Healing the Pain of Frozen Shoulder

Frozen shoulder can be a perplexing condition. One day, you might notice a little soreness in your shoulder, then within a week or so, the pain becomes intense, and you can’t raise your arm. You haven’t injured your shoulder, so what the heck is going on?

Blame inflammation in the capsule surrounding the ball and socket joint of the shoulder, says UNC Health sports medicine specialist Gregory Summerville, MD. “The capsule around the ball and socket is like a water balloon, holding everything together around the shoulder. But in some people, the capsule starts to shrink and becomes tighter and tighter.”

The result is adhesive capsulitis, more commonly known as frozen shoulder.

The Cause of Frozen Shoulder Is Unknown

Frozen shoulder affects people who are in the gym every day and those who barely move away from their computer screen.

“Your activity level doesn’t seem to matter,” Dr. Summerville says.

Typically, it affects people between the ages of 40 and 60. More women than men get the condition.

A common risk factor is diabetes, although experts aren’t sure why. Uncontrolled diabetes, in particular, can make the symptoms of frozen shoulder worse and may lengthen recovery time.

Other diseases that appear to raise a person’s risk of experiencing frozen shoulder include hypothyroidism, hyperthyroidism, Parkinson’s disease and cardiac disease.

Occasionally, frozen shoulder can develop after an injury or surgery, he says, “but most of the time it’s not the result of trauma. It comes out of nowhere.”

The Three Stages of Frozen Shoulder

Frozen shoulder comes on in three distinct stages. First is the freezing stage: Your level of pain increases and your range of motion decreases. This stage typically lasts from six weeks to nine months. The lost range of motion makes it difficult to do simple chores like brushing your hair or hooking a bra in the back. It’s hard to reach things on a shelf above shoulder level. You may feel the pain in your shoulder and down the front of your arm.

“There’s pain with movement and pain with rest,” Dr. Summerville says. “A lot of people say the pain is worse at night and wakes them up.”

Next comes the frozen stage. The pain may ease during this time, he says, but the stiffness and limited movement remain. Expect this stage to last four to six months.

Finally, you reach the thawing stage. Your shoulder motion gradually improves, but it may take six months to two years for normal strength and range of motion to return.

“Despite knowing what it is and how to treat it, there’s nothing we can do to stop the freezing stage once it’s started,” Dr. Summerville says. “It’s going to continue.”

Getting Frozen Shoulder Diagnosed

If you’ve had shoulder pain or stiffness for more than two weeks, see your doctor, Dr. Summerville says. Frozen shoulder is typically straightforward to diagnose.

“You don’t need to have an MRI (magnetic resonance imaging) or an ultrasound to make a diagnosis,” he says. “If the X-ray is normal and you have loss of range of motion, you probably have frozen shoulder.”

While most cases are unexplained, in some cases an injury can lead to a frozen shoulder months later.

“I’ve had patients tell me they fell and were sore for about a month, but recovered,” he says. “Then, two months later, their shoulder freezes up. This is the less common or atypical type of frozen shoulder, where trauma or a tear can cause inflammation that leads to frozen shoulder.”

Treatment Options for Frozen Shoulder

Patients usually receive a combination of common treatments, Dr. Summerville says.

  • Physical therapy: A physical therapist can teach you stretches to exercise the capsule. “This stretching can be very painful,” Dr. Summerville says. “The capsule is inflamed, and you are putting pressure on it. But you have to stretch that capsule to restore your range of motion.”
  • Medications: Nonsteroidal anti-inflammatory drugs, or NSAIDs, help relieve inflammation and pain. These include aspirin, ibuprofen (Advil, Motrin) and naproxen sodium (Aleve). Avoid taking NSAIDs for too long, because of possible side effects such as irritation of the stomach lining that can lead to ulcers, as well as potential damage to the kidneys, Dr. Summerville says.
  • Cortisone injections: A clinician can inject a steroid into the shoulder to relieve pain and improve range of motion. “Usually one injection is given into the ball and socket joint,” Dr. Summerville says, “but sometimes several are needed over a period of months.”
  • Hydrodilatation: This injection is a large volume of fluid that includes a numbing medicine, saline and smaller amount of cortisone than injections of cortisone alone. “This fluid stretches the capsule very effectively,” says Dr. Summerville, who is leading a research study at UNC to assess the difference between hydrodilatation and cortisone injections.
  • Surgery: Shoulder arthroscopy, in which a surgeon cuts through tight portions of the joint capsule, may also be used.

“Another option is to do nothing,” Dr. Summerville says. “I tell patients that their shoulder will hurt for a year and a half to two years, and then slowly get better—but it will be a miserable year and a half.”

Recovering from Frozen Shoulder

People with frozen shoulder can do exercises at home that help stretch the shoulder, Dr. Summerville says.

“I tell patients that they have to push themselves to regain their motion,” he says. “They have to push through the pain, or their range of motion is not going to come back. They should feel tolerable discomfort when they are stretching.”

If you stretch so hard that you are too sore the next day to stretch, you’ve gone too far, he says.

“The key is consistency,” he says. “You should do your stretches three times a day if you can.”

Having professional physical therapy also is critical to recovery, he says, especially when you are building back your strength.

“You should start physical therapy as soon as you can, especially after the large-volume injections, so you can keep stretching the capsule,” he says. “The physical therapist will manipulate your shoulder, making sure it is stretching correctly and building up the shoulder strength the right way.”

Frozen Shoulder Can Come Back

Unfortunately, frozen shoulder can recur. “If it comes back, it’s not usually right away, but a couple of years down the line. It’s the same process; it’s not better or worse the second time. You just have to work through the freezing and unfreezing phases.”

And you can get it in the other shoulder.

“Sometimes people get it in both shoulders at the same time,” Dr. Summerville says. “But fortunately, that’s not common.”

If pain or stiffness in your joints is interfering with your daily life, talk to your doctor, or find one near you.