You woke up one morning and your shoulder is hurting a lot! You also notice that it feels a little stiff. You do not recall a significant injury. A frozen shoulder is simply a stiff and painful shoulder that doesn’t move as much as your normal one. The cause of a frozen shoulder is still a bit of an unknown. Some frozen shoulders might occur due to injury, while most cases of a painful stiffness, or adhesive capsulitis have no known obvious cause.
In most situations you woke up one morning and your shoulder was bothering you. The pain worsened throughout the next few days, and over time the shoulder has become stiff. This is how a typical frozen shoulder progresses. The pain usually starts first, before the freezing or stiffness phase. Most of you will not remember any injury. You may find that the shoulder pain is waking you up at night. A frozen shoulder is associated with significant sleep abnormalities. If you are a side sleeper, you notice that you can not get that arm up and under your head. Luckily, for most of you, the management of a stiff and painful shoulder which is significantly affecting your quality of life is often straightforward.
In this post, and the videos below we are going to learn about the most common causes of a frozen shoulder, and how you can overcome it. Most of you can expect to recover fully over the next few months. Some people will not recover rapidly and need our assistance. This post and the video below explains the treatments available if physical therapy and stretching are not helping to resolve your stiff painful shoulder joint.
A Stiff and Painful Shoulder
A frozen shoulder can cause very severe pain with severely limited motion in some people. Others might have a more mild variant. Recovery from a frozen shoulder can take months and usually does not involve surgery. There are different methods to improve your pain and improve your motion after you have been diagnosed with a frozen shoulder, or adhesive capsulitis. Adhesive capsulitis is the medical term for a frozen shoulder. Severe pain is often present early on during the initial phase of a frozen shoulder due to significant inflammation.
A frozen shoulder progresses through very predictable phases.
The (painful) freezing phase.
During the freezing phase you will have severe pain, but your motion is not very restricted. What’s happening inside your shoulder is that the lining of the joint, what we call the capsule, is becoming very inflamed. If we could look in with a camera which we see a red, angry appearing capsule. This inflammation causes severe pain, because when you try and move the shoulder, you are stretching this inflamed joint capsule.
The frozen phase.
During the frozen phase of adhesive capsulitis your pain might improve, but you begin to notice that your shoulder is very stiff. The stiffness phase is caused by the initial inflammation. The inflammation triggered the capsule to become thicker, much thicker. A thicker capsule will make it harder to move your shoulder, because if is not as flexible or giving as a normal capsule is. Think of a thin rubber band versus a thick and heavier rubber band. It is much harder to stretch the thicker band. During this phase, you will notice that washing your hair, putting on a coat or a shirt, or reaching up to get something out of a cabinet can be difficult.
The thawing phase
The thawing phase of a frozen shoulder is when the tight and thick capsule and ligaments in your shoulder begin to loosen up. The capsule is starting to become thin and flexible once again. During this phase your pain will diminish and your motion will improve. Below you will see stretches you can review with your doctor to see if they are appropriate for your frozen shoulder. Stretching and exercise are the most successful way of treating a frozen shoulder. Unfortunately, most patients with a stiff and painful joint will not try and move it out of fear they are causing harm. That’s a normal response to an injury. In a frozen shoulder it is safe to assume that you run very very little risk of injuring yourself by stretching.
What Is a Frozen Shoulder?
A frozen shoulder is a stiff and painful shoulder. Nearly 2% of people will develop a frozen shoulder. Women are affected more than men. Diabetics are also more prone to developing a frozen shoulder. People with lipid disorders and high cholesterol also seems to get it more often.
We do not completely understand why this occurs. Most people will not recall any event or injury which preceded their stiffness and pain. The stiffness occurs because the capsule or the ligaments that hold the shoulder joint together becomes very inflamed. Then the ligaments surrounding the shoulder joint starts to shrink and thicken. As the ligaments thicken you lose your ability to move the shoulder easily. Because of the inflammation attempts to move the shoulder can cause severe pain. If we were to look inside a normal shoulder with a camera everything would be white and pristine, however, if we look inside your frozen shoulder everything is red and inflamed. The capsule or lining of the shoulder would have a very angry appearance.
Why Is My Shoulder Stiff?
We do not know why most people have a frozen shoulder. Some of you will recall an injury. Some might have noticed their pain began after a simple injection like a flu shot. Most of you will note that you had mild pain for a few weeks or months. That pain gradually worsened and then you noticed the loss of motion and stiffness. For reasons we do not understand even mild injuries or injections seem to be able to lead to adhesive capsulitis. Rest assured .. you did not do anything wrong. You don’t have adhesive capsulitis because you exercised too much.
How Do You Treat a Frozen Shoulder?
An actively treated frozen shoulder in someone without diabetes will usually resolve within 2-6 months. Improvement in your shoulder motion might take much longer in some people. Many of you spent weeks not moving the shoulder or not using it in fear that you were hurting yourself. Now that you understand that pain doesn’t always imply harm, you can get going on your recovery exercises. Even untreated, most of you will notice that the pain and stiffness will eventually go away. In some people it can take 6-12 months for that to happen, but most of you will recover fully from a frozen shoulder. That may not be the case with diabetics.
For some reason a frozen shoulder may not fully resolve in diabetics, despite long term treatment, including surgery. Because inflammation is the issue that led to the shoulder capsule becoming stiff and thickened, many of you will notice a significant improvement in your pain and stiffness after a steroid injection is placed into the shoulder joint itself. That is not an easy injection to give because the joint is so small, so an ultrasound guided injection might be recommended.
The most important part of the recovery process is a carefully structured stretching program. An injection might help diminish the inflammation which makes the stretching exercises easier to tolerate. Far too many people are afraid of moving their shoulders because they are afraid of causing more harm. Therefore as a physician, the most important thing we can do is to educate you about the natural history of a frozen shoulder. This should allay the fear of causing harm. We are there to act as a support and guide as you work your way through this. Recent studies have shown that a carefully guided strengthening program can also improve your frozen shoulder symptoms. This is interesting as we used to avoid strengthening exercises initially during the recovery process. The thought here is that strengthening causes stretching of the capsule while applying weight — theoretically leading to a better stretch.
Surgery For A Frozen Shoulder
Surgery is rarely needed for a frozen shoulder. We consider surgical intervention if injections, stretching, and physiotherapy are not resulting in improvement in your shoulder pain or your shoulder motion. The decision to proceed with surgery is a quality of life decision. When we operate on a frozen shoulder we will manipulate the shoulder to stretch or rip the tight tissues. We will then place a small camera in the shoulder and use a small device to open the ligaments which allows them to stretch back to their normal position. Although shoulder surgery for a frozen shoulder is successful for many, it is not always as effective as we would like it to be. Many are left with some residual loss of shoulder motion; this is especially true in diabetics.
Recovery Process For A Frozen Shoulder:
Once the inflammation has diminished physical therapy and stretching become critical to help you alleviate the stiffness and recover. Many people believe that they should limit their use and motion of the shoulder when it hurts. When you have a frozen shoulder, the opposite is true. Typically, the more you stretch it the, more rapid your recovery should be. After a steroid injection your shoulder pain is usually less, so that you can stretch your shoulder more effectively.
Most patients will respond very favorably to physical therapy. Be prepared, it also takes a lot of patience since recovery from a frozen shoulder can take a long time.
Occasionally patients fail to respond to therapy and injections. In those patients a manipulation under anesthesia, or surgery (arthroscopy) to release the tight capsule might improve your stiffness. Again, in diabetics you may not respond to the therapy or surgery. The surgery for a frozen shoulder is called a capsulotomy. The means that we release the capsule of lining of the shoulder, making it longer and hopefully easier to move. Many of you who have the surgery will wake up and notice that the shoulder still feels stiff. That’s because the release doesn’t result in immediate changes. It will still take time for you and your physical therapist to stretch the shoulder capsule further even after the release. This can be a very frustrating and challenging condition for many people.
If you have a painful stiff shoulder, there is a good chance that you have a frozen shoulder. Seeing a shoulder specialist to rule out other causes of stiffness and pain might be a good idea before starting an aggressive stretching program.
This video includes some very simple stretches…. talk to your doctor to be sure about your diagnosis and the appropriate treatment you need first.
Disclaimer: this information is for your education and should not be considered medical advice regarding diagnosis or treatment recommendations. Some links on this page may be affiliate links. Read the full disclaimer.