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Frozen Shoulder Mysteries Revealed

March 10, 2024

Frozen Shoulder Mysteries Revealed: Causes, Symptoms, and Management

As a physical therapist specializing in shoulder conditions, I frequently encounter patients struggling with a condition known as frozen shoulder, or adhesive capsulitis. This debilitating condition not only causes discomfort but can also significantly restrict shoulder mobility. In this comprehensive guide, we will explore the causes, symptoms, stages, and management strategies for frozen shoulder, offering insights and practical advice for those affected by this condition.

What is Frozen Shoulder?

Frozen shoulder is a condition characterized by stiffness and pain in the shoulder joint. Over time, the shoulder becomes very hard to move. It typically affects one shoulder, but in some cases, it can spread to the other shoulder.

Causes of Frozen Shoulder:

  1. Idiopathic Causes:
    • Often, the exact cause of frozen shoulder is unknown. However, it tends to develop more frequently in individuals over the age of 40 and is more common in women.
  2. Post-Injury or Surgery:
    • Frozen shoulder can develop after an injury or surgery that results in prolonged immobility of the shoulder joint.
  3. Medical Conditions:
    • Certain medical conditions like diabetes, thyroid disorders, and cardiovascular disease are associated with a higher risk of developing frozen shoulder.

Symptoms of Frozen Shoulder:

  1. Pain:
    • One of the first symptoms is usually a dull or aching pain in the shoulder. The pain can worsen at night, often disturbing sleep.
  2. Stiffness:
    • Gradual increase in stiffness, making it difficult to perform everyday activities like dressing or reaching overhead.
  3. Limited Range of Motion:
    • As the condition progresses, the shoulder's range of motion significantly decreases.

Stages of Frozen Shoulder:

  1. Freezing Stage:
    • The shoulder becomes painful, and the range of motion starts to become limited. Pain typically increases gradually. This stage can last from 6 weeks to 9 months.
  2. Frozen Stage:
    • Pain may begin to diminish during this stage, but the shoulder becomes stiffer, and using it becomes more difficult. This stage generally lasts 4 to 6 months.
  3. Thawing Stage:
    • The range of motion in the shoulder begins to improve. This final recovery stage can take from 6 months to 2 years.

Diagnosis of Frozen Shoulder:

A diagnosis is typically made through a physical examination. Your physical therapist or doctor will assess your shoulder's range of motion and pain. Imaging tests like X-rays or MRIs are sometimes used to rule out other conditions.

Management and Treatment:

  1. Physical Therapy:
    • Physical therapy is a cornerstone of managing frozen shoulder. It focuses on exercises to improve flexibility and range of motion. The therapy is tailored to each stage of the condition.
  2. Pain Management:
    • Over-the-counter pain relievers like NSAIDs can help manage pain. In some cases, corticosteroid injections may be recommended.
  3. Home Exercises:
    • Alongside physical therapy, home exercises play a crucial role. These exercises aim to maintain the joint’s mobility and decrease pain.
  4. Heat and Cold Therapy:
    • Applying heat can help loosen the shoulder before performing exercises. Cold packs can reduce pain and swelling after exercising.

Physical Therapy Techniques:

  1. Stretching Exercises:
    • Gentle stretching exercises help to restore flexibility and range of motion. These might include the pendulum stretch, towel stretch, and finger walk.
  2. Strengthening Exercises:
    • As the condition improves, strengthening exercises for the shoulder muscles are incorporated.
  3. Manual Therapy:
    • Physical therapists may use manual techniques to help increase joint mobility and reduce pain.

Living with Frozen Shoulder:

  1. Daily Activities:
    • Modify daily activities to avoid movements that exacerbate pain. Focus on maintaining as much range of motion as possible.
  2. Pacing Yourself:
    • It’s important to pace yourself and not rush the recovery process. Overexertion can aggravate the condition.

Surgical Options:

In cases where conservative treatments are not effective, surgical options like joint distension or shoulder arthroscopy may be considered. These procedures aim to stretch or release the joint capsule. Research indicates the results are poor.

Prevention of Frozen Shoulder:

  1. Regular Exercise:
    • Regular shoulder exercises can help maintain mobility and prevent stiffness.
  2. Early Intervention:
    • Addressing shoulder pain or stiffness early can prevent the development of frozen shoulder.

Frozen shoulder can be a long and frustrating condition, but with the right management strategies, including physical therapy and home exercises, improvement and recovery are possible. Patience and persistence are key, as is working closely with healthcare.


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