Adhesive Capsulitis - what you need to know about frozen shoulder

What is a frozen shoulder?


Frozen shoulder causes significant pain and disability. The lifetime prevalence of frozen shoulder is up to 5% in the general population. It generally affects patients in their 40s to 60s. Women are more affected than men. It can last up to 2 years if left untreated.


How does frozen shoulder occur?


We don’t fully understand what causes frozen shoulder. It is associated with other diseases such as diabetes, thyroid disorders, and autoimmune diseases. Frozen shoulder can also develop after shoulder injuries or surgery.


What are frozen shoulder symptoms?


Frozen shoulder results from scar tissue adhesions that form along the shoulder joint. The scar tissue contracts the joint. The contraction restricts movement and causes pain.


Frozen shoulder progresses through three phases.

  1. Painful freezing phase. This can last up to 9 months.

  2. Frozen adhesive phase. This can last up to 12 months.

  3. Thawing phase. This can last up to 12 months.

Aggressive treatment can shorten the duration spent in each phase.


How is frozen shoulder diagnosed?


Medical history and physical exam is critical to the diagnosis of frozen shoulder. Patients will have pain and restricted range of motion. Passive and active range of motion will be limited. Strength testing may or may not provoke pain.


Imaging is usually unnecessary but can help assess for other underlying conditions. X-rays can help look for shoulder osteoarthritis. MRI or diagnostic ultrasound can evaluate the rotator cuff.


How is frozen shoulder treated?


Oral anti-inflammatory medications such as ibuprofen or naproxen can help control pain. A home exercise program or physical therapy can help increase range of motion. Steroid injections can provide significant pain relief and help break up scar tissue. Manipulation under anesthesia or arthroscopic surgery are usually seen as last resorts.


This study found that newer procedures such as an ultrasound guided capsular distention can significantly reduce pain and improve function.


When can I return to sport or activity after a frozen shoulder?


The goal of treatment is to rehabilitate the shoulder as quickly and as safely as possible. Advancing or returning too soon may lead to additional injury. You can expect to return to activity when the shoulder has regained its strength and range of motion.


What are some exercises for the treatment of frozen shoulder?


Frozen shoulder stretches and exercises: video #1 and video #2.


Work your way up to doing these stretches at least three times a day.