes the capsule to thicken, forming bands of scar tissue. Over time, this restricts movement and leads to pain and stiffness (Itoi et al., 2016).

Doctors classify frozen shoulder into two types:

• Primary (idiopathic): This happens without a clear reason.
• Secondary: This is triggered by conditions like shoulder injuries, diabetes, thyroid problems, or even after surgeries (Rangan et al., 2015).

If you have diabetes or thyroid issues, you might be more likely to experience frozen shoulder. In fact, research suggests that frozen shoulder could even be an early warning sign of diabetes (Wong et al., 2016).

---

How Does Frozen Shoulder Progress?

Frozen shoulder typically follows three phases:

1. Freezing Phase (2-9 months): This phase starts with pain. The shoulder hurts more and more, especially at night, and movement becomes increasingly difficult.
2. Frozen Phase (4-12 months): The pain starts to ease, but stiffness takes over. Moving the shoulder becomes very limited.
3. Thawing Phase (12-42 months): Gradually, the shoulder loosens up, and movement improves (Rangan et al., 2015).

However, this textbook progression doesn’t apply to everyone. Some people recover faster, while others are left with stiffness or pain that lasts for years. Studies show that up to 41% of people with frozen shoulder have lingering symptoms even after years of treatment (Wong et al., 2016).

---

What Causes Frozen Shoulder?

The exact cause of frozen shoulder isn’t fully understood, especially in idiopathic cases. But researchers know that inflammation and scarring are key players. The body’s immune response produces chemicals like transforming growth factor-beta, which cause the capsule to thicken and contract. This makes the shoulder less flexible and painful to move (Itoi et al., 2016).

If you have diabetes or thyroid issues, you’re at greater risk. These conditions might interfere with how your body heals and deals with inflammation, making the shoulder capsule more prone to fibrosis (Rangan et al., 2016).

---

How Is Frozen Shoulder Diagnosed?

Diagnosing frozen shoulder can be tricky, especially in the early stages. Doctors usually rely on:

• A detailed history of your symptoms. Frozen shoulder develops gradually, unlike injuries that cause sudden pain.
• A physical exam to check how far your shoulder can move. With frozen shoulder, both passive (when someone else moves your arm) and active (when you move it yourself) movements are limited, especially in external rotation (turning your arm outward).
• Imaging tests like X-rays or MRIs. These don’t show frozen shoulder directly but can rule out other issues like arthritis or rotator cuff tears (Rangan et al., 2015).

---

What Are the Treatment Options?

Treatment for frozen shoulder depends on the phase of the condition and how severe your symptoms are.

Early Phase: Easing the Pain

In the early stages, when pain is the main problem, treatments focus on relief. Corticosteroid injections can help reduce inflammation and provide short-term pain relief (Rangan et al., 2016). These injections work best during the first six to twelve months. Over-the-counter pain relievers like NSAIDs (non-steroidal anti-inflammatory drugs) can also help.

Gentle exercises guided by a physiotherapist can prevent the shoulder from becoming even stiffer. The goal here isn’t to force the shoulder but to keep it moving as much as possible.

Middle Phase: Tackling the Stiffness

Once the pain eases, stiffness becomes the biggest challenge. This is where treatments like hydrodilatation come in. In this procedure, a doctor injects a mix of saline and corticosteroids into the joint to stretch the tight capsule. Combined with physical therapy, this can significantly improve movement (Rangan et al., 2016).

More intensive physiotherapy is also key. Exercises at this stage focus on stretching and strengthening the shoulder to improve range of motion.

Severe or Persistent Cases: Going Further

If stiffness doesn’t improve after months of treatment, doctors might recommend more invasive options like:

• Manipulation under anesthesia (MUA): The shoulder is forcibly moved while you’re asleep to break the tight bands of scar tissue.
• Arthroscopic capsular release: This is a minimally invasive surgery to cut through the thickened capsule and restore movement (Rangan et al., 2015).

Both procedures have risks, so they’re usually reserved for severe cases that don’t respond to other treatments.

---

What to Expect from Treatment

The good news is that many people see significant improvement with treatment. Physiotherapy, especially when combined with corticosteroid injections, can reduce pain and improve mobility. However, recovery can take time—sometimes years—and outcomes vary. People with diabetes or thyroid issues may find recovery slower and less complete (Rangan et al., 2015; Wong et al., 2016).

---

What Else Should You Know?

Frozen shoulder doesn’t just affect the joint. It also impacts the muscles and the way your body moves. Many people develop compensatory patterns, like overusing the upper back or neck muscles, which can cause additional pain. Addressing these adaptations with physiotherapy can make a big difference (Itoi et al., 2016).

And remember, frozen shoulder rarely comes back in the same shoulder, but it can affect the other one. This happens in about 6-17% of cases within five years (Rangan et al., 2016).

---

Wrapping Up

Frozen shoulder is a tough condition, but understanding its phases, causes, and treatment options can help you manage it better. Early intervention, tailored to your symptoms, is key to improving outcomes. Whether it’s a simple steroid injection or a tailored physiotherapy program, there’s a path to better shoulder health.

If you’re dealing with shoulder pain or stiffness, don’t wait. Talk to a healthcare provider who can guide you through your options. Frozen shoulder may feel like it lasts forever, but with the right approach, you can get back to doing the things you love.

---

References

Itoi, E., Arce, G., Bain, G. I., Diercks, R. L., Guttmann, D., Imhoff, A. B., Mazzocca, A. D., Sugaya, H., & Yoo, Y. S. (2016). Shoulder stiffness: Current concepts and concerns. Arthroscopy: The Journal of Arthroscopic and Related Surgery, 32(7), 1402–1414. https://doi.org/10.1016/j.arthro.2016.03.024

Rangan, A., Goodchild, L., Gibson, J., Brownson, P., Thomas, M., & Kulkarni, R. (2015). Frozen shoulder. Shoulder & Elbow, 7(4), 299–307. https://doi.org/10.1177/1758573215601779

Rangan, A., Hanchard, N., & McDaid, C. (2016). What is the most effective treatment for frozen shoulder? BMJ, 354, i4162. https://doi.org/10.1136/bmj.i4162

Wong, C. K., Levine, W. N., Deo, K., Kesting, R., Mercer, E., Schram, G., & Strang, B. (2016). Systematic review of the natural history of frozen shoulder: Fact or fiction? Physiotherapy, 102(1), 3–12. https://doi.org/10.1016/j.physio.2016.05.009