Frozen Shoulder: Symptoms, Causes, Diagnosis and Treatment

Frozen shoulder or Adhesive Capsulitis is a condition that causes stiffness and pain in the shoulder joint.

Signs and symptoms usually begin gradually, worsen over time, and then resolve usually within 1 to 3 years.

Your risk of developing frozen shoulder increases if you are recovering from a medical condition while you move your shoulder.

Moreover, it can also result from a procedure that prevents you from moving your arm.

These procedures include a stroke or mastectomy.

There are a number of treatment options available ranging from exercises to sometimes corticosteroids and numbing medications.

Your doctor might inject these medications into the joint capsule.

In some cases, however, arthroscopic surgery may be required.

This may be indicated to loosen the joint capsule so that it can move freely.

It is unusual for a frozen shoulder to recur, however, some individuals can develop it in the opposite shoulder.

Let’s learn more about its causes, symptoms, diagnosis, and treatment in detail.

Symptoms of a Frozen Shoulder

Frozen shoulder usually develops slowly and in 3 stages.

Each of these stages can last a number of months. Let’s discuss them as follows;

Freezing Stage: Any movement of your shoulder can cause pain, and your shoulder’s range of motion starts to become limited.

Frozen Stage: During this stage, pain may begin to diminish.

However, your shoulder can become stiffer, and using it becomes more difficult.

Thawing Stage: During this stage, the range of motion in your shoulder begins to improve.

For some individuals, the pain can worsen at night, even disrupting their sleep sometimes.

Causes of Frozen Shoulder

The bones, ligaments, and tendons that make up your shoulder joint are encased in a capsule of connective tissues.

However, a frozen shoulder can occur when this capsule thickens and tightens around the shoulder joint, thus restricting the movement.

Doctors are not sure why this happens, although it is more likely to occur if you have type 1 diabetes or type 2 diabetes.

Moreover, it can also occur if you had to immobilize your shoulder for a long period of time.

This usually includes not using your shoulder after a surgery or an arm fracture.

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Immobility and Systemic Diseases

If you had prolonged immobility or reduced mobility of your shoulder, you are at a higher risk of developing a frozen shoulder.

This immobility can result from a number of factors.

These are rotator cuff surgery, broken arm, stroke, or recovery from surgery.

On the other hand, if you are suffering from systemic diseases then you are more likely to develop a frozen shoulder.

Medical conditions that can increase your risk are as follows:

Diabetes, overactive thyroid, or hyperthyroidism, underactive thyroid, or hypothyroidism.

Cardiovascular diseases, tuberculosis, and Parkinson’s diseases can also increase your risk of developing them.

Diagnosis of Frozen Shoulder

During the physical examination of the frozen shoulder, your doctor will ask you to move your arms and shoulder in certain ways.

This will help them to check for pain and evaluate the range of motions or active range of motions.

They may ask you to relax your muscles while you move your arm or passive range of motion.

It is important to note the frozen shoulder affects both active and passive range of motions.

In some cases, your doctor may also order image tests like an X-ray or an MRI scan to rule out the presence of other conditions.

Moreover, they might also inject your shoulder with a numbing medication or anesthetic to determine your passive and active range of motion.

Treatment Options

You can leave your frozen shoulder untreated, however, the pain and stiffness can remain there for up to 3 months.

A combination of the following can help speed up your recovery:

Physical therapy, medication, surgery, and home care.

Let’s discuss these options as follows:

Physical Therapy

One of the most common treatment options for a frozen shoulder is physical therapy.

The goal is to stretch your shoulder joint and regain the lost motions. However, it can take a few weeks to 9 months at least to see progress.

Moreover, a home exercise program of gentle range of motion exercises can help.

If you do not see any progress after 6 months of intense, daily exercises, talk to your doctor about other options.

Medications

To treat the pain and reduce the joint inflammation, your docotr may prescribe anti-inflammatory medications.

These include using aspirin, ibuprofen, or naproxen sodium.

Moreover, a steroid injection to your shoulder joint can also help.

Home Care for Frozen Shoulder

Placing an ice pack on your should for at least 15 minutes at a time, a number of times per day can help to decrease the pain.

Moreover, if you are already working with a physical therapist, then they will provide some instructions on the type of exercises you can do.

They will also guide you on how often you can do them and when to push yourself harder.

For most individuals, a frozen shoulder can improve without surgery.

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Surgery for Frozen Shoulder

In case, physical therapy is not helping to treat your frozen shoulder, then surgery is an option.

From a surgical viewpoint, the options are to manipulate the shoulder and put it through a full range of motions under general anesthesia.

This helps to break up any adhesions in your shoulder.

Another option is arthroscopic surgery.

This option includes making a small cut to your shoulder and using a small camera or Arthroscope, to remove the scar tissue or release it.

This allows your shoulder to recover its lost motion.

However, if this condition is the result of an injury, surgery is typically more successful.

This is the case if your doctor performs it within a few weeks of injury.

Surgery will be carried out on an outpatient basis.

Your doctor will remove the stitches after 10 days.

Postoperative physical therapy is also recommended after the procedure.

It is important to note that you will have the full range of motion back within 3 months.

However, surgeries carry risks, thus, make sure to talk to your doctor before deciding on any procedure.

You might have some or stiffness afterward or is unable to handle the pain of physical therapy.

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Now let’s learn about some gentle range of motion exercises you can try at home.

Gentle Range-of-Motion Exercises

Go slow in the first and most painful stage of a frozen shoulder.

Increase the repetitive motion gradually, without increasing the pain you are experiencing.

According to a study, if you exercise within the limits of pain, you will reach near-normal, painless shoulder motion at 13 months or 64%  and 24 months or 89%.

This is in comparison to those individuals who are receiving more intensive physical therapy by 63% reaching near-normal, painless shoulder motion at 24 months.

Let’s discuss some of these exercises as follows:

1# Behind the back Stretch

For this exercise follow the instructions as follows:

Stand with your legs shoulder-width apart and put your affected arm behind your back.

Use your other hand to gently push the palm of the affected arm up toward the opposite shoulder.

Hold the stretch from 1 to 5 seconds, and stop when you begin to feel pain.

It is important to repeat the stretch 2 to 3 times a day.

2# Abduction Stretch

Abduction means to move your arm away from the midline of your body.

Follow the instructions below:

Sit next to a table, while resting your affected forearm and elbow on the surface.

Slowly slide your forearm away from the body and stop when you begin to feel pain.

Your body will tilt or move with this motion, however, do not lean on the table.

Repeat this stretch at least 2 to 3 times a day.

3# External Rotation Door Stretch

Follow the instructions below for this stretch:

Stand in the door frame with the elbow of the affected arm bent at a 90-degree angle.

Rest your palm and wrist against the door frame.

Keeping your forearm in one place, slowly turn your body away from the doorframe.

Stop the stretch when your begin to feel pain and repeat at least 2 to 3 times a day.

4# Pendulum Exercise

This exercise requires you to use a passive range of motion to manipulate your arm and shoulder without using the muscles in your affected shoulder.

For this exercise follow the instructions below:

Sit or stand next to a table with your affected arm dangling at your side and your other arm on the table.

Lean forward from your wrist, and use your body to move the affected arm in small circles.

Thus, keeping your shoulders relaxed.

Repeat this exercise 2 to 3 times a day for at least 1 to 2 minutes at a time.

5# Wall Climb Stretch

Moving to the second stage of a frozen shoulder with less pain, you can increase the stretch times and the repetition.

Moreover, you can add in some strengthening activities as well.

Try adding a small weight to your affected arm in exercise 4 like a soup pain.

Or, push your affected arm further up your back in exercise 1.

For wall climb stretch, follow the instructions below:

Stand facing the wall, with the hand of your affected arm against the wall.

Slide your hand and arm up the wall as far as you can without pain.

Move your body closer to the wall so that you are able to stretch higher up the wall, and hold the stretch for 15 to 20 seconds.

Repeat this stretch at least 10 times.

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6# Adduction Exercise

Adduction means to move your arm toward the body and is the opposite of abduction.

For this exercise:

Tie an exercise band or a resistance band onto a doorknob or something heavy.

Hold the other end in the hand of your affected arm.

Then stand far enough from where you have anchored the band so that the band is taut when your arm is outstretched.

Move your arm towards your body and then away, in a gentle back-and-forth motion, at least 10 times.

It is important to note that do not do this exercise if you have increased pain.

Thus, as you get stronger, you can increase your repetitions.

Final Thoughts

With the help of physical therapy, routine stretching, and exercises, you can reduce pain both in short term and long term and also increase the range of motion in the frozen shoulder. Thus seek medical advice.

Moreover, your doctor may advise you of an exercise program in combination with medications like NSAIDs, pain relief medications, and corticosteroids, hydrodilatation, or hyaluronan injections. However, consult your doctor or physiotherapist before trying any exercise at home.