Frozen shoulder

Thawing Frozen Shoulder

In Upper Extremity Pains by Royce Bowman, PT, Director

Frozen shoulder, or adhesive capsulitis, can change your life and not in a good way. Frozen shoulder occurs in up to 5% of the population. Females are 4 times more often affected than men, while the non-dominant shoulder is more prone to be affected.

And, if that’s not scary enough, 35 to 40% of individuals who have adhesive capsulitis in one shoulder end up, at some point, affected in the opposite shoulder at some point.

The onset of frozen shoulder adhesive capsulitis occurs when the shoulder capsule and joint become inflamed, resulting in stiffness and pain.

This inflammation often presents with no prior warning and can affect the surrounding shoulder muscles, ligaments, tendons, and bursa.

As someone who has treated frozen shoulder pain and discomfort for 25 years, I’ve witnessed firsthand how debilitating this condition can become. Simple, daily activities such as reaching up to a shelf, driving a car, or putting on a shirt can grow painful and difficult to complete.

Individuals with frozen shoulder may experience pain when moving or lifting their arm, or reaching behind their back. Sleeping can become difficult, leading to fatigue and disrupting one’s sleep pattern.

  • You’ll feel pain when moving or lifting your arm, or reaching behind your back.
  • Sleeping can, and often, becomes difficult. This disturbs sleep and leads to fatigue.
    • Note: How to sleep with frozen shoulder. While there is no specific position to sleep in for someone with a frozen shoulder, supporting the arm with a pillow or taking pain or anti-inflammatory medication may reduce symptoms to allow for a more comfortable night of sleep. Typically, ice works better for reducing night pain versus heat packs.
  • Weakness in your arm/shoulder makes it difficult to lift and carry objects
  • Decreased range of motion and pain make it difficult to cook, clean, or take care of your personal grooming.
  • Hobbies, sports, and work activities become affected and decrease your quality of life. In turn, you can feel frustrated, sad, or angry when your limitations become clear.

Causes of Frozen Shoulder

While the exact causes of frozen shoulder remain a mystery, risk factors include a previous shoulder injury, shoulder surgery, a prolonged period of immobility, and underlying conditions such as diabetes, stroke, thyroid disorder, Dupuytren disease, Parkinson’s disease, cancer, and complex regional pain syndrome.

The Connection Between Frozen Shoulder Syndrome and Diabetes

Notably, individuals with diabetes are more susceptible to developing frozen shoulder due to high blood sugar levels, which can damage the connective tissues that make up the joint capsule in the shoulder. This damage can lead to inflammation and thickening of the tissues, resulting in a frozen shoulder. Moreover, nerve damage caused by diabetes can exacerbate the pain and discomfort associated with frozen shoulder.

It is crucial for individuals with diabetes to take steps to prevent frozen shoulder, such as maintaining good blood sugar control, engaging in regular exercise, taking care of the shoulders, and seeking prompt treatment when experiencing shoulder pain or stiffness. By taking proactive measures, one can reduce the risk of developing this debilitating condition and manage symptoms effectively if they arise.

Symptoms of Frozen Shoulder

Understanding the symptoms of frozen shoulder pain can help you treat it as early as possible.

Frozen shoulder can vary from person to person in terms of how much range of motion they lose, some people may only lose 25 to 30% and others could lose as much as 65 to 70%.

However, 100% of people will suffer from intense pain once they reach their point of limitation. This further limits some of their activities of daily living (ADL’s).  For women, this might be trying to reach behind their back to fasten their bra or holding a blow dryer above the head to style their hair.

What are the pains from frozen shoulder?

Typical shoulder joint pain descriptions include “achy” or “stiff”. After long periods of sitting, lying down, or no movement, this stiffness can amplify due to no joint movement. With a painful stiff shoulder, if you don’t stretch the capsule out for 6 to 7 hours, it has the propensity to re-tighten and restart the inflammatory process.

The shoulder capsule, formed mainly by ligaments which, as they stretch, allows the joint to move through full anatomical motion. But like a thick, stretched rubber band, the ligaments want to recoil back to a relaxed position.

Like all ligaments in the human body, there are fine nerves intertwined throughout the ligament fibers. They communicate to the brain how much stretch is being placed on the capsule.

Frozen shoulder

If you suffer from frozen shoulder, your nerve-brain communication becomes dysfunctional.

As the capsule becomes progressively tighter, these “stretch sensitive” nerve endings reset their threshold to the tighter range of motion. In turn, the nerve endings send intense pain signals to the brain saying “STOP” or something is going to tear! This is reminiscent of big brother twisting your arm behind your back until you say “UNCLE”!

In other words, when you stretch your stiff shoulder joint into the pain zone, your brain receives a false reading by the nerves as to how much stretch is being applied to the capsule.

Therefore, you must stretch into the pain zone as much as you can tolerate. This stretches the capsule and desensitize the nerve endings to the tighter position. You should see a slow but progressive improvement in your shoulder range of motion as well as your pain tolerance.

Frozen Shoulder Diagnosis

Diagnosing shoulder adhesive capsulitis can be tricky because symptoms often overlap those of other shoulder conditions.

In our practice, we look at your medical history and examine your shoulder. We measure the pain and stiffness in your shoulder joint. Also, we’ll measure your range of motion limitation. Since there can be other reasons for range of motion limitations. Your therapist decides whether your limitation indicates a frozen shoulder.

The hallmark feature of a frozen shoulder are proportional loss of motion in all planes of movement although some may be more limited than others.

If you are experiencing symptoms of what you think could be frozen shoulder, you should seek treatment. There are many treatments available that can help improve mobility and reduce pain.

What can be mistaken for frozen shoulder?

Frozen Shoulder vs. Arthritis

With arthritis, shoulder joint cartilage breaks down causing pain and inflammation. Both conditions can be painful and debilitating, but there are some key differences between them.

Frozen shoulder is more likely to occur in people who are middle-aged or older, while shoulder arthritis can affect people of any age. A frozen shoulder is also more likely to affect people who have had an injury to the shoulder, while arthritis is more likely to develop gradually over time.

Frozen shoulder vs. rotator cuff

Frozen shoulder is a condition where the shoulder joint becomes stiff and painful. The rotator cuff, a group of 4 muscles and tendons that surround the shoulder joint, help keep the arm in place. A torn rotator cuff occurs when one of the tendons ruptures of tears. Both can be extremely painful and make it difficult to move the arm.

It is IMPORTANT to remember that a frozen shoulder is stiff and painful in all planes of movement, whereas the other common conditions listed above tend to be painful in one or two planes.  An experienced orthopedic PT should be able to diagnose a frozen shoulder by simply moving your arm in all directions and assessing how stiff and painful your ligaments are.


Both conditions cause shoulder pain and stiffness while causing inflammation. Typically, frozen shoulder starts with an injury or overuse. Often, Bursitis begins with infection or excess friction on the bursa. Frozen shoulder stiffens the ligaments surrounding the shoulder joint, making it difficult to move the arm. On the other hand, Bursitis results in swelling and inflammation of the bursa, a small fluid-filled sac that cushions the joint. Both conditions can be treated with rest, ice, and physical therapy. In severe cases, surgery may be necessary for bursitis and manipulation under anesthesia (MUA) for frozen shoulder.


Both common shoulder problems, frozen shoulder is a condition in which the shoulder joint becomes stiff, making it difficult to move the arm. Impingement happens when the upper arm bone rubs against the shoulders bony “roof”, causing pain. Frozen shoulder is more common in women and people over the age of 40, while impingement is more common in young athletes. Both conditions can be successfully treated with physical therapy.

Pinched nerve

Frozen shoulder and pinched nerve in shoulder are two very different things. With frozen shoulder, shoulder ligaments freeze up and you can’t move your arm. It’s usually caused by an injury or surgery. A pinched nerve in shoulder is when a nerve in your shoulder is compressed, or pinched. This can happen from an injury, a herniated disc in your neck, or other conditions. The symptoms of a frozen shoulder include increasing pain and stiffness. The symptoms of a pinched nerve in the shoulder include pain, numbness, and tingling in the arm and hand.

Frozen shoulder

What are the stages of frozen shoulder?

  • Freezing – Pain increases gradually and shoulder mobility becomes less and less. This stage could last anywhere from 6 weeks to 4 months.
  • Frozen – Pain intensity may diminish, but the shoulder remains stiff. This stage could last 4-6 months and cause daily activities to be difficult because of limited mobility.
  • Thawing – What are the signs that frozen shoulder is starting to thaw? Your shoulder’s range of motion improves and pain decreases. As you regain mobility, regaining your strength becomes important. Otherwise, lack of strength could lead to other problems such as shoulder impingement.

Treatments For Frozen Shoulder

Various treatment options exist, including physical therapy, medications, and surgery. The best treatment option depends on the severity of your condition and your overall health.

With Bowman Physical Therapy, we’ll first address your pain. We have a range of modalities to lessen your pain. You and your therapist will develop a series of frozen shoulder exercises designed to improve the mobility of your shoulder joint. These exercises may include stretching, range-of-motion exercises, and strengthening exercises.

Medications – Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can help to alleviate your pain. Your doctor may also prescribe corticosteroid injections to help reduce inflammation and pain.

Surgery – In severe cases of frozen shoulder, surgery may be necessary. The most common surgical procedure for frozen shoulder is called a capsular release, which involves cutting through the tight capsule to improve mobility.

Frozen Shoulder Recovery Time

Most people see improvement within 6 to 8 weeks of beginning treatment. However, full recovery can take 4 to 6 months for complete resolution.

There are a few things that you can do to help reduce pain and inflammation and speed up your recovery.

First, consider taking over-the-counter pain relievers such as ibuprofen or aspirin. You can also apply ice to the affected area for 20 minutes at a time, several times a day. Heat pads can also help loosen you up prior to stretching/exercising. You can also try doing your stretches in the shower with hot water directed at the involved shoulder.

Finally, be sure to keep your arm moving as much as possible. At first, this may be difficult, but movement is essential for preventing stiffening of your shoulder. With some time and effort, you should be able to fully recover from a frozen shoulder.

Common Misconceptions About Frozen Shoulder

  • Only Affects Older Adults – while more common in older adults, frozen shoulder affects people of all ages. In fact, people in their 40s and 50s are at a higher risk of developing this condition. Also, regardless of age, adhesive capsulitis can occur as a result of an injury, surgery, or medical condition.
  • Always Requires Surgery – in severe cases, surgery may become necessary, but not always required. Physical therapy, anti-inflammatory medications, and corticosteroid injections help manage symptoms and improve range of motion. Recommending surgery happens when other treatments have not been effective.
  • Resolves on Its Own – without treatment, the condition can last for years, and may never fully resolve. Early treatment can help to reduce pain and improve range of motion in the affected joint.
  • Rare Condition – Adhesive Capsulitis is actually a fairly common condition, affecting up to 5% of the general population. While it may not be as well-known as other conditions such as arthritis, it is still a significant health concern for many people.
  • Just a Stiff Shoulder – frozen shoulder is much more than just a stiff shoulder. It can cause severe pain and discomfort, as well as limited range of motion in the affected joint. This can make it difficult to perform everyday tasks, and can significantly impact quality of life.

Adhesive Capsulitis and Long-Term Damage

If left untreated, Adhesive Capsulitis can cause long-term damage to the shoulder joint. The thickening and tightening of the joint capsule can cause the tissues to become scarred and fibrotic, leading to a loss of elasticity and mobility in the joint. This results in a permanent decrease in range of motion, and can make it difficult to perform everyday tasks such as reaching or lifting.

If you are experiencing the long-term effects of frozen shoulder, there are several things you can do to manage your symptoms and improve your quality of life.

  1. Seek treatment: It is never too late to seek treatment for frozen shoulder. Even if you have been living with the condition for a long time, physical therapy exercises and other treatments can help to improve range of motion and reduce pain.
  2. Keep moving: Regular exercise and physical therapy can help to keep your shoulder joint mobile and prevent further damage.
  3. Use heat therapy: Applying heat to the affected joint can help to reduce pain and stiffness, and improve range of motion.
  4. Consider surgery: In severe cases of frozen shoulder, surgery may be necessary to release the tightened joint capsule and improve range of motion. This is typically only recommended if other treatments have not been effective.

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