What is a frozen shoulder?

Frozen shoulder is a painful illness that causes reduced mobility in the shoulders. Freeze shoulder is also known as adhesive capsulitis.

Frozen shoulder can occur from thinning, stiffening, and inflaming the shoulder joint capsule, which is the connective tissue that surrounds the shoulder joint. The head of the upper arm bone is fixed to the shoulder socket by ligaments in the joint capsule, which holds the joint in place. You may also refer to this as a ball-and-socket joint.

This is sometimes called a "frozen" shoulder because the more you hurt, the less likely you'll use your shoulder. The more you don't use your shoulder, the tighter and thicker your shoulder capsule becomes — your shoulder becomes even more challenging to move; it's "frozen" in place.

What are the symptoms of a frozen shoulder (adhesive capsulitis)?

Healthcare providers divide symptoms of a frozen shoulder into three stages:

The "freezing" stage: When moving, your shoulder gets stiff and sore. This discomfort grows, and it could grow at night. You cannot move your shoulder as much as you used to. This begins at six weeks and lasts for nine months.
Stage "Frozen": Pain may reduce, but your shoulder feels stiff, making it hard to perform everyday activities. It takes between two to six months.
The "thawing" (recovery) stage: You experience decreasing pain here, and the shoulder can be moved slowly. You are now close to a full recovery, as usual strength and movement return. The stage lasts from six months to two years.

What is the leading cause of frozen shoulder (adhesive capsulitis)?

Scientists are unsure of the exact reason why frozen shoulder develops. The condition occurs through inflammation that causes swelling and tightening of the capsule of the shoulder joint. With time, thick bands of scar tissue called adhesions occur, leaving you with less synovial fluid in your shoulder joints to lubricate them, making it harder for your shoulder to move and rotate smoothly.

Who's at risk for developing a frozen shoulder?

The following are the risks to which you are most likely to get a frozen shoulder:

Age: Frozen shoulder mainly occurs among adults aged 40 to 60 years.
Sex: AFAB has a more common risk than AMAB.
Recent shoulder injury: You have a higher risk of getting a frozen shoulder if you have had shoulder surgery or an injury that requires you to limit your shoulder's range of motion (e.g., using a brace, sling, wrap, or other similar device). Examples include upper arm, collarbone, or shoulder blade fractures as well as tears in the rotator cuff.
Diabetes: Frozen shoulder occurs in around 10 to 20 percent of diabetics.
Other medical conditions: There are many, including a stroke, hypothyroidism (an underactive thyroid gland), hyperthyroidism (an overactive thyroid gland), Parkinson's disease, and heart disease. Your arm and shoulder may not move as freely in stroke patients. Scientists are not sure why, but people with other diseases and conditions have a greater risk of developing frozen shoulder.

To determine whether a diagnosis of a frozen shoulder, also known as adhesive capsulitis, will be confirmed for you, your healthcare provider will begin by discussing your symptoms with you and taking some time to review your medical history. Next, they'll perform a physical examination of your arms and shoulders. They'll check your passive range of motion by moving your shoulder in various directions to see how much the pain hurts when motion is applied.

Notice how you move your shoulder to see your "active range of motion."COMPARE THE TWO KINEMESISOMEONE WITH FROZEN SHOULDER HAS A LIMITED RANGE OF BOTH ACTIVE AND PASSIVE MOTION.

Your doctor may order shoulder X-rays to ensure that the cause of your symptoms is not another problem with your shoulder, such as arthritis. It would help if you rarely had advanced imaging tests like an MRI or ultrasound to diagnose a frozen shoulder. However, your doctor may order these if he wishes to look for other problems, such as a rotator cuff tear.

What is the best treatment for a frozen shoulder?

Treatment for a frozen shoulder is usually centered on treating the pain until the acrimonious phase resolves. If the motion does not return spontaneously, you will likely require physical therapy or surgery to regain it.

Some straightforward Adhesive Capsulitis treatments are:

Heat and cold compresses: Warm and cold compresses are used to reduce aching and swelling.
Anti-inflammatory and pain-relieving drugs: Some examples are acetaminophen (Tylenol®) and nonsteroidal antiinflammatory drugs (NSAIDs), such as ibuprofen (Advil®, Motrin®). Your physician may prescribe other analgesics or painkillers. Steroid injections also tend to be beneficial in treating more severe cases of shoulder pain and swelling. Your physician will inject a corticosteroid, such as cortisone, directly into your shoulder joint.
Physical medicine: You can learn stretches from a physical therapist that will increase your range of motion.
Home exercise program: Your doctor can teach you exercise that you can do at home.
Transcutaneous electrical nerve stimulation (TENS): A small, battery-operated device that blocks pain by interrupting nerve impulses

If your treatments have not relieved your pain and stiffness in your shoulders for a year or so, your doctor may prescribe additional treatments. These include:

Manipulation under anesthesia: In this procedure, you will be asleep. Your provider will push on your shoulder and make it move into a full range of motion, potentially making your joint capsule stretch or even tear, which loosens the tightness to increase your range of motion.
Shoulder arthroscopy: Your doctor will make small cuts in the tight parts of your joint capsule (capsular release) and insert very small, pencil-size instruments through small cuts (incisions) around your shoulder.

Providers often use these two procedures in combination to get better results.

Can a frozen shoulder be prevented?

You can reduce your risk of developing a frozen shoulder if you start physical therapy soon after any shoulder injury where the motion of the shoulder is painful or stiff. Your orthopedic surgeon or physical therapist can design an exercise program suitable for you.

What is the prognosis for a frozen shoulder (adhesive capsulitis)?

Simple treatments like pain relievers and shoulder exercises, combined with an injection of cortisone, often make it possible again to regain motion and function within a year or less. Even left completely untreated, your range of motion and use of your shoulder continue to improve on their own, but often over a slower time. Full or nearly complete recovery is seen after about two years.