By Michael Hannett, SPT, CSCS from Ivy Rehab Hackensack, New Jersey location clinic.
Shoulder pain can disrupt even the simplest daily tasks, making routine activities feel like a challenge. For many, this discomfort isn’t just temporary—it’s a sign of a more complex condition known as frozen shoulder. Understanding this condition and its implications can empower you to recognize symptoms early, explore treatment options, and regain mobility. Let’s dive into what you need to know about frozen shoulder, from its causes to its impact on daily life.
What is Frozen Shoulder?
A “frozen shoulder”, also referred to as adhesive capsulitis, occurs when the shoulder becomes increasingly stiff and painful. Frozen shoulder can occur after a minor injury, surgery, or without a known cause. It is known to be linked to some diseases such as diabetes and thyroid disease. Patients with frozen shoulder are limited in their ability to carry out everyday tasks including dressing, grooming, and reaching. The condition occurs most commonly in those between 40 and 65 years of age and currently affects 2-5% of the population of the United States.
Symptoms of Frozen Shoulder
Frozen shoulder typically progresses in three stages. Here’s an overview of the symptoms:
- Freezing stage – The initial phase is marked by increasing shoulder pain, often worse at rest, and significant discomfort with movement. The pain may also disrupt sleep, making rest difficult. Stiffness begins to develop, and daily activities, such as brushing hair or reaching overhead, can become challenging.
- Frozen stage – As the condition advances, the shoulder becomes increasingly stiff, limiting the range of motion. Pain remains persistent, and movement becomes more restricted, further complicating basic tasks. This stage can also disrupt sleep as the pain intensifies.
- Thawing stage – In this stage, the shoulder begins to recover. Pain typically subsides, and the range of motion gradually improves, although some stiffness may persist for a while. Over time, daily activities become easier, and the shoulder’s functionality returns.
How Long will Symptoms Last?
The stiffness can persist for 1-2 years and there is a characteristic course of disease progression. Typically, the initial period is characterized by aching at rest and severe pain with movement. The individual typically has difficulty sleeping due to shoulder pain and a progressive loss of motion is noted. Over the next several months, there is often less pain but progressively greater difficulty performing everyday tasks. Eventually, there is a gradual return of range of motion, leading to a return of function. More recently, clinicians have begun to challenge this characteristic disease progression with the thought that it can be altered with effective interventions such as physical therapy treatment.
Treatment for Frozen Shoulder
A frozen shoulder can be a painful and frustrating experience but there is treatment available.
Physical Therapy
There is a multitude of evidence to support the effectiveness of physical therapy in reducing the pain and decreased range of motion seen in patients with frozen shoulder. Physical therapy interventions for frozen shoulder include manual therapies, joint mobilizations, therapeutic exercises, stretching, therapeutic ultrasound, laser therapy, and modalities such as electrical stimulation/TENS, heat or ice.
Steroid Injections
There is evidence to support that intra-articular steroid injection in combination with physical therapy can result in significant improvements in the shoulder range of motion in the short-term (6 weeks). However, the evidence does not show that these improvements are maintained in the long term.
Manipulation
Translational manipulation under anesthesia can be performed for a patient who does not respond to conservative physical therapy treatment.
If you think you may be suffering from a frozen shoulder, make an appointment with your physical therapist or primary care physician to begin your road to recovery.
Risk Factors for Frozen Shoulder
Frozen shoulder doesn’t occur randomly—certain factors can increase your likelihood of developing this painful and restrictive condition. These risk factors include:
- Diabetes – Individuals with diabetes, especially those with poor blood sugar control, are more prone to frozen shoulder.
- Thyroid Disease – Hypothyroidism or hyperthyroidism may increase the risk of developing this condition.
- Previous injury or surgery – Shoulder injuries or surgeries, such as rotator cuff repair, can trigger frozen shoulder.
- Other health conditions – Diseases like Parkinson’s or cardiovascular issues can contribute to its onset.
- Age and gender – Frozen shoulder is most common in people aged 40-65, with women being affected more often than men.
Complications of Frozen Shoulder
Frozen shoulder doesn’t just affect your immediate ability to move your arm. It can lead to lingering issues that impact your quality of life for months or even years. Frozen shoulder can lead to long-term complications, such as:
- Chronic pain – While pain may decrease over time, some individuals experience persistent discomfort.
- Limited range of motion – Without proper treatment, the shoulder’s mobility may remain limited even after the initial pain subsides.
- Muscle atrophy – Prolonged immobility can lead to muscle weakness and atrophy around the shoulder joint, further complicating recovery.
Understanding these potential complications underscores the importance of timely intervention and rehabilitation efforts to minimize their effects.
Is Surgery Necessary?
For most individuals with frozen shoulder, non-surgical treatments like physical therapy and medications are effective in managing symptoms and restoring mobility. However, when these methods fall short, surgery may be the next step. While surgery is not always required, understanding the available options and what they involve can help you make an informed decision if it becomes necessary. Surgical options may include:
- Arthroscopic release – A minimally invasive procedure where the tight capsule around the shoulder is cut to improve range of motion.
- Capsular release – In more severe cases, a surgeon may release the tight capsule to allow for greater shoulder movement.
Your Next Steps
Frozen shoulder can be a challenging condition, but with early diagnosis and the right treatment plan, you can regain mobility and reduce pain. Whether it’s physical therapy, steroid injections, or in rare cases, surgery, there are effective options available to help you manage symptoms and improve your quality of life. If you’re experiencing shoulder pain or stiffness, don’t wait to seek help. Contact Ivy Rehab today and start your path to recovery.