Frozen Shoulder: Causes, Symptoms, and Treatments

It's the most mobile joint in the body and when it becomes painful and stops doing what it's supposed to do it can really set you back. Frozen shoulder, or adhesive capsulitis, often has no identifiable cause but affects some 200,000 people in the US a year. Learn more.

Think about it. Without the mobility of the shoulder we can't get out of bed, use or fork and spoon to eat, pull a shirt over our head, or wash our hair. Never mind driving and just about any household-related task—most daily routines involve the shoulder.

The shoulder is a ball-and-socket joint meaning the rounded "ball"  (the head of the humerus bone) fits into a hallowed out joint (the shoulder socket) . This configuration gives it the greatest mobility of any other body part. (The hip is also a ball-and-socket joint but not nearly as flexible.) A complicated network of bones, muscles, tendons, and ligaments holds it all together and keeps it in place but when one part of that intricate area get inflammed or injured, the entire shoulder can be impacted. 

The shoulder is a ball-and-socket joint (like the hip but much smaller). The configuration enables the related body parts to rotate and move forward, backward, and sideways. The shoulder requires good range of motion to function properly. Frozen shoulder can severely limit that ability making daily activities (dressing, driving, etc.) challenging.

What Is Frozen Shoulder?

A shoulder that loses its mobility, or becomes "stuck" with limited mobility is known as a frozen shoulder. The medical term is adhesive capsulitis. It causes causes pain and stiffness and can make even simple tasks, like getting dressed, very difficult. Severe pain, even at night, is typically what gets people in front of a doctor. 

“It’s a very annoying problem to have,” says Jeffrey Schildhorn, MD, an orthopedic shoulder and sports medicine surgeon at Lenox Hill Hospital/Northwell Health in New York City. “And the frustrating part is that for most people there isn't any explanation or underlying reason for why it occurs. It often just happens.”

The capsule of your shoulder joint is made of ligaments that hold your shoulder bones in place. But when this capsule gets inflamed, the bones no longer move freely and you can experience pain and trouble moving your shoulder. Of course, the more pain you have, the less likely you are going to be to move your shoulder.

“Think of the capsule of the shoulder like a doorknob, it turns smoothly when well lubricated,” says Sherry McAllister, MS (Ed), DC, CCSP, presidentof the Foundation for Chiropractic Progress.  “But when the shoulder capsule thickens and stiff bands of tissue form (called adhesions) the lubricant starts to go away and the area can become inflamed. Without lubrication and an increase in inflammation, your shoulder doesn’t want to move anymore.”  

“It can become a vicious cycle,” says Yili Huang, DO, director of the Pain Management Center at Northwell Health’s Phelps Hospital in Sleepy Hollow, New York. “When you don’t move your shoulder, this leads to worsening mobility and more pain. You want to break the vicious cycle.”

Who's At Risk of Developing Frozen Shoulder?

The the causes of frozen shoulder are ususally idopathic (no known reason), research indicates there are some risk factors that make you more likely to experience this condition:

  • Being female and between the ages of 40 and 60 (menopause may somehow be related)
  • Having diabetes or a thyroid condition1
  • Shoulder or trauma from surgery (i.e. rotator cuff injury or surgery) or a broken/fractured arm that results in a period of shoulder immobilization.

Occasionally, after shoulder surgery, an individual can experience an excessive inflammatory reaction, says Dr. Schildhorn. “The joint gets inflamed and very painful and the shoulder just becomes very stiff,” he says.

The Three Stages of Frozen Shoulder

There are actually three stages of frozen shoulder—freezing, frozen, and thawing.

#1. The freezing stage. This is first stage when the pain gets worse and loss of range of motion in the shoulder starts to become noticeable. This stage can last anywhere from six weeks to nine months.

#2.The frozen stage is the second stage. The pain may actually improve during this period but the stiffness can worsen and turn debilitating enough to limit daily activities. 

#3. The thawing stage is the final stage. In this stage the pain lessens and the person slowly regains normal, or close-to-normal movement. It can last from six months to two years.2

Can Frozen Shoulder Resolve on Its Own?

Frozen shoulder can resolve on its own but it can take many months. Without treatment, there's a risk that full range of motion may never completely return.

In the meantime, some helpful treatments include physical therapy (stretching and other exercises to help increase range of motion) and cortisone injections, Dr. Schildhorn says. If you are having symptoms, the best thing you can do to help yourself is to see your doctor.

Anti-inflammatory medications and steroid injections may reduce the pain, he explains. “The idea is to make it comfortable enough for the person to do their exercises, which are important,” he says. “I always hope that my patients will come to me within a month of feeling that something is wrong with their shoulder,” Dr. Schildhorn says.

Physical Therapy for Frozen Shoulder: Painful but Necessary

You may be prescribed physical therapy two or three times per week and it can take several months to make progress.

But, Dr. Schildhorn says at-home exercises are an important companion to physical therapy and vital for getting the shoulder moving again. "There should be daily home stretching,” he says. “You should be learning the exercises at home.”

 With physical therapy, he says, most people regain 80 to 90% of the motion in that arm and shoulder.

“But to resolve a frozen shoulder, it can take months,” says Dr. Huang. “It is important to address it right away. Some patients have pain and ignore it but it is insidious. It catches up with you.”

Other Treatments for Frozen Shoulder

In some cases, frozen shoulder may require more intervention: a procedure under anesthesia.

Your doctor may try a manipulation or preform arthroscopy. Manipulation to stretch the capsule (and break through scar tissue that may be inhibiting movement) can be painful so it's usually done under anesthesia. The goal of a manipulation is to decrease the tightening of the shoulder and restore the range of motion.

In shoulder arthroscopy, the doctor makes tiny incisions around the shoulder and cuts through tight portions of the joint capsule. Manipulation and arthroscopy can be used together. 2

Surgery is not typically needed. “We always try to treat non-operatively first,” says Leesa Galatz, MD, professor or orthopedics and chair of orthopedic surgery at Mount Sinai Health System in New York City. “I would say 85% of the patients who come to my office get better without surgery.”

If you do require an operation, physical therapy following the procedure will likely be prescribed. “PT is key. We start it right away because the body tries to heal itself immediately, and we want the shoulder to maintain the motion we achieved at surgery,” Dr. Galatz says. “It is important to get moving right after surgery. There will be a lot of stretching. But surgery today is safer and less risky than ever before.”

A New Non-Surgical Procedure for Frozen Shoulder

A new, non-surgical procedure for frozen shoulder involves inserting a catheter through a pinhole-sized incision in the patient’s wrist that is used to feed microsphere particles into up to six arteries in the shoulder to reduce inflammation. An interventional radiologist performs the procedure, which is in a Phase II FDA-approved Investigational Device Exemption clinical trial. It could be done on an outpatient basis and takes about an hour.3

“What they do is catheterize the small blood vessels in the shoulder and inject these nanoparticles into the shoulder in an effort to embolize the tiny vessels,” Dr. Schildhorn says. “It is a clever idea and takes advantage of the idea that if there is new vessel formation, there would be more inflammation and more pain. In the studies where it was done here, the patients’ pain scores improved.”

“Patients with frozen shoulder are essentially told to tough it out until their symptoms improve, but considering the significant pain and decreased function many experience, we looked to determine if this treatment model of embolization, already in use in other areas of the body, could provide immediate and durable relief,” said Sandeep Bagla, MD, CEO of Vascular Interventional Partners, NOVA and lead author of the study, in a news release. “We were shocked at the profound and dramatic improvement patients experienced in pain and use of their shoulder.”

While you may have to wait awhile before getting this new treatment, physical therapy, medication, and stretching at home can improve your pain and your mobility should you develop frozen shoulder. 

 

 

 

Updated on: 08/19/21
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Shockwave Therapy (EPAT): A Non-Surgical Treatment Option for Pain
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