What Is Frozen Shoulder?
Frozen shoulder, sometimes called adhesive capsulitis, is a condition that limits movement in shoulder joint. You usually have pain and stiffness that comes on gradually, gets worse, and then finally goes away.
Your shoulder has three bones that form a ball-and-socket joint, including your upper arm (humerus), shoulder blade (scapula), and collarbone (clavicle). Strong connective tissue surrounding your shoulder joint holds everything together. This is called the shoulder capsule.
With frozen shoulder, this capsule becomes so thick and tight that it’s hard to move. Bands of scar tissue form and there’s less of a liquid called synovial fluid to keep the joint lubricated. These things limit your shoulder motion even more.
The condition is called “frozen” shoulder because as your shoulder gets more painful, you use it less. The less you use it, the thicker your shoulder capsule becomes, and the more difficult it is to use. So your shoulder feels “frozen” in place.
Frozen Shoulder Symptoms
The main symptoms of a frozen shoulder are pain and stiffness that make it difficult or impossible to move.
You’ll likely feel a dull or achy pain in one shoulder. You might also feel the pain in the shoulder muscles that wrap around the top of your arm. You might feel the same sensation in your upper arm. Your pain may get worse at night, which can make it hard to sleep.
Stages of frozen shoulder
You usually go through three phases with a frozen shoulder.
- You have pain (sometimes serious) in your shoulder any time you move it.
- It slowly gets worse over time and may hurt more at night.
- Your shoulder movement is limited.
- This stage can last from 6-9 months.
- Your pain might get better, but your stiffness gets worse.
- Moving your shoulder gets more difficult and it gets harder to do some daily activities.
- This stage can last 4-12 months.
- Your range of motion starts to go back to normal.
- This can take anywhere from 5 months to 2 years.
Frozen Shoulder Causes
It’s not clear why some people get frozen shoulder, but some groups are more at risk.
Frozen shoulder happens more often in women (and those designated female at birth). You’re more likely to get it between the ages of 40 and 60. Another major risk factor is being unable to move your shoulder for a long time. So your chances go up if you’re recovering from a medical condition like a stroke, or surgery like a mastectomy that keeps you from moving your arm.
You're also at higher risk of you have reduced movement in your shoulder because of inflammation, like from rotator cuff tendinitis or bursitis.
Certain medical conditions increase your risk. too. You may also be more likely to get frozen shoulder if you have diabetes. About 10% to 20% of people with diabetes get frozen shoulder. Other medical problems, linked to frozen shoulder include:
- Heart disease
- Thyroid disease
- Parkinson’s disease
Frozen Shoulder Diagnosis
There's no specific frozen shoulder test. To diagnose it, your doctor will give you a physical exam. You'll move your arm in different ways to see how much how it hurts. They may also move your shoulder for you and note the differences.
They may inject anesthetic in your shoulder to numb the area so they can better judge your range of motion. This is called an injection test.
A physical exam is usually all your doctor needs to diagnose frozen shoulder. But they might order imaging tests such as X-rays, ultrasound, or MRI to rule out other problems like arthritis or a torn rotator cuff.
Frozen Shoulder Treatment
Most of the time, frozen shoulder eventually gets better on its own, even it you don't treat it.
Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibuprofen can help relieve the pain and inflammation in your shoulder. If they don’t help, your doctor might prescribe a stronger medication.
If your symptoms are intense or don’t improve over time, your doctor might recommend other kinds of frozen shoulder treatment, including:
- A corticosteroid injection in your shoulder joint to reduce your pain and improve your range of motion.
- Joint distension. This means your doctor will inject sterile water into your shoulder capsule to stretch it. This can help you move your shoulder more easily.
- Physical therapy. While it's often used for frozen shoulder, it isn't always effective. It may be more useful during certain phases of frozen shoulder than others.
- Surgery. This is rarely necessary to treat frozen shoulder. But if other treatments haven’t helped, your doctor may suggest arthroscopic surgery (a less-invasive type of surgery that uses cameras and small tools) to remove scar tissue.
- Shoulder manipulation can help loosen up your shoulder tissue, but is very rarely used because arthroscopic surgery has better results. With this method, a doctor forcefully moves your shoulder while you're under general anesthesia.
How to cure frozen shoulder quickly
Unfortunately, there's no fast cure for frozen shoulder. But you might be able to ease some frozen shoulder symptoms with methods like:
Hot/cold compression packs. Applying heat or cold to your shoulder can ease pain and swelling. Warm compresses increase blood flow to the inflamed area, while cold compresses slow blood flow and reduce swelling and pain. You can alternate between the two. For heat compression, warm a moist towel in the microwave or use a heating pad. Apply to your shoulder for up to 20 minutes, three times a day. For cold compression, wrap an ice pack or bag of frozen vegetables in a towel. Apply it to your shoulder every 2 to 4 hours for no more than 20 minutes at a time. If you're alternating the two, apply heat for 15 to 20 minutes. A few hours later, apply ice.
Transcutaneous electrical nerve stimulation (TENS). TENS therapy uses a low-voltage electrical current to block or change how you perceive pain. We need more research into how it might work. Some doctors think it may activate nerve cells that block pain signals. The current may also boost your body’s natural painkillers, a group of hormones called endorphins.
The TENS device is about the size of a small smartphone. It has several sets of wires that connect to pads with adhesive backings that are placed on your skin along nerve pathways. The unit sends pulses of low electrical currents. It's usually done by a health care provider in their office or clinic. But you can also buy units you can use at home. Don't use one without checking with your doctor first. They're not recommended for people with certain health conditions, like heart disease or cancer.
Exercises For a Frozen Shoulder
Increasing the mobility in your shoulder with gentle stretching exercises can help to both treat and prevent frozen shoulder. It's a good idea to check with your doctor before trying any exercises for frozen shoulder. Go slowly, and modify or stop any exercise that's very painful.
Before you get started, warm up your shoulder. The best way to do that is to take a warm shower or bath. Another option is to use a heating pad or a moist, microwaved towel.
For the following exercises, stretch until you feel tension, but not so much that you’re in pain.
- Pendulum stretch. Stand with your arms at your side and your shoulders relaxed. Lean slightly forward, allowing your affected arm to hang. You can rest the hand of your good arm on a table for support, if needed. Swing your hanging arm in a circle about a foot in diameter 10 times in one direction and then 10 in the other direction. As your pain decreases and your mobility increases, make the circles bigger. As your symptoms improve, you can do the exercises while holding a light weight of no more than 3 to 5 pounds.
- Cross-body reach. Place the hand of your good arm on the elbow of your hurt arm. Lift your hurt arm up and across your chest until you feel the stretch in your shoulder. Hold for 15 to 20 seconds. Repeat 10 to 20 times a day.
- Towel stretch. Stand, holding each end of a 3-foot-long towel behind your back vertically, with your affected arm holding the bottom edge of the towel and your good arm holding the top edge. Slowly raise the unaffected arm up your back until you feel the stretch in your shoulder. Hold for 10 seconds. Do five times, twice a day for 5 days.
- Outward rotation. Stand with your upper arms against your sides and your elbows bent at a 90-degree angle. Hold each end of a rubber exercise band in each hand. Keeping your good arm still, gently pull the affected arm out to your side about 2-3 inches. Hold for 5 seconds. Repeat 10-15 times daily.
- Inward rotation. Stand next to a closed door. Loop one end of an exercise band around the doorknob and hold the other end in the hand of your affected arm. With your elbow at a 90-degree angle and your upper arm by your side, pull the band toward your body about 2-3 inches. Hold for 5 seconds, and repeat 10-15 times daily.
How to Sleep With a Frozen Shoulder
Here are some ways to make sleeping with frozen shoulder a little easier.
Sleep with proper head and neck support. Whether you’re a back sleeper or a side sleeper, you need a pillow that keeps your head and neck in line with your spine. For side sleepers, this means a thicker pillow to lift your head. Back sleepers need a slightly lower loft, while belly sleepers need a relatively flat pillow.
Sleep with extra pillows. The best sleeping position for a frozen shoulder is on your unaffected side with an extra pillow between your arm. This helps open your chest and keeps your shoulders aligned. If you don’t have a body pillow, put a smaller pillow in your armpit and hug it to avoid curling your shoulders inward. A pillow between your knees can help keep your hips and spine aligned and keep you from curling inward.
Sleep with arms by your side. If you’re more comfortable sleeping on your back, rest your arms by your sides with your palms facing your mattress. This position puts the least amount of pressure on your shoulder joints and provides a gentle stretch to your shoulder muscles.
Sleep with heat. Warm compresses increase blood flow and relieve pain in your shoulder. If you want to use a heating pad on your shoulder while you sleep, be sure it has safety features such as turn-off switch. You can also use a microwaveable buckwheat or weighted beanbag, which will gradually cool over time.