Written by Edward Umheiser, PT, DPT
Edited by Alex Ariza

Injuries to the shoulder are fairly common in everyday life. Strains and sprains resulting from repetitive activities such as throwing a ball or twisting your arm while reaching behind your car seat happen all the time, and usually heal on their own in only a few days. But what happens if your shoulder suddenly starts to lose its normal range of motion for an unexplained reason?

In this article, I would like to talk about the diagnosis known as adhesive capsulitis, more commonly referred to as frozen shoulder.

What is Frozen Shoulder?

Frozen shoulder is a fairly common diagnosis, but is not well understood and does not always have a known cause. Many people develop frozen shoulder following a surgical procedure to the shoulder, or after an injury that results in the shoulder needing to be immobilized for a short period of time. However, in some cases, some people develop symptoms with no known trigger.

The symptoms are fairly clear-cut – a marked loss of normal range of motion and stiffness of the shoulder joint that may or may not be accompanied by pain.

This shoulder stiffness affects motion in all directions such as reaching up in the air or trying to place the hand behind the back or behind the head. Adhesive capsulitis begins as an inflammatory process within the shoulder and leads to scar tissue formation which can restrict shoulder motion.

For some people, this scar tissue formation can lead to pain in the shoulder joint, especially with movement and during the evening hours while trying to sleep.

The Stages of Frozen Shoulder

There are several stages of frozen shoulder each with their own unique characteristics:

Inflammatory Stage

The inflammatory stage lasts approximately three months and is characterized by pain with shoulder movement in most directions. Pain is often sharp with movement at the end of the range, and there is an ache at rest. Pain is also commonly felt at night, making it difficult to fall asleep.  The range of motion may still be normal at this early stage.

Freezing Stage

The freezing stage typically lasts 3-9 months. This is when flexibility of the shoulder begins to reduce due to pain. At this time, people often begin to notice difficulty reaching overhead, or reaching behind their back. This stage, known as the frozen stage, is when the stiffness is most severe. The inflammatory process inside the shoulder joint is starting to decrease at this stage so pain is lessened or non-existent. Over the past several months a thick layer of scar tissue has formed around the shoulder capsule, which makes it difficult to move. This is the stage when most people are diagnosed with frozen shoulder.

Thawing Stage

Finally, the thawing stage is when shoulder motion gradually starts to return to normal. This stage can last anywhere from 9 months to two years and may leave some minor limitations in shoulder range of motion afterward.

Treating A Frozen Shoulder

Physical therapy along with treatment provided by your doctor such as cortisone injections are the first line of defense in reducing the time a patient may experience the symptoms related to a frozen shoulder.

A doctor will typically take some images of the shoulder to rule out other possible structural involvement such as the rotator cuff or the labrum.

At that point, physical therapy treatment 2-3x a week is generally recommended where manual shoulder stretching, massage, mobilization, and exercises are performed to keep the shoulder as pain-free as possible, and to help increase the range of motion.

It is also important to continue to perform the prescribed stretching exercises at home under the guidance of a physical therapist. Generally, the time it takes for a frozen shoulder to “thaw” can be halved under physical therapy treatment. Most patients do not need surgical intervention to correct this diagnosis.

Steps to Take If You Suspect Having a Frozen Shoulder

If you have noticed that you have a lot more difficulty with overhead shoulder motion following a shoulder injury, let your doctor know. If this has persisted for several months, it may be a sign of adhesive capsulitis. An orthopedist can help you make that diagnosis, and physical therapy can help you get onto the road to recovery.

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