Introduction

Photo of a woman with shoulder pain (PantherMedia / imagepointfr)

In frozen shoulder, the joint gradually becomes painful and stiff without there being any clear cause. It most commonly affects people around the age of 50.

Frozen shoulder usually gets better without treatment. It can take several months for the pain to go away completely, though, and a lot longer until you can move your shoulder normally again.

Medication and physiotherapy can help to relieve the pain and improve mobility. Surgery is only rarely considered because its effectiveness is doubtful and there are various risks involved.

Symptoms

Frozen shoulder starts very gradually. The symptoms are usually only mild at first, but become more severe over the course of a few months and often make it hard to sleep. The pain is often described as "dull" or "deep-seated." It can also spread into the biceps. It becomes increasingly difficult to lift your arm up or move it backwards. Over time, the arm can become so stiff that it is nearly impossible to move, as if “frozen” in place. The medical term for frozen shoulder is “adhesive capsulitis.”

Frozen shoulder can be very distressing and make many different activities more difficult. It can become a real challenge or even impossible to get dressed, cook, clean, reach a back pocket or shift gears while driving. Sometimes it is then no longer possible to do your job – especially if it often involves reaching up over your head.

Some people show a lack of understanding for the condition, which can make it harder for those affected. That has to do with the fact that the symptoms aren't easy to explain: A frozen shoulder isn't caused by an injury, isn't visible, and often isn't diagnosed right away.

Causes

The different bones in our bodies are connected by joints. In the shoulder joint, the rounded end of the bone in the upper arm (humerus) fits into a socket in the shoulder blade (scapula). This ball and socket joint is surrounded by a strong fibrous membrane called the joint capsule.

 

Illustration: Shoulder with an inflamed joint capsule – as described in the articleShoulder with an inflamed joint capsule  

Illustration: Frozen shoulder: Scar-like tissue (adhesions) in the joint capsule – as described in the articleFrozen shoulder: Scar-like tissue (adhesions) in the joint capsule

In frozen shoulder, scar-like tissue (adhesions) forms in the joint capsule, causing it to thicken and shrink. Inflammations are believed to play a major role here, but it's not entirely clear what happens. Usually, no underlying cause is found.

In rare cases, frozen shoulder may develop following an accident, an inflammation or immobilization of the shoulder joint, for example after surgery. It is then referred to as “secondary” frozen shoulder.

Prevalence

Frozen shoulder is most common in people between the ages of 40 and 60. It is estimated that 2 to 5% of the population are affected by frozen shoulder at some point, and it is somewhat more common in women than in men. People with diabetes are particularly likely to develop a frozen shoulder: About 10 to 20% of them get it, but it's not yet known why this happens.

Outlook

Frozen shoulder usually gets better on its own without treatment, but it can take quite a while.

Frozen shoulder tends to go through three phases:

  1. In the first phase, the shoulder starts hurting and becomes more and more painful. The pain may also occur at night, especially if you lie on the affected shoulder, or if you move your shoulder upwards or backwards. This stage can last 2 to 10 months.
  2. In the second phase, the shoulder “freezes.” It becomes increasingly difficult to move, but it hurts less. The shoulder muscles often weaken somewhat due to limited movement. This phase lasts between 3 and 12 months.
  3. In the third phase the pain goes away. The frozen shoulder gradually improves and it becomes easier to move the arm. It can take a few months to several years for the shoulder to become as flexible or nearly as flexible as before.

The time that frozen shoulder lasts can vary greatly. Many people have hardly any problems with their shoulder after one to two years. But the healing process can take a lot longer in some people. In one study, about 6% of the participants still had severe symptoms four years later.

Most people only have frozen shoulder once in their life. But about 6 to 17% of people who have had frozen shoulder get it in their other shoulder within five years.

Diagnosis

Shoulder pain can be caused by different things. Doctors diagnose frozen shoulder based on a description of the symptoms and a physical examination of the shoulder. This involves testing the mobility of the shoulder and the arm, and feeling the joint. The doctor watches from behind to see how your shoulder blades move when you lift both arms up and stretch them out to the sides, level with your shoulders. In frozen shoulder, you can't raise your arm up sideways without lifting the shoulder blade too, which doesn't normally happen.

You might have an x-ray or MRI scan of your shoulder to rule out other possible problems like osteoarthritis, or if it's difficult to determine the cause of your symptoms.

Treatment

A frozen shoulder needs time to heal. But there are various pain relief options and ways to improve shoulder mobility. In the first phase, the goal of treatment is to relieve the pain. In later phases, the main aim is to make it easier to move the shoulder again.

The pain can be relieved with steroid tablets or injections into the shoulder joint. Anti-inflammatory painkillers like ibuprofen (tablets or a cream) probably aren't effective enough. Some people like to use heat or cold packs.

Stretching exercises and physiotherapy can be used to improve joint mobility. Especially in the early phases, it's important to be careful when doing the exercises because the pain could get worse otherwise. The movements shouldn't be forced or very painful.

Doctors used to mobilize the affected shoulder joint while using a general anesthetic. But there are no good-quality study on whether this approach has any benefits. Mobilizing the shoulder using a general anesthetic can injure or even break the shoulder, though – which in turn results in other shoulder problems.

There is also no proof that surgery can relieve the symptoms. As with any surgical procedure that is done under general anesthetic, there are associated risks.

And because frozen shoulder usually goes away on its own, there's usually no reason to have a risky treatment. If your doctor recommends surgery, it may be helpful to get a second medical opinion.

Learn more

Further information

When people are ill or need medical advice, they usually go to see their family doctor first. Read about how to find the right doctor, how to prepare for the appointment and what to remember.

Labels: Adhesive capsulitis, Frozen shoulder, M75, Muscles, bones and joints, Periarthritis