Frozen Shoulder 101: Understanding Symptoms, Causes, and Recovery

Frozen shoulder, medically known as adhesive capsulitis, is a condition in which the shoulder becomes painful and stiff. Over time, shoulder movements become restricted, sometimes leading to a nearly 'frozen' joint with significantly-reduced mobility. The condition often develops gradually, and with each passing day, even simple daily activities like reaching for a shelf, dressing, or sleeping on the affected side become extremely challenging. Though the exact cause of frozen shoulder is unclear, understanding the symptoms, stages, and available treatment options can help you manage the condition effectively. So without further ado, let's dive into everything you need to know to overcome the frozen shoulder!

What is a Frozen Shoulder? 

Frozen shoulder is a condition characterised by stiffness, pain, and limited range of motion in the shoulder joint. It occurs when the connective tissue surrounding the shoulder joint (the shoulder capsule) thickens and tightens, restricting movement. While the exact cause of frozen shoulder isn’t always clear, it’s commonly seen in people over 40, especially those recovering from shoulder injuries or surgeries, or dealing with conditions like diabetes. Without proper treatment, frozen shoulders can take months or even years to fully resolve.

What are the Stages of Frozen Shoulders? 

Frozen shoulder typically progresses through three distinct stages, each with its own set of symptoms and challenges:

Freezing Stage (Painful Phase)

• Duration: Typically lasts 2 to 9 months.
• Symptoms: This stage begins with increasing pain in the shoulder, often worse at night or when lying on the affected side. Gradually, stiffness sets in, limiting shoulder movement. The pain can be severe, making it difficult to perform daily activities. As the condition progresses, stiffness worsens.

Frozen Stage (Stiff Phase)

• Duration: Generally lasts 4 to 12 months.
• Symptoms: Although pain starts to ease, significant stiffness remains, severely limiting the range of motion. The thickening and scarring of the shoulder capsule make movements like rotating the arm outward particularly difficult. This stiffness can cause muscles around the shoulder to weaken due to reduced use. However, pain at rest is often minimal compared to the freezing stage.

Thawing Stage (Recovery Phase)

• Duration: Can last 1 to 3 years.
• Symptoms: During this final stage, pain and stiffness gradually diminish, and shoulder movement slowly returns to normal or near-normal levels. However, occasional pain, especially at night, may still occur. Recovery can vary greatly, with some individuals experiencing quicker improvement, while for others, it can take several years. Untreated, the entire cycle typically lasts about 2 to 3 years, but the severity and duration can differ significantly between individuals.

Throughout these stages, symptoms can interfere with everyday activities such as driving, dressing, or sleeping, making early diagnosis and treatment crucial for faster recovery.

What are the Symptoms of Frozen Shoulder?

Symptoms of frozen shoulder progress over several weeks or months, and worsen as time goes on. Recognizing the symptoms early on can help in seeking timely treatment to prevent further complications. Here are some of the common signs and symptoms of frozen shoulder:

• Stiffness in the Shoulder: Stiffness usually affects one shoulder at a time, making it difficult to move the joint freely.
• Severe Pain: Pain is often localised around the shoulder and can be particularly intense at night, especially when lying on the affected side. This discomfort can disrupt sleep and make resting difficult.
• Limited Range of Motion: Simple activities, like reaching overhead, tucking in a shirt, or wearing a bra, become challenging due to restricted shoulder movement.
• Impact on Daily Activities: The extent of symptoms can vary depending on whether the dominant or non-dominant shoulder is affected, leading to varying levels of disability.

What are the Causes of Frozen Shoulders?

The exact causes of a frozen shoulder are not fully understood. However, it is believed to be related to the formation of scar tissue within the shoulder capsule. The shoulder capsule is a thin, elastic tissue that surrounds and protects the shoulder joint. In cases of frozen shoulder, scar tissue may cause this capsule to thicken, contract, and restrict movement. The reasons why this scar tissue develops are unclear, but it leads to tightening and stiffening of the shoulder joint, limiting its range of motion and causing pain. 

The Orthopaedics specialist at Max Hospital, Shalimar Bagh, explains that frozen shoulder can have various causes and may even result from conditions outside the shoulder itself. It can develop after prolonged immobilisation, such as wearing a sling or cast for a wrist or elbow fracture, recovering from upper limb surgery, or even after procedures like cardiac catheterization. In some cases, remote causes like chemotherapy—especially following breast cancer—can trigger it. However, the most common underlying factor is diabetes, with an estimated 1 in 5 diabetics, particularly those dependent on insulin, experiencing frozen shoulder in one or both shoulders.

Who Develops Frozen Shoulders? 

Frozen shoulder most commonly affects people between the ages of 40 and 65, with a higher prevalence among women. It is also more frequently seen in individuals with diabetes or other conditions such as thyroid disorders. While either shoulder can be affected, it typically occurs in the non-dominant shoulder—for instance, the left shoulder in right-handed individuals.

What are the Risk Factors for Frozen Shoulders?

Several factors can increase the likelihood of developing frozen shoulders/adhesive capsulitis. Understanding these risk factors can help in early detection and management of the condition:

• Age and Gender: Frozen shoulder is most common in people between the ages of 40 to 60, with a higher prevalence among women than men.
• Prolonged Shoulder Immobilization: Keeping the shoulder immobile for an extended period due to an injury, surgery, or fracture can lead to the development of frozen shoulder. This is why patients recovering from shoulder surgeries are often advised to begin physical therapy early.
• Chronic Health Conditions: Certain medical conditions, like diabetes, hypothyroidism, hyperthyroidism, cardiovascular disease, and Parkinson’s disease, increase the risk of adhesive capsulitis. Notably, individuals with diabetes are more prone to developing this condition, and it may be more severe in such cases.
• Previous Shoulder Problems: A history of shoulder issues, such as rotator cuff injuries or bursitis, can increase the risk of developing frozen shoulders later on.
• Sedentary Lifestyle: Lack of physical activity and sedentary behaviour can contribute to joint stiffness, making it more likely for the shoulder capsule to tighten and restrict movement.
• Autoimmune and Inflammatory Conditions: Conditions that trigger chronic inflammation can also lead to scarring and thickening of the shoulder capsule, increasing the risk of frozen shoulder.

How is Frozen Shoulder Diagnosed?

Diagnosing frozen shoulder (adhesive capsulitis) typically involves a combination of medical history review, physical examination, and imaging tests. Here’s how doctors usually confirm the condition:

Medical History and Symptom Assessment

The doctor will start by asking about the symptoms, such as pain, stiffness, and any previous injuries or surgeries involving your shoulder. They’ll also consider underlying health conditions like diabetes, which are known risk factors for frozen shoulders.

Physical Examination

The doctor will examine the frozen shoulder to check for range of motion. This includes:

• Active Range of Motion: the patient will be asked to move your arm in different directions to see how much mobility you have.
• Passive Range of Motion: The doctor will gently move the patient’s arm to assess how far it can go.

A noticeable reduction in both active and passive range of motion, accompanied by pain, often indicates frozen shoulder.

Imaging Tests

While a physical exam is usually sufficient for diagnosis, imaging tests like X-rays, MRI, or ultrasound may be used to rule out other conditions, such as arthritis, a torn rotator cuff, or structural damage. These tests help ensure that symptoms are not caused by other shoulder issues but are indeed due to the tightening of the shoulder capsule characteristic of frozen shoulder.

What are the Complications of Frozen Shoulder? 

If frozen shoulder (adhesive capsulitis) is not properly treated, it can lead to several long-term issues that can significantly impact one’s quality of life. Early intervention is crucial to avoid prolonged discomfort and limited mobility.

Here are some potential complications:

• Chronic Pain and Discomfort: Persistent pain, especially during the freezing stage, can significantly impact daily activities, sleep quality, and overall well-being.
• Permanent Loss of Range of Motion: Untreated frozen shoulder may result in permanent stiffness, limiting arm movements.
• Muscle Weakness and Atrophy: Limited shoulder use due to pain can lead to muscle weakening and atrophy around the joint.
• Impact on Daily Activities: Routine tasks like dressing, driving, reaching overhead, or lifting objects can become extremely challenging, affecting independence and productivity.

• Emotional and Psychological Effects: Chronic pain and reduced mobility can cause frustration, anxiety, or even depression, particularly if it limits your ability to work or enjoy hobbies and social activities.
• Long Recovery Time: The recovery or "thawing" stage can take anywhere from a few months to several years, especially if treatment is delayed. Without early intervention, the shoulder may take much longer to regain its full range of motion and function, prolonging the impact on daily life.

What are the Treatment Options for Frozen Shoulder?

The primary goal of treatment for frozen shoulder is to reduce pain and stiffness while maintaining the shoulder's range of motion as much as possible until the condition resolves.

Medications for Frozen Shoulder

• Painkillers: Medications like paracetamol, often combined with an opioid such as tramadol, can help relieve pain and improve sleep.
• Anti-inflammatory Painkillers: Drugs like diclofenac reduce inflammation in the shoulder joint, alleviating pain, especially during the early stages of frozen shoulder. In some cases, oral steroids may be prescribed for short-term relief.

Therapies for Frozen Shoulder

• Shoulder Exercises: Stretching the tight shoulder capsule and strengthening surrounding muscles are crucial for recovery. In addition, doing exercises designed for a frozen shoulder can help improve flexibility and maintain range of motion, reducing the risk of long-term stiffness.
• Physiotherapy: Techniques such as laser therapy, TENS (Transcutaneous Electrical Nerve Stimulation), ultrasound, and moist heat therapy can effectively reduce pain and enhance shoulder mobility through guided exercises. These physical therapy methods are guided by trained professionals to ensure safe and gradual improvement in shoulder mobility.

Surgical and Minimally Invasive Interventions

• Steroid Injections: Steroids injections administrating directly into the joint can significantly reduce inflammation and shorten recovery time to 6-8 weeks. This treatment is often combined with stretching exercises and can effectively resolve symptoms in nearly 95% of patients. Typically, up to 2-3 injections can be administered safely over 6-8 weeks. However, individuals with diabetes should control their blood sugar levels before receiving injections.
• Manipulation Under Anesthesia (MUA): This procedure involves moving the joint through its full range of motion while the patient is under general anaesthesia to break adhesions. However, due to the risk of complications like rotator cuff tears and fractures, it is rarely used today.
• Arthroscopic Capsular Release: This minimally invasive procedure is reserved for patients who do not respond to at least three months of conservative treatment. In severe cases with significant joint deformities, arthroscopy is performed through small incisions. A medical camera is used to visualise the joint, and a radiofrequency device (commonly mistaken for a laser) releases tight tissues. This is typically a daycare procedure, providing immediate pain relief and restoring the full range of motion.

Note: Most patients experience significant improvement with non-surgical treatments, but in resistant cases, surgical options may be necessary to achieve optimal results.

How Can Frozen Shoulder Be Prevented?

While frozen shoulder isn’t always preventable, especially when linked to underlying medical conditions, certain proactive measures can be taken to significantly reduce the risk of developing it:

• Maintain Shoulder Mobility by regularly engaging in shoulder stretches and range-of-motion exercises, 
• Avoid Prolonged Shoulder Immobilisation
• Stay Physically Active
• Manage Underlying Health Conditions, such as diabetes, thyroid disorders, or cardiovascular disease 

When to See a Doctor for Frozen Shoulder?

You should see a doctor if you experience persistent shoulder pain that doesn’t improve with rest or over-the-counter pain relievers, especially if it disrupts your sleep or daily activities. 

Additionally, if you notice a gradual loss of shoulder mobility that makes it difficult to perform routine tasks like reaching overhead, dressing, or lifting, it's crucial to seek medical advice. 

Early evaluation is particularly important if you've had a recent shoulder injury, surgery, or if you have underlying conditions like diabetes, which increase the risk of frozen shoulder. Timely diagnosis and treatment can help prevent worsening stiffness and speed up recovery.

Conclusion

Frozen shoulders can significantly impact daily life, but with early diagnosis and the right treatment, it's possible to manage pain and restore mobility. Understanding the symptoms, causes, and available therapies can make a big difference in recovery. Max Hospitals offers expert care with advanced treatment options to help you regain shoulder function quickly and effectively. Don’t let shoulder pain limit your life—reach out to the specialists at Max Hospitals for a consultation and personalised treatment plan. Book your appointment today to take the first step toward a pain-free life.

Frequently Asked Questions about Frozen Shoulder

1. Are frozen shoulders painful?

Yes, they can be very painful, especially during the initial stages and at night.

2. Are frozen shoulder injections painful?

There may be mild discomfort during the injection, but it’s generally well-tolerated and quickly relieves pain.

3. What are the best exercises for frozen shoulders?

Gentle stretches, like the pendulum swing, wall climbs, and cross-body stretches, help improve flexibility.

4. Which muscles are affected in frozen shoulder?

The rotator cuff muscles and surrounding shoulder muscles are primarily affected due to stiffness.

5. Can frozen shoulder come back?

It’s uncommon, but it can recur, especially in the other shoulder.

6. Can frozen shoulder be cured?

Yes, with proper treatment and physical therapy, most cases can be fully resolved.

7. Can frozen shoulder cause neck pain?

Yes, compensating for shoulder stiffness can strain the neck, leading to pain.

8. Is frozen shoulder permanent?

No, with appropriate treatment, it usually resolves within 1-3 years.

9. How did I get frozen shoulder?

It can develop due to prolonged immobility, injury, or underlying conditions like diabetes or thyroid disorders.

10. Why is it called frozen shoulder?

The term refers to the shoulder becoming “frozen” due to pain and stiffness, limiting movement.

11. Can I fully recover from frozen shoulder?

Yes, most people achieve full recovery with a combination of therapies, although it may take time.