Frozen Shoulder (Adhesive Capsulitis)

What is frozen shoulder?

Frozen shoulder is a painful condition in which your shoulder movement becomes limited. Another name for frozen shoulder is adhesive capsulitis.

Frozen shoulder occurs when the strong connective tissue surrounding your shoulder joint (called the shoulder joint capsule) becomes thick, stiff and inflamed. The joint capsule contains the ligaments that attach the top of your upper arm bone (humeral head) to your shoulder socket (glenoid), firmly holding the joint in place. This is more commonly known as a ball-and-socket joint.

The condition is called “frozen” shoulder because the more pain you feel, the less likely you’ll use your shoulder. Lack of use causes your shoulder capsule to thicken and become tight, making your shoulder even more difficult to move — it’s “frozen” in its position.

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

Healthcare providers divide frozen shoulder symptoms into three stages:

• The “freezing” stage: In this stage, your shoulder becomes stiff and is painful to move. The pain slowly increases. It may worsen at night. Inability to move your shoulder increases. This stage lasts from six weeks to nine months.
• The “frozen” stage: In this stage, pain may lessen, but your shoulder remains stiff. This makes it more difficult to complete daily tasks and activities. This stage lasts for two to six months.
• The “thawing” (recovery) stage: In this stage, pain lessens, and your ability to move your shoulder slowly improves. Full or near full recovery occurs as typical strength and motion return. The stage lasts from six months to two years.

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

Researchers don’t know exactly why frozen shoulder develops. The condition occurs when inflammation causes your shoulder joint capsule to thicken and tighten. Thick bands of scar tissue called adhesions develop over time, and you have less synovial fluid to keep your shoulder joint lubricated. This makes it more difficult for your shoulder to move and rotate properly.

Who’s at risk for developing frozen shoulder?

The following risk factors increase your likelihood of developing frozen shoulder:

• Age: Frozen shoulder most commonly affects adults between the ages of 40 and 60 years old.
• Sex: The condition affects females more often than males.
• Recent shoulder injury: Any shoulder injury or surgery that results in the need to keep your shoulder from moving (for example, by using a shoulder brace, sling, shoulder wrap, etc.) increases your risk of frozen shoulder. Examples include a rotator cuff tear and fractures of your shoulder blade, collarbone or upper arm.
• Diabetes: Between 10% and 20% of people with diabetes develop frozen shoulder.
• Other health diseases and conditions: This includes stroke, hypothyroidism (underactive thyroid gland), hyperthyroidism (overactive thyroid gland), Parkinson’s disease and heart disease. Stroke is a risk factor for frozen shoulder because movement of your arm and shoulder may be limited. Researchers aren’t sure why other diseases and conditions increase the risk of developing frozen shoulder.

How is frozen shoulder diagnosed?

To diagnose frozen shoulder (adhesive capsulitis), your healthcare provider will discuss your symptoms and review your medical history. They’ll also perform a physical exam of your arms and shoulders. They’ll:

• Move your shoulder in all directions to check your range of motion and if there’s pain with movement. This type of exam, in which your provider moves your arm, is called determining your “passive range of motion.”
• Watch you move your shoulder to see your “active range of motion.”
• Compare the two types of motion. People with frozen shoulder have a limited range of both active and passive motion.

Your provider will likely order shoulder X-rays to make sure the cause of your symptoms isn’t due to another problem with your shoulder, like arthritis. You usually don’t need advanced imaging tests like magnetic resonance imaging (MRI) and ultrasound to diagnose frozen shoulder. But your provider may request them to look for other problems, like a rotator cuff tear.

What treatment is best for frozen shoulder?

Frozen shoulder treatment usually involves pain relief methods until the initial phase passes. You may need therapy or surgery to regain motion if it doesn’t return on its own.

Some simple adhesive capsulitis treatments include:

• Hot and cold compresses. These help reduce pain and swelling.
• Medicines that reduce pain and swelling. These include nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen (Advil®, Motrin®) and acetaminophen (Tylenol®). Your healthcare provider may prescribe other painkiller/anti-inflammatory drugs. You can manage more severe pain and swelling with steroid injections. Your provider will inject a corticosteroid, like cortisone, directly into your shoulder joint.
• Physical therapy. A physical therapist can teach you stretching and range-of-motion exercises.
• Home exercise program. Your healthcare provider can show you exercises you can do at home.
• Transcutaneous electrical nerve stimulation (TENS). Use of a small, battery-operated device that reduces pain by blocking nerve impulses.

If these noninvasive treatments haven’t relieved your pain and shoulder stiffness after about a year, your provider may recommend other procedures. These include:

• Manipulation under anesthesia: During this surgery, you’ll be put to sleep and your provider will force movement of your shoulder. This will cause your joint capsule to stretch or tear to loosen the tightness. This will lead to an increase in your range of motion.
• Shoulder arthroscopy: Your provider will cut through the tight parts of your joint capsule (capsular release). They’ll insert small, pencil-size instruments through small cuts (incisions) around your shoulder.

Providers often use these two procedures together to get better results.

Can frozen shoulder be prevented?

You can reduce your risk of frozen shoulder if you start physical therapy shortly after any shoulder injury in which shoulder movement is painful or difficult. Your orthopedic surgeon or physical therapist can develop an exercise program to meet your specific needs.

What’s the outlook for frozen shoulder (adhesive capsulitis)?

Simple treatments, like the use of pain relievers and shoulder exercises, in combination with a cortisone injection, are often enough to restore motion and function within a year or less. Even left completely untreated, range of motion and use of your shoulder continue to get better on their own, but often over a slower course of time. Full or nearly full recovery is seen after about two years.