Frozen Shoulder – A Common Cause of Shoulder Pain

Frozen Shoulder, also known as adhesive capsulitis, is one of the most common shoulder problems treated by orthopedic specialists. In fact, a shoulder surgeon may see several patients each week with this condition.

Can Frozen Shoulder Come Back? Causes and Treatment in Texas

Frozen shoulder, also known as adhesive capsulitis, is one of the most common shoulder problems treated by orthopedic specialists. In fact, a shoulder surgeon may see several patients each week with this condition.

Frozen shoulder can affect both men and women but is more common in women, especially those aged 40 to 60. The peak incidence occurs with people in their 50s. The good news is that once someone has a frozen shoulder, it rarely comes back in the same shoulder. The bad news is that about 50% of individuals who experience it may be predisposed to developing it in the opposite shoulder in the future.

What Is Frozen Shoulder?

Frozen shoulder occurs when the flexible tissue that surrounds the shoulder joint, known as the shoulder capsule, becomes inflamed and thickened. The shoulder is a ball-and-socket joint, specifically the glenohumeral joint, formed by the humeral head (upper arm bone) fitting into the glenoid cavity. The shoulder capsule is a strong connective tissue that surrounds the joint and contains synovial fluid for lubrication. Within the capsule, the anterior capsule and rotator interval can become particularly thickened and fibrotic in frozen shoulder.

It helps to think of the capsule as a balloon surrounding the joint. With frozen shoulder, that balloon becomes inflamed and thick, almost like a leather belt. It can be 10 to 15 times thicker than normal, which causes stiffness and pain. With inflammation and adhesions, the shoulder cannot move freely, leading to loss of range of motion, hence the term “frozen shoulder.” Both passive and active movement are significantly reduced in this condition.

Frozen shoulder usually starts gradually with pain, stiffness, and reduced motion in the shoulder, and it tends to worsen over time. It can be painful and may interfere with daily tasks such as dressing, washing hair, or putting on a coat. The pain can be sharp and burning with quick movements and often worsens at night, disrupting sleep.

What Causes Frozen Shoulder?

The exact cause is not fully understood, but certain risk factors increase the likelihood of developing frozen shoulder, including:

Previous shoulder injury or surgery that limits motion in the joint
Diabetes or thyroid disease
Genetic predisposition, such as individuals of Scandinavian descent who are also more prone to Dupuytren’s contracture, a condition where thickened tissue forms in the hands and fingers

The Three Phases of Frozen Shoulder

Frozen shoulder typically develops slowly and progresses through three stages:

Freezing stage (inflammatory stage): The shoulder becomes increasingly painful and stiff. Movement is limited, and pain often worsens at night. This stage lasts 2 to 9 months.
Frozen stage: Pain decreases, but stiffness remains, making daily activities difficult. This stage can last 4 to 12 months.
Thawing stage: Shoulder mobility gradually improves as inflammation subsides. This stage may last 6 months to 2 years.

Diagnosing and Treating Frozen Shoulder

Diagnosis is based on symptoms, a physical exam, and imaging to rule out other causes. Frozen shoulder is sometimes mistaken for a rotator cuff problem, but the two conditions differ. Unlike rotator cuff injuries, frozen shoulder rarely requires surgery.

Treatment often includes a corticosteroid injection into the joint capsule and physical therapy to stretch and strengthen the shoulder. Some stretches are performed lying down to improve mobility. Steroid injections reduce inflammation and help relieve the sharp, aching pain, particularly at night. Once pain is under control, consistent stretching exercises help restore range of motion.

Most patients are encouraged to continue exercises at home five to seven days a week until full motion returns. Although frozen shoulder can take up to two years to resolve, most people regain normal function and live pain-free.

Dr. Mitchell Fagelman is a board-certified orthopedic surgeon at OrthoTexas specializing in diagnosing and treating shoulder pain and injuries.

Diagnosing Shoulder Conditions

Diagnosing shoulder conditions such as frozen shoulder begins with a comprehensive evaluation by a physical therapist or orthopedic surgeon. During your visit, the specialist will review your medical history and symptoms, such as shoulder pain, stiffness, and any previous injury. A physical exam assesses your shoulder’s range of motion, strength, and stability to distinguish frozen shoulder from other issues like a rotator cuff tear or shoulder dislocation.

Imaging tests such as X-rays, MRI, or CT scans may be recommended to rule out other causes of shoulder pain. In some cases, a diagnostic injection of corticosteroids or anesthetics may help pinpoint the source of pain. Accurate diagnosis is essential for developing an effective treatment plan and achieving the best outcome.

Causes of Frozen Shoulder

Frozen shoulder often occurs after a shoulder injury, surgery, or trauma that limits joint movement. When the shoulder is immobilized for an extended period, such as after a fracture, rotator cuff repair, or other injury, the capsule can become inflamed and thickened. This leads to scar tissue that restricts motion and causes stiffness.

Medical conditions like diabetes are also linked to a higher risk. Poorly controlled diabetes can affect connective tissues, making them more prone to inflammation. Extended immobility or poor posture can contribute to muscle imbalances and strain on the shoulder, further increasing the risk.

Treatment Options for Frozen Shoulder

Treatment usually combines multiple approaches to reduce pain, restore movement, and improve function. Physical therapy is the cornerstone of care, focusing on gentle stretching, range-of-motion improvement, and strengthening the shoulder muscles. Consistent participation helps most patients regain normal function over time.

Corticosteroid injections may be used early in treatment to reduce inflammation and make therapy more effective. In severe cases where conservative measures fail, arthroscopic capsular release surgery may be considered. This minimally invasive procedure releases tight portions of the joint capsule to restore movement. Other techniques, such as suprascapular nerve block injections, may help manage pain. With proper care, most patients can expect gradual recovery and a return to normal activities.

Living With and Managing Frozen Shoulder

Managing frozen shoulder requires patience and consistency. Regular physical therapy and home exercises are key to maintaining mobility. Movements such as forward flexion, external rotation, and internal rotation can help reduce stiffness.

Applying heat or cold packs may relieve pain and inflammation. Maintaining good posture, avoiding heavy lifting, and taking breaks to stretch during repetitive activities can help prevent strain. Modifying daily routines, such as adjusting work tasks or using the opposite shoulder for certain actions, may also reduce discomfort. With steady progress and support from your healthcare team, most people regain full function and return to their regular routines.

When to Seek Professional Help

If you experience severe pain, persistent stiffness, or reduced shoulder mobility, seek medical attention. People with a history of shoulder injury, surgery, or medical conditions such as diabetes are at higher risk and should consult an orthopedic specialist or physical therapist promptly.

Immediate evaluation is recommended if you experience sudden pain, numbness, or tingling, as these could indicate a more serious condition. Early diagnosis and treatment can prevent complications and improve recovery outcomes.

Your path to recovery starts here. If you’re experiencing shoulder pain or stiffness, schedule an appointment with the orthopedic specialist at OrthoTexas today to discuss personalized treatment options. Book your appointment online or call (972) 492-1334

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