Frozen Shoulder: What Is It, and How Is It Treated?

Adhesive Capsulitis, more commonly known as “frozen shoulder” is a relatively routine condition relating to tightness of the shoulder joint capsule, and it is associated with painful and limited movement of the shoulder and arm. This condition can occur spontaneously, but could also be caused by overuse, a traumatic event, or even a minor irritation that sets off a runaway inflammatory process. In this situation the result is that the shoulder capsule itself tightens, and shoulder motion becomes painful and limited.

Shoulder anatomy

The shoulder capsule is made of collagen that surrounds the shoulder joint and provides some external stability for the joint itself. This collagen is generally flexible and allows for the significant freedom of movement that the shoulder is known for. During the onset of frozen shoulder, inflammation in the shoulder capsule causes irritation or surrounding tissues, and the body responds by generating stiffer cartilage, similar to scar tissue. These tissues contract and tighten around the shoulder joint and result in decreased and painful shoulder mobility as you try to stretch. The cartilage is also sensitive to changes in hormone levels in the body, resulting in the highest incidence of frozen shoulder to land with women of peri- or post- menopausal age. As the estrogen levels change, this causes the cartilage to lose flexibility, leading to increased stiffness, which predisposes this population to have more limiting effects as a result. This does not exclude men from experiencing this condition, however it is less likely to occur in that population.

Usually, this condition is confirmed by recognizing a particular pattern of motion loss in the shoulder referred to as the “capsular pattern.” This presents as a proportional loss of 3 primary shoulder motions, with the most limited motion being external rotation, (think about the motion of reaching into the backseat while sitting in the front of your car.) You may also experience limitations with abduction (raising your arm to the side), and flexion (reaching forward), respectively.

Phases of Frozen Shoulder

Frozen shoulder generally progresses over the course of months in loosely defined phases. Initially, as you start to notice pain in your shoulder, you will also experience a gradual decrease in the amount of motion you can comfortably move your shoulder through. This is colloquially known as the “freezing” phase. As this progresses over the course of a few weeks, you may experience pain in your shoulder at rest, and you may have sharp pains if you exceed your available range of motion. You will start to notice more persistently painful limits to how far you can move in certain directions.

The next phase is the “frozen” stage. During this time frame, there will be consistent restrictions in your shoulder mobility, and you may have slightly less pain with motions as long as you stay within your available range. Your range of motion will plateau in this phase for a while; you can stretch to your maximum available range but it is unlikely that you will see lasting improvements in flexibility.

Frozen shoulder then progresses into the third and final phase of the condition, the “thawing.” As you move into this stage, you will still have pain in your shoulder as you stretch into the higher ranges of motion, but you will start to notice that you are able to maintain some of those ranges that were previously out of reach.

First Steps

If you find yourself diagnosed with a frozen shoulder, the next step might be to make an appointment with a physical therapist to have them perform an assessment of your shoulder. The first session will likely include a conversation about your medical history and a review of your shoulder range of motion and strength as well as a review of your overall function. You will discuss treatment options and your personalized plan of care to help you understand what to expect as you navigate the rehabilitation process.

Treatment for adhesive capsulitis includes shoulder stretching and shoulder strengthening. You may also be encouraged to use heat on your shoulder to help improve tissue flexibility and to reduce pain. With each of the phases, treatment must change to match the stage of recovery. There is a need to understand the healing process and how to adapt exercises and activities to gain the optimal benefit.

Early on the goals for treatment include decreasing pain and improving your shoulder range as much as possible before the shoulder truly reaches the frozen stage. In this first timeframe you will work on active and passive stretching for the structures around the shoulder, as well as light strengthening to promote muscle activation.

In the second phase, the therapy goals for frozen shoulder include optimizing your personal available range of motion. You will work on stretching your shoulder through as much of your range of motion as possible and strengthening within that range as well. During this “frozen” phase, the primary goal is to maintain as much motion and strength as possible in order to have a good starting position when the shoulder does start to release.

In the third phase of this process the focus for PT is on return to function. As your shoulder “thaws” and your motion improves, you will work with your therapist to strengthen the muscles throughout your full range of motion to regain full mobility and function. In addition to this you will work on emphasizing good shoulder mechanics to prevent future issues.

How Long Does Frozen Shoulder Last?

The overall time frame for this disease progression is about 1.5 to 2 years. The timeframes that each of the stages take is highly variable and is usually specific to each individual. One of the biggest factors contributing to a successful rehab for this condition is recognizing the initial problem, performing the appropriate exercises, and performing those exercises consistently. If you are committed to the plan of care, you can expect to experience a favorable outcome. While the course of treatment for this condition is certainly a longer process, applying the appropriate treatment can lead to a full recovery of function!

If you have shoulder pain with limited motion, it may be frozen shoulder, or adhesive capsulitis. Give us a call at (518) 439-5006, and we can set up an appointment to assess your condition and formulate an appropriate plan of care.