What is frozen shoulder?
Frozen shoulder, also called adhesive capsulitis, is when the tissues surrounding your shoulder joint, called the shoulder joint capsule, become inflamed. The inflammation causes discomfort, stiffness and a limited range of motion.
Although many conditions can cause shoulder pain and stiffness, frozen shoulder causes pain that lasts for more than three months, as the inflammation associated with frozen shoulder causes adhesions or scarring in the shoulder joint capsule.
Frozen shoulder stages
Frozen shoulder usually develops in three stages:
- Freezing stage: In this stage, the inflammation causes discomfort that slowly worsens and limits shoulder movement, reducing your ability to use it. Your pain may be worse at night. This stage can last from six weeks to nine months.
- Frozen stage: During the second stage, your pain may improve, but your shoulder still feels stiff and you still have a hard time using it. This stage can last as few as four and as many as 12 months.
- Thawing stage: This is the recovery stage of frozen shoulder when you gradually regain strength and full range of motion in your shoulder. Full recovery can take up to two years, but it may take longer for some people.
Fortunately, frozen shoulder often gets better without surgery. Physical therapy and stretching exercises can help most people manage symptoms.
Frozen shoulder symptoms
The main symptoms of frozen shoulder are pain and stiffness that make moving your shoulder or arm difficult.
The pain may appear suddenly, and you may feel it in the outer part of your shoulder or upper arm. For some people, discomfort can start as a dull ache and worsen when using the shoulder. The pain and stiffness can get worse over time until moving your shoulder becomes nearly impossible.
You may also develop neck pain with a frozen shoulder as your neck muscles try to compensate for your shoulder’s limited movement.
When to see a doctor
See your doctor if you experience shoulder pain for more than three months. Although frozen shoulder heals on its own over time, treating the condition in its early stages may help reduce its impact on your quality of life.
The more discomfort you feel, the less likely you are to use your shoulder, causing the shoulder capsule to get even thicker and tighter, leading to less mobility. If left untreated, your shoulder can become immobile or “frozen,” making everyday activities difficult.
What causes frozen shoulder?
Frozen shoulder occurs when inflammation causes the shoulder joint capsule to thicken and tighten. As a result, the joint becomes less flexible and can “freeze.” Scar tissue, called adhesions, can develop and impact the production of synovial fluid that keeps the shoulder joint lubricated. This makes shoulder movement and rotation difficult and painful.
Researchers do not know what causes this inflammation that leads to frozen shoulder. However, injuries that prevent you from moving your shoulder and other medical conditions are often associated with the condition.
Frozen shoulder risk factors
Frozen shoulder can happen to anyone, affecting about 5% of the population. Although doctors don’t know what causes frozen shoulder, certain factors can put you at greater risk.
- Age: Adults ages 40 to 60 are at greatest risk for frozen shoulder.
- Bursitis and rotator cuff tendonitis: These conditions cause inflammation that can lead to frozen shoulder.
- Diabetes: Frozen shoulder occurs in up to 20% of people with diabetes, who also take longer to recover than people without diabetes.
- Injury: Not using your shoulder can increase your risk of frozen shoulder, so injuries or surgeries that force you to keep your shoulder still are risk factors for the condition.
- Sex: Women are four times more likely than men to develop frozen shoulder.
- Other health conditions: In addition to diabetes, conditions that increase the risk of frozen shoulder include:
- Cancer
- Cardiovascular disease
- Complex regional pain syndrome
- Dupuytren’s contracture
- Hyperthyroidism (overactive thyroid)
- Hypothyroidism (underactive thyroid)
- Parkinson’s disease
- Stroke
How to diagnose frozen shoulder
There’s no specific test used to diagnose frozen shoulder. The condition can usually be diagnosed by a provider based on a physical exam. Your doctor will ask about symptoms and examine your shoulder. You may need imaging to help your doctor rule out other conditions, but imaging tests can’t diagnose a frozen shoulder definitively.
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Medical history and exam
Your doctor will review your medical history and may ask questions about your pain, such as when it started and what type of activities bring it on.
During the physical exam, your doctor will test your shoulder’s “passive” range of motion by moving your shoulder in different directions to see how well it moves and whether doing so causes pain. They’ll ask you to perform some movements on your own—your “active” range of motion—to see whether your shoulder moves more easily. Then, they’ll compare the two tests. A frozen shoulder typically limits active and passive range of motion.
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Imaging tests
Imaging tests aren’t normally necessary to diagnose frozen shoulder. Still, your doctor may order one if they suspect another condition, such as arthritis or a rotator cuff tear, is causing your symptoms.
- X-ray: An X-ray can clearly show the bones in your shoulder, helping to rule out fractures, arthritis or similar conditions.
- Ultrasound or MRI scan: These tests can show soft tissue injuries, such as a rotator cuff tear, that can also cause pain and limit your shoulder’s range of motion.
Frozen shoulder treatment
Most cases of frozen shoulder benefit from medications and physical therapy and do not need surgery. Your doctor will recommend a treatment plan based on the results of your physical exam and the stage at which your frozen shoulder was diagnosed. If your frozen shoulder is related to an underlying condition, your doctor will work with you to help treat or manage the condition.
Medication
Medications that reduce discomfort and inflammation can help in the early stages of a frozen shoulder. Many medications can be purchased over the counter, but if those don’t relieve your pain, your doctor may try prescription medications or injections.
- Over-the-counter pain relievers: Acetaminophen and nonsteroidal anti-inflammatory medications, including aspirin, ibuprofen and naproxen sodium, can help you manage pain.
- Corticosteroids: These are steroids injected directly into the shoulder to treat the inflammation causing your symptoms.
Physical therapy
In physical therapy, you will learn a variety of stretches and exercises intended to improve your shoulder strength and range of motion. In many cases, your physical therapist will also teach you exercises to do at home between sessions to help your shoulder continually improve.
Complementary therapy
Integrative medicine, which includes therapies like acupuncture, TENS and mindfulness, can work alongside traditional treatments to help manage your frozen shoulder symptoms. Talk to your medical provider to make sure these treatments are safe and right for you.
- Acupuncture: Acupuncture uses thin, flexible needles gently inserted into specific points on the body. The needles typically stay in place for 15 to 40 minutes and are inserted shallowly. Most people find the treatment painless or only mildly uncomfortable.
- Nerve stimulation (TENS therapy): TENS (transcutaneous electrical nerve stimulation) delivers a small electrical current through electrodes placed on the skin along nerve pathways. This painless treatment may help reduce pain by triggering the release of natural painkillers (endorphins) or blocking pain signals.
Surgery and other procedures
Generally, you need more intensive medical treatment if your frozen shoulder doesn’t respond to medications and physical therapy. There are three procedures your doctor may perform:
- Hydrodilation: Your doctor injects a special fluid into your shoulder. The idea is that pressure from the fluid will stretch out the tissues in the shoulder joint capsule.
- Shoulder manipulation: While you are under anesthesia, your doctor creates movement in your shoulder joint. This stretches or tears the capsule and scar tissues that have formed, loosening your shoulder.
- Shoulder arthroscopy: Arthroscopy is a minimally invasive procedure that involves a special camera and small instruments. For a frozen shoulder, your surgeon uses the procedure to cut the tight tissues causing your symptoms.
Find specialized care for frozen shoulder
At Baylor Scott & White, we have multiple locations across North and Central Texas to provide you with access to expert care. Whether you're seeking diagnostic testing, treatment options or ongoing support for frozen shoulder, our teams are here to help you.
Baylor Scott & White Clinic - Pflugerville Medical Center Building 2
2600 E Pflugerville Pkwy Building 2, Pflugerville, TX, 78660- Monday: 8:00 am - 5:00 pm
- Tuesday: 8:00 am - 5:00 pm
- Wednesday: 8:00 am - 5:00 pm
- Thursday: 8:00 am - 5:00 pm
- Friday: 8:00 am - 5:00 pm
Baylor Scott & White Orthopedic Associates of Dallas - Complex Shoulder Institute
1631 Lancaster Dr Ste 230, Grapevine, TX, 76051- Monday: 8:00 am - 5:00 pm
- Tuesday: 8:00 am - 5:00 pm
- Wednesday: 8:00 am - 5:00 pm
- Thursday: 8:00 am - 5:00 pm
- Friday: 8:00 am - 5:00 pm
Baylor University Medical Center, part of Baylor Scott & White Health
3500 Gaston Ave , Dallas, TX, 75246Hours of Operation
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Frequently asked questions
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What does frozen shoulder feel like?
Frozen shoulder feels like a dull, aching pain in one shoulder, often spreading to the upper arm. It causes stiffness that makes movement difficult and can worsen at night, disrupting sleep.
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How do you get frozen shoulder?
Frozen shoulder often develops after shoulder immobilization from an injury or surgery. Inflammation from conditions like rotator cuff tendonitis or bursitis can also cause stiffness, limiting motion and leading to the condition. The exact cause isn’t fully understood.
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How long does frozen shoulder last
Frozen shoulder can last anywhere from several months to two years. It goes through three stages: freezing (pain and stiffness), frozen (stiffness with less pain), and thawing (gradual improvement in movement). With the right care and time, most people fully recover.
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Is frozen shoulder the same as shoulder impingement?
No, frozen shoulder and shoulder impingement are different conditions. Frozen shoulder causes pain and stiffness, making it hard to move your arm, often from inactivity or inflammation. Shoulder impingement causes pain when lifting your arm, especially overhead, due to a swollen tendon rubbing against bone.
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Is frozen shoulder painful?
Yes, frozen shoulder can be painful, causing stiffness and limited movement in your shoulder, often lasting for months or even years. Treatment options like pain relievers, steroid injections, physical therapy and exercises can help reduce pain and improve shoulder movement over time.
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Can frozen shoulder come back?
A frozen shoulder usually doesn’t come back in the same shoulder once treated, but about 20% of people may get it in the other shoulder. Regular physical therapy to keep your shoulder moving can help prevent it from happening again.