Frozen shoulder, known as adhesive capsulitis, causes pain, stiffness, and limited range of motion in the shoulder, making it very difficult to move the joint. This condition starts slowly, gradually becoming worse over time. Various medical conditions and procedures increase the risk of developing frozen shoulder. Treatment involves regular therapy, and it can take as long as three years to regain full range of motion. Symptoms of a frozen shoulder can be similar to other conditions, such as arthritis, but the underlying causes vary.

Understanding the Anatomy of the Shoulder

Shoulders have a greater range of motion than any other joint in the body. The glenohumeral is a ball and socket joint that connects the humerus bone to the glenoid cavity in the shoulder blade or scapula. Surrounding the joint is a capsule filled with synovial fluid that allows the joint to move smoothly. Ligaments and tendons that connect muscle and bone surround the capsule. The band of tendons and muscles that surround the joint and help to stabilize the shoulder is the rotator cuff.

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What Happens When a Shoulder Freezes?

The natural ability of each of these components to stretch and move smoothly is what lets the shoulder move in the many directions that it can. With a frozen shoulder, flexible and stretchy tendons and connective tissue thicken and contract, limiting the ability to stretch. A frozen shoulder is not something that happens overnight -- it can take many months to develop. As the shoulder stiffens, it enters the "freezing stage."

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The Freezing Stage

In the freezing stage, pain and stiffness develop. It gradually becomes more difficult to perform daily tasks, such as reaching up to put away dishes or reaching behind the back to clasp a bra, without experiencing more and more pain. As the pain continues to worsen, the range of motion becomes further limited. While the condition is called a frozen shoulder, the freezing stage can be the most painful. This stage typically lasts as little as six weeks to as long as nine months.

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The Frozen Stage

The frozen stage gets its name because, in this stage, the joint often freezes in place with little to no range of motion. While movement is extremely difficult, the pain subsides. Performing daily activities during this stage may be almost impossible, with many people requiring assistance. The frozen stage typically lasts four to six months.

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The Thawing Stage

The thawing stage is a sign that the shoulder is on the road to recovery. With regular treatments and exercises, the shoulder joint slowly allows for movement and range of motion increases. This slow process can take anywhere from six months to two years. Every person is different, and while one person may recover quickly with little to no treatment, another may require extensive therapy.

symptoms of frozen shoulder Dean Mitchell / Getty Images


Risk Factors that Contribute to Frozen Shoulder

Anyone can suffer from a frozen shoulder, but certain factors can increase the risk. An injury or medical condition that prevents arm movement for an extended period can raise the likelihood of developing a frozen shoulder. Older people and women, in general, are more likely to get the condition, as are people with diabetes, hyperthyroidism, hypothyroidism, cardiovascular disease, Parkinson’s disease, and tuberculosis.

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Testing for a Frozen Shoulder

Unlike other conditions, there aren’t any specific tests to identify a frozen shoulder. Doctors may order tests like x-rays to rule out other conditions such as a rotator cuff injury or arthritis. In cases of arthritis, x-rays will reveal bone and joint damage. For the most part, the doctor will rely on a physical examination, evaluating the ability to move the shoulder and the patient's reactions manipulation of the joint.

frozen shoulder muscle Mikolette / Getty Images


Treatment Options for Frozen Shoulder

Initial treatment for a frozen should focus on reducing pain with medications and improving range of motion through physical therapy and exercises. Regularly performing these exercises is essential to recovery. In cases where physical therapy is not enough, the doctor may inject corticosteroids into the joint to reduce pain and inflammation. Severe cases may require surgical intervention, usually through arthroscopic methods that seek out and remove scar tissue or adhesions inside the joint.

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Exercises to Improve Shoulder Range of Motion

A variety of different exercises can help improve the range of motion in the shoulder. Before starting any exercises, have a warm shower or apply a heating pad to warm up the joint. Some sample exercises include the pendulum stretch, where a person leans over an object with the arm extended downward and slowly allows the arm to swing like a pendulum. The towel stretch requires taking a towel behind the back and the cross-body reach stretches out the shoulder by reaching across the body.

shoulder andresr / Getty Images


Seek Medical Care for a Frozen Shoulder

Anyone who suspects a frozen shoulder should seek medical care as soon as possible. The doctor will rule out any underlying conditions, such as a bone, joint, or muscle injury, as well as arthritis. Once these are ruled out, and the individual receives a diagnosis, the doctor can develop a therapy plan that will slowly help the patient regain use of the shoulder.

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