Frozen Shoulder 101: What It Is, Why It Happens, and How to Get Relief

Waking up with a stiff shoulder that aches with every little movement is a frustrating reality for many. Reaching for an item on a high shelf becomes a difficult task, and simple actions like getting dressed can feel almost impossible. This painful and limiting condition, where the arm loses its range of motion, is not just a minor ache. It can profoundly affect daily life, making even simple tasks feel like a major challenge.

This article will help you understand frozen shoulder, also known as adhesive capsulitis. We will explain what it is, why it occurs, and describe the journey it takes a person on. We will also provide practical advice and treatment options to help manage the symptoms and regain function.

What Exactly Is Frozen Shoulder?

Adhesive capsulitis is a condition marked by pain and stiffness in the shoulder joint. The shoulder joint is a ball and socket joint that is protected by a connective tissue capsule.  This capsule tightens and thickens, creating scar tissue, when a person has frozen shoulder. This process severely limits the shoulder’s movement. While the exact cause is not always clear, the result is a progressively painful condition that hinders movement. It typically develops slowly over time and can affect one or both shoulders. 

The condition often impacts people aged 40 to 60, with women more commonly affected than men. According to data from various studies, it is estimated that between 2% and 5% of the general population suffers with adhesive capsulitis.

The Three Stages

Frozen shoulder typically follows a predictable progression through three distinct stages. Each phase has its own symptoms and can last for several months, making the condition a long-term experience for many.

• The Freezing Stage
  This phase often marks the start of the condition. Pain begins gradually, becoming more intense with time. The pain is often described as a constant, dull ache that worsens with movement and can be particularly severe at night. As the pain increases, the person begins to lose their range of motion. The shoulder feels progressively stiffer, making it difficult to perform everyday tasks. This stage can last anywhere from six weeks to nine months, and during this time, the person’s mobility continues to decrease. It’s during this stage that patients often seek medical advice because of the new and persistent symptoms.

• The Frozen Stage
  During this phase, the pain may start to subside, but the shoulder’s stiffness and limited range of motion become the primary issue. The joint feels very rigid, and any attempt to move it beyond its restricted range causes discomfort. Activities such as dressing, reaching for a seat belt, or even holding a bag become challenging. This stage can last from four to twelve months. While the pain is less of an issue, the significant reduction in mobility can greatly affect a person’s quality of life. The shoulder is described as “frozen” because the joint’s movement is severely limited.

• The Thawing Stage
  This is the recovery phase. The shoulder’s range of motion slowly and gradually returns. The pain continues to decrease, and the person begins to regain function. This process can be very slow, taking anywhere from five months to two years, and in some cases, even longer. While most people see a full or nearly full recovery, some may experience some persistent stiffness. This stage requires patience and consistent effort to help the shoulder heal and restore its mobility.

Key Symptoms

Shoulder stiffness and pain can manifest in several ways. If a person is experiencing multiple of these symptoms, they may have frozen shoulder:

• A progressive, dull, and aching pain in the shoulder.
• Pain that worsens with movement or at night, often disrupting sleep.
• A gradual loss of both active and passive motion.
• Difficulty with reaching overhead, reaching behind the back, or out to the side.
• Challenges with daily activities like getting dressed, brushing hair, or driving.
• A feeling of tightness and rigidity in the shoulder joint.
• Pain radiating down the arm.

Why Does It Happen? Causes and Risk Factors

While the exact cause of adhesive capsulitis is not fully understood, there are several known factors that increase a person’s risk of developing the condition. The formation of scar tissue and inflammation in the shoulder capsule is the underlying problem.

• Diabetes
  Individuals with diabetes are at a significantly higher risk of developing frozen shoulder, with an incidence rate of up to 15%. The high blood sugar levels associated with diabetes can cause collagen fibres in the shoulder to become sticky, leading to the thickening and contracting of the joint capsule. Managing diabetes to prevent joint problems is an important part of overall health for people with the condition.

• Prolonged Immobilization
  If the shoulder is kept still for an extended period, it can lead to the formation of scar tissue and stiffness. This can happen after a surgical procedure, a broken arm, or other injuries that require a person to wear a sling or a cast. Shoulder injury and post-operative care must include a plan for maintaining motion.

• Systemic Diseases
  Certain medical conditions are linked to a higher incidence of frozen shoulder. These include hypothyroidism, hyperthyroidism, and other thyroid disorders. Parkinson’s disease, heart disease, and autoimmune conditions are also known risk factors. Joint stiffness and medical conditions are often connected.

• Age and Gender
  Frozen shoulder is most common in individuals between the ages of 40 and 60. Women are more likely to develop the condition than men. Hormonal and biological differences between genders may play a part in this disparity. Shoulder health over 40 becomes a greater concern.

• Prior Shoulder Issues
  A history of previous shoulder injuries, such as rotator cuff tears or tendinitis, can increase the risk of developing a frozen shoulder. The body’s inflammatory response to these injuries can contribute to the tightening of the joint capsule. Preventing frozen shoulder after injury is a key concern.

• Inactivity
  Leading a sedentary lifestyle or not being physically active can increase the risk of frozen shoulder. Lack of movement can cause the shoulder joint and surrounding tissues to become stiff and prone to issues. Physical activity and joint health are closely related.

How to Get Relief

Recovery from a frozen shoulder requires a patient and consistent approach. The primary goals of any treatment plan are to manage pain, reduce inflammation, and restore as much mobility as possible.

• Physical Therapy
  This is often the first and most vital part of a treatment plan. A physical therapist can guide a person through a series of gentle stretching and range-of-motion exercises to restore movement and break down scar tissue. Consistency is crucial, and a person must follow their prescribed home exercise routine. 

• Pain Management
  Over-the-counter pain relievers such as non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help to reduce pain and swelling. In more severe cases, a doctor may recommend prescription medication or corticosteroid injections directly into the joint to alleviate pain and inflammation.

• Heat and Cold Therapy
  Applying heat to the shoulder before exercise can help loosen the joint and improve flexibility. A warm compress or hot shower can be effective. After exercise, applying an ice pack can help reduce pain and inflammation. At-home remedies for stiff shoulder can provide relief.

• Hydrodilatation
  This treatment includes injecting a substantial amount of a sterile fluid into the shoulder joint to extend and enlarge the capsule.  To lessen discomfort, an anaesthetic is frequently used during the procedure. This treatment can increase the joint’s range of motion and is sometimes combined with a corticosteroid injection.

• Acupuncture
  Some people find relief from frozen shoulder symptoms through acupuncture. This involves the insertion of fine needles into specific points on the body. It may help reduce pain and improve function by promoting blood flow and releasing tension in the muscles around the shoulder.

• Surgery
  Surgery is considered a last resort and is only an option if other treatments have not been successful. Procedures include manipulation under anaesthesia, where the surgeon manually forces the arm to move to break up scar tissue, or arthroscopic capsular release, where a tiny incision is made to cut away the tight parts of the joint capsule.

Frozen shoulder is a condition that requires patience, persistence, and a focused treatment plan. While the journey through the three stages can be long and challenging, most people will see a significant improvement and a return to normal function. The key is to manage the pain, stay consistent with a movement plan, and work with a healthcare professional to determine the most suitable course of action.

Do not allow frozen shoulder symptoms to disrupt your life. Getting help early is a significant step towards a faster recovery. If you or someone you know is experiencing persistent pain and stiffness in the shoulder, consider reaching out to a qualified physical therapist. For help with frozen shoulder and other musculoskeletal conditions, contact the physiotherapy services at PARC Ontario. Visit us at our various locations: (416) 445-2075 or (416) 430-0314 [Scarborough], (905) 897-2092 [Mississauga], (905) 686-9081 [Ajax], (905) 430-2112 [Whitby], and (905) 579-9938 [Oshawa].