If you hear the term frozen shoulder and think of a shoulder encased in ice, you’re not too far off. Also called adhesive capsulitis, frozen shoulder is a condition that makes the shoulder capsule stiff and inflamed. It’s often painful, and there’s reduced range of motion in your shoulder. You may feel as if your shoulder is “frozen.”

Frozen Shoulder Causes

Health providers often don’t know what causes frozen shoulder in patients, says Dr. Thomas “Quin” Throckmorton, a professor in the department of orthopaedic surgery at the University of Tennessee-Campbell Clinic in Germantown, Tennessee. However, some known causes include a shoulder injury or immobilization of your shoulder for a long period of time. For instance, your arm was in a cast for a while, or you had surgery on your upper body and couldn’t move your shoulder much during recovery.

Frozen shoulder is more common in females age 40 to 60. Among people over age 40, it affects 2% to 4% of the population. Frozen shoulder also occurs more often in people with certain health conditions, such as:

When frozen shoulder is diagnosed in someone with diabetes, it’s often associated with uncontrolled blood sugars, says Dr. Anthony Miniaci, an orthopedic surgeon and deputy chief medical executive of Baptist Health Orthopedic Care in Florida. In fact, he previously helped discover diabetes in a patient who didn’t know they had it; the patient’s frozen shoulder diagnosis led to a check of blood sugar levels, which helped diagnose diabetes.

Anecdotally, Theresa Marko, a board-certified clinical specialist in orthopedic physical therapy, owner of Marko Physical Therapy in New York City and a spokesperson for the American Physical Therapy Association Media Corps, has observed that frozen shoulder tends to occur more often in those who are going through a stressful time in their life. This could be due to increased inflammation in the body during periods of stress.

Frozen Shoulder Symptoms and Diagnosis

Symptoms of frozen shoulder include:

Frozen shoulder’s symptoms can be confused with several other conditions or health problems, such as:

These conditions may give you similar pain, but frozen shoulder has a more marked loss of range of motion, Marko says.
To help pinpoint the exact cause of stiffness and inflammation, health providers will complete a medical history and physical exam. This, combined with the presenting symptoms, often can help lead to the diagnosis. To formally confirm frozen shoulder, a health provider may order an MRI, an X-ray or both.

The Phases of Frozen Shoulder

Frozen shoulder goes through three distinct phases:

Treatments for Frozen Shoulder

Treatment for frozen shoulder includes:

Frozen shoulder has a long recovery time. It may get better in a little under a year, or it may take as long as one to three years, says Amanda Steward, a physical therapist at Strive Physical Therapy, which has various locations in New Jersey and Pennsylvania.
“Patients need to know that there may not be a quick fix with either surgical or non-surgical treatment,” Throckmorton says.

Frozen shoulder is a self-limiting problem, meaning that it will get better even if no active treatments are used. Yet the available treatments can help reduce pain and assist in managing your symptoms and range of motion.

At-Home Pain Relief

At-home treatments for frozen shoulder include:

These at-home treatments won’t make frozen shoulder get better faster, but they help with any bothersome symptoms, Miniaci says.

Cortisone Injection and Hydrodilatation

A doctor treating frozen shoulder can offer a cortisone shot to reduce inflammation and stiffness. The shot will help symptoms for four to six months, though that length of time will vary by person. If you have diabetes, you’ll need to speak with your health provider about whether a cortisone injection is right for you as it can raise blood sugars.

Another option is called hydrodilatation, which places an injection of saline in the joint and expands the ligaments to stretch them out. When Miniaci performs this, he will follow up with a cortisone injection.

Surgery

Surgery is sometimes used for frozen shoulder if more conservative treatments haven’t helped. One surgical procedure involves manipulation under anesthesia. The surgeon will force the shoulder to move, causing the capsule and scar tissue to stretch. This can release tightening and improve range of motion, according to the American Academy of Orthopaedic Surgeons.

A second procedure is shoulder arthroscopy, during which a surgeon will cut through the joint capsule’s tight portions. Sometimes, both procedures are done at the same time.

Surgery for frozen shoulder usually has good results. Still, it’s possible for frozen shoulder symptoms to recur after surgery, Miniaci says. This is one major reason why he uses surgery as a last resort for frozen shoulder.

Physical Therapy

Working with a physical therapist to help treat frozen shoulder can help in several ways:

Physical therapists use several techniques to help those with frozen shoulder:

The exercises done in physical therapy can help improve your tolerance to your symptoms in frozen shoulder’s various stages. They don’t necessarily move you through the stages more quickly, though, Steward says.
A physical therapist also may help you regain strength in your shoulder. When you have frozen shoulder, you may be able to do some lighter strength training, such as arm movements involving your biceps or triceps, Marko says. More intense strength building will likely have to wait until you have better range of motion and less pain, Throckmorton adds.

For muscles like the deltoids and external rotators, follow advice from your physical therapist so you work in your range of motion without straining and reinforcing bad patterns of movement, Marko advises. The physical therapist also can advise on regaining strength after any muscle weakness from not moving your arm for a long time.

Exercises for Frozen Shoulder

You should follow the home exercises given to you by a health provider as they will match where you are in the frozen shoulder stages. The exercises below are generically appropriate if you have frozen shoulder:

Some Final Words on Frozen Shoulder

It’s possible for frozen shoulder to recur in your other shoulder. This happens in 20% to 25% of patients, Throckmorton says. Regular range-of-motion stretches for your shoulders, physical activity and a healthy diet can keep your shoulders healthy. There’s no guarantee that these steps will prevent a recurrence though.

Frozen shoulder can be painful, and the recovery may seem frustratingly long. Yet it does get better. Follow any at-home exercises as needed, visit a physical therapist if you can and do what you need to relieve pain.