What is frozen shoulder?

The term “frozen shoulder” is often misused to refer to a range of shoulder problems associated with loss of motion. To clear up things, we sat down with Dr. Amarpal Arora, a board-certified orthopedic surgeon with Sharp Rees-Stealy Medical Group, to discuss identifiers of frozen shoulder and how it can be treated.

What is frozen shoulder and why does it occur?
By definition, primary adhesive capsulitis, or “frozen shoulder,” occurs when both active and passive motion of the shoulder is limited from the soft-tissue surrounding the shoulder getting stiff. As its name implies, frozen shoulder freezes shoulder joint motion.

Most cases of frozen shoulder are idiopathic, meaning we don't have a reason for why it occurred. However, possible contributing factors include thyroid dysfunction, Type 1 or Type 2 diabetes, certain neurological conditions, such as Parkinson’s disease, and cardiovascular disease. Patients with these conditions have a higher incidence of frozen shoulder compared to those who do not.

It is important to note that one must differentiate between frozen shoulder and a secondary shoulder stiffness, as the latter may develop when there is a known intrinsic or extrinsic shoulder problem like post-surgical or post-traumatic stiffness. The two causes of shoulder loss of motion are very different and require a very different clinical approach.

What are the symptoms of frozen shoulder?
There are three stages associated with this condition:

Stage One: Freezing
This painful and inflammatory stage is the beginning of frozen shoulder symptoms and can last anywhere between four to nine months. It is characterized by painful shoulder motion and developing limitation in movement.

Stage Two: Frozen
Also known as the adhesive stage, this phase typically lasts between four and nine months as well, and is best characterized by the slow resolution of pain, but with persistent joint stiffness. It is during this stage that patients may develop neck and upper back soreness after favoring the frozen shoulder for so long.

Stage Three: Thawing
This recovery phase is best characterized by the gradual return of shoulder motion and normal shoulder function. This stage can last anywhere between five and 12 months.

How is frozen shoulder treated?
Once frozen shoulder has been successfully diagnosed, it is typically treated with anti-inflammatory injections administered by clinical orthopedic specialists and partnered with a supervised physical therapy program. Frozen shoulder is a condition where good physical therapy can make a tremendous difference in recovery. I always tell my patients facing this condition to plan on making their physical therapist their new best friend for the best results and quickest recovery.

That being said, given the length of the stages associated with frozen shoulder, treatment of the condition can be a long process, requiring vigilance of both the patient and the doctor.

It is imperative that patients and their doctors refrain from any manipulation or surgical intervention during the first two phases of the disorder. Aggressive manipulation or surgical intervention can lead to worsening inflammation and increased symptoms if done during these initial stages, leading to prolonged pain and a less-than-desired outcome.

For the news media: To talk with Dr. Arora for an upcoming story, contact Erica Carlson, senior public relations specialist, at erica.carlson@sharp.com.