What Is Frozen Shoulder?
Learn more about what frozen shoulder is, its symptoms and causes and how to get proper care for the condition.
This article is based on reporting that features expert sources.
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:
- Diabetes. Frozen shoulder affects up to 25% of people with diabetes versus the 2% to 4% among the general middle-aged or older population, according to the American Diabetes Association.
- Thyroid disease. It may be more common in those with thyroid disease due to the increased presence of inflammation.
- Parkinson’s disease.
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:
- Pain in the shoulder area.
- Reduced range of motion with certain moves that involve your shoulder. This can make several activities harder to do, such as reaching the top shelf, washing your hair or picking something up, Marko says. Activities like dressing and putting on deodorant also are more challenging.
Frozen shoulder’s symptoms can be confused with several other conditions or health problems, such as:
- Bicep tendinitis.
- Bursitis, or an inflammation of the bursa, fluid-filled sacs that provide a cushion between bones and other parts of the body.
- Rotator cuff problems, such as a tear.
- Shoulder impingement, which is when the top outer edge of your shoulder blade pinches the rotator cuff that’s beneath it.
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:
- Freezing. This is when the shoulder is painful and becomes limited in its movements. This may take two to nine months, according to Mayo Clinic. Some health providers also add a stage before freezing called pre-freezing, used to describe the first month to three months with symptoms.
- Frozen. Although pain may get better during the frozen stage, the shoulder will get stiffer. The estimated time for the frozen stage is 4 to 12 months.
- Thawing. Within 5 to 24 months, the shoulder regains its range of motion.
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 treatments for frozen shoulder include:
- Anti-inflammatory drugs, such as ibuprofen.
- At-home exercises.
- Self-massage or massage by a professional. This can help loosen muscles or other parts of the body that become tighter when you have frozen shoulder. The muscles are working harder to compensate what you can’t do with your shoulder.
- Topical creams or lotions that help with pain.
These at-home treatments won’t make frozen shoulder get better faster, but they help with any bothersome symptoms, Miniaci says.
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 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.
Working with a physical therapist to help treat frozen shoulder can help in several ways:
- It prevents the shoulder capsule stiffness from getting worse.
- The activities done with a physical therapist can help improve the quality of your movements and function without making your symptoms worse, according to Steward.
- You’ll learn how to manage your symptoms.
- You can find out if you’re limiting certain movements because of loss of range of motion or because you’re guarding the shoulder area of the body – meaning you don’t want to move because you’re afraid it will hurt, Marko says.
- The physical therapist will give you exercises you can do at home to help maintain any benefits you obtained during in-person sessions.
Physical therapists use several techniques to help those with frozen shoulder:
- Manual therapy, or manipulation of the affected joints and muscles.
- TENS, or electrical stimulation therapy to help manage pain.
- Trigger point release, which uses massage or other techniques to release tension and pain.
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:
- Pendulums. Hang the affected arm down toward the ground. Move the arm in circles or side to side for up to two minutes. Perform up to three times daily to help manage pain.
- Shoulder blade squeezes. Squeeze your shoulder blades back. Hold for five seconds. Release. Perform two sets of 10, up to three times a day.
- Cane stretch. Using a cane or longer umbrella, lay down on the floor. Hold the cane or umbrella in both hands, and let your arms move it back toward your ears and to the floor. The non-affected side of your body should guide the side with frozen shoulder to move further. Go as far as you can go to feel a stretch but not pain. Repeat five times. “I like the lying-down-cane exercise because one can really relax their body and let gravity be your friend to help open the shoulder,” Marko says.
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.
What to Ask a Pain Management Doctor
The U.S. News Health team delivers accurate information about health, nutrition and fitness, as well as in-depth medical condition guides. All of our stories rely on multiple, independent sources and experts in the field, such as medical doctors and licensed nutritionists. To learn more about how we keep our content accurate and trustworthy, read our editorial guidelines.
Theresa Marko, PT, DPT, MS
Marko is 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.
Anthony Miniaci, MD
Miniaci is an orthopedic surgeon and deputy chief medical executive of Baptist Health Orthopedic Care in Florida.
Amanda Steward, PT, DPT, OCS
Steward is a physical therapist at Strive Physical Therapy, which has various locations in New Jersey and Pennsylvania.
Thomas “Quin” Throckmorton, MD
Throckmorton is a professor in the department of orthopaedic surgery at the University of Tennessee-Campbell Clinic in Germantown, Tennessee.