Frozen shoulder, medically known as adhesive capsulitis, is a condition defined by stiffness and pain in the shoulder joint. These symptoms begin gradually, worsen over time, and can significantly limit the joint’s range of motion. The condition originates in the shoulder’s joint capsule, the connective tissue that encloses the ball-and-socket joint. When this capsule becomes thick, stiff, and inflamed, movement becomes progressively more difficult and painful, restricting everyday activities.
Symptoms and Stages of Frozen Shoulder
The experience of frozen shoulder unfolds over three distinct stages. The “freezing” stage can last from two to nine months and is marked by the gradual onset of shoulder pain, which intensifies with movement and often worsens at night. As the pain increases, the shoulder’s mobility steadily decreases.
The “frozen” stage follows, lasting from four to twelve months. During this period, sharp pain may lessen, but the shoulder becomes significantly stiffer. This increased rigidity makes it difficult to perform daily tasks, and the loss of motion becomes the primary complaint.
The final stage is the “thawing” or recovery phase. This stage is a slow, gradual improvement in the shoulder’s ability to move over a period that can last from five months to two years.
Associated Causes and Risk Factors
The underlying mechanism of frozen shoulder involves the connective tissue capsule that surrounds the shoulder joint becoming inflamed, thick, and tight. Bands of scar tissue, called adhesions, can form, and the volume of lubricating synovial fluid within the joint may decrease, restricting movement.
Certain factors increase a person’s risk of developing this condition. It most commonly affects individuals between 40 and 60 years old and is more prevalent in women. Prolonged immobility of the shoulder after surgery, a broken arm, or a stroke is a significant risk factor.
Systemic diseases also play a role. People with diabetes are at a much higher risk of developing the condition. Other associated medical issues include thyroid conditions, Parkinson’s disease, and cardiovascular disease.
The Diagnostic Process
Diagnosing frozen shoulder is a clinical process based on a patient’s symptoms and a physical examination. A physician will discuss the history of the symptoms, noting the gradual onset of pain and stiffness. The diagnosis involves assessing the shoulder’s range of motion by checking both active movement, where the patient moves their own arm, and passive movement, where the doctor moves the patient’s arm.
A primary indicator of frozen shoulder is a limitation in both active and passive range of motion, particularly in external rotation. This helps differentiate it from other conditions, like a rotator cuff tear, where passive motion might still be intact.
While the physical exam is often sufficient, imaging tests may be used to rule out other problems. An X-ray might be ordered to check for issues like arthritis, while an MRI can exclude other soft tissue injuries.
Available Treatment Options
The management of frozen shoulder focuses on controlling pain and restoring movement, with most cases improving with conservative treatments. The foundation of recovery is physical therapy, which utilizes specific stretching and range-of-motion exercises to improve flexibility. A physical therapist can guide a patient through these exercises to ensure they are performed correctly.
To manage pain, over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are commonly recommended. For more severe pain, a doctor may suggest a corticosteroid injection into the shoulder joint. This can provide significant pain relief, making physical therapy more productive.
For cases where symptoms do not improve after several months of conservative treatment, more advanced procedures may be considered. One option is hydrodilatation, where sterile fluid is injected to expand the capsule. Another is manipulation under anesthesia, and in the most persistent cases, arthroscopic surgery may be used to cut through the tight portions of the joint capsule.