Thawing Out That Frozen Shoulder

Having trouble reaching behind your back? Do you struggle to button your shirt or tie your necktie? Does your shoulder hurt more at night while you’re trying to sleep? Is your golf game suffering because of shoulder pain? If so, you might be experiencing a painful — yet common — condition called adhesive capsulitis, also known as “frozen shoulder.” Read on to learn more about it, including treatment options.

What is frozen shoulder?
Frozen shoulder is a condition that causes pain and stiffness in your shoulder joint. Over time, the ability to move your shoulder is reduced, and it may get to the point where your shoulder literally becomes “frozen.” Frozen shoulder is not the same thing as arthritis, however.

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Your shoulder joint is a ball and socket joint, much like your hip joint. The joint is covered by a capsule of ligaments. When frozen shoulder occurs, it means that the capsule and ligaments swell and become tight, making it difficult — or even impossible — to move your shoulder.

Who’s at risk for frozen shoulder?
People between the ages of 40 and 60 are more likely to have frozen shoulder, and this condition affects women more than men. In addition, you have a higher risk of it if you’ve had the following:

• Rotator cuff injury
• Broken arm
• Stroke
• Shoulder injury
• Surgery

Certain medical conditions also increase the likelihood of frozen shoulder, including:

• Diabetes
• Thyroid disease (under- or overactive thyroid)
• Heart conditions
• Parkinson’s disease
• Tuberculosis
• Hormonal changes

As you can see, having diabetes is a risk factor. It’s thought that uncontrolled blood sugars may cause changes in connective tissue, which, in turn, can boost your chances of this painful condition. According to the American Diabetes Association, 10–20% of people who have diabetes will get frozen shoulder. And if it does occur, symptoms tend to be pretty severe.

What are symptoms of frozen shoulder?
The symptoms of frozen shoulder are often described as occurring in three phases or stages:

Painful (“freezing”) stage: Moving your shoulder causes pain, and you may notice that your range of motion becomes limited. You might also experience muscle spasms. This stage may last for six weeks to nine months.

Frozen stage: Shoulder pain may improve, but your shoulder feels stiff. This stage lasts for about four to six months.

Thawing stage: Your range of motion improves. This stage lasts for about six months to two years.

The pain and stiffness from a frozen shoulder can initially be mildly annoying. Over time, though, you’ll find that it can seriously affect your ability to perform simple tasks, such as getting dressed, reaching over your head, taking a shower, or even working. If you take insulin, for example, you may find that you can no longer inject insulin in your arm.

Frozen shoulder can recur, and while it usually affects just one shoulder, it can affect the other shoulder, as well.

How is frozen shoulder diagnosed?
See your doctor if you have any of the above symptoms. He or she will do a physical exam and have you perform certain movements to gauge your range of motion. If there’s any question about your diagnosis, you may need an imaging test, such as an x-ray or an MRI, to rule out other conditions.

How is frozen shoulder treated?
In some instances, frozen shoulder will resolve on its own, but you still may have pain and stiffness. And if your symptoms are more severe, your doctor will likely recommend a course of treatment. Treatment can consist of any or all of the following:

Physical therapy (PT): PT helps you to regain your range of motion, and reduce pain and stiffness. Depending on the severity of your symptoms, PT may include the use of ice and/or heat, along with ultrasound. You may need to perform exercises at home. Keep in mind that it can take several weeks or even months to notice improvement.

Medication: Over-the-counter pain relievers, such as ibuprofen (brand names Advil, Motrin), naproxen (Aleve, Anoprox), or aspirin can help lessen the pain and reduce inflammation. Prescription-strength pain relievers might be needed. Other drugs might help, such as a muscle relaxer or medicine to help you sleep. And in some cases, you may need a cortisone shot in your shoulder joint. The shots are a temporary measure and won’t cure the condition, but they can provide symptom relief. Cortisone shots are best given in conjunction with physical therapy sessions. Also, keep in mind that cortisone is a steroid, and may raise your blood sugar levels. Talk with your doctor or diabetes educator about how to tweak your diabetes medicine if this happens.

Surgery: Surgery may be recommended if PT and/or medications aren’t doing the trick after about a year. Your doctor may suggest shoulder manipulation, which involves moving the shoulder into different positions to help break up scar tissue (this is done under general anesthesia). Or, you may have arthroscopic surgery to remove scar tissue and adhesions in the shoulder joint. Surgery is usually done on an outpatient basis, and you’ll likely need PT afterwards.

Can you prevent frozen shoulder?
There’s no surefire way to prevent frozen shoulder, unfortunately. If it occurs due to an injury, however, you can stay a step ahead of the issue by asking your doctor for exercises that you can do to help keep your shoulder flexible. Or check out the frozen shoulder exercises here. If you have diabetes, work with your care team to help you get and keep your blood sugars in a healthy range.

Want to learn more about frozen shoulder? Read “Frozen Shoulder” and “Frozen Awareness?”