Updated June 3rd, 2022
Introduction
Let it go!! Let it go!! I can't take this shoulder pain any more!! Get it? Frozen, frozen shoulder? Rough crowd. Anyways, here we are talking about the one and only frozen shoulder, AKA adhesive capsulitis. As a physical therapist I would say frozen shoulder is one of the most common diagnoses I see in the clinic, which can also be one of the most frustrating, since it can take a little more time throughout the rehabilitation process. That being said, with time and patience there is always a light at the end of the tunnel so have some faith! It is very important to follow the guidance of your healthcare professionals in order to maximize potential for success.
The Anatomy Basics
So let's get to it, what does “frozen shoulder” mean? It is an inflammatory condition and pathological process in which the body forms excessive scar tissue or adhesions across the glenohumeral joint, leading to pain, stiffness and dysfunction (1)(2). So essentially your shoulder is stiffening secondary to scar formation within your shoulder joint. The shoulder is a ball-and-socket joint which is made up of humerus (upper arm bone), shoulder blade (scapula) and the collarbone (clavicle) (3).
This may get boring but bare with me through this section and I promise you'll make it to the bullet points.
The humerus connects into a shallow socket of the shoulder blade which forms the joint. The joint is surrounded by strong connective tissue which makes up the shoulder capsule. With a frozen shoulder that capsule gets tight due to adhesion formation which is why the medical diagnosis is called “adhesive capsulitis”.
Okay wow, we made it through, good job!
Stages of Frozen Shoulder
It is important to note that there are 3 stages of frozen shoulder: the freezing stage, frozen stage, and thawing stage. All of these stages can extend through a variable amount of time.
Freezing:
Typically this phase is the most painful and is when progressive loss of motion is noticed. Many people begin using slings or stop using the injured shoulder as often in this stage. Usually can last anytime between 6 weeks to 9 months
Frozen:
Pain may have decreased within this phase but you may notice more of a conclusive lock in motion. Within this phase, activities of daily living and functional tasks become more difficult. These can include:
Reaching overhead
Removing a shirt or bra
Washing hair and back
Performing the entire YMCA dance (Y, M, and A most difficult)
Usually time in this phase can last between 2 months to 6 months
Thawing:
During this phase you begin to start to notice improvements in motion. Pain may also lessen and improvements in strength occur.
This phase can last between 6 months and 2 years
Risk Factors
Common risk factors that may lead to a frozen shoulder include:
Shoulder injury with direct impact
Diabetes
Extended period of immobilization
Shoulder surgery
Most common between 35-65 years old
Most common in women (70% of cases)
What Can Be Done?
It is important to seek a healthcare professional once you begin to feel symptoms. The earlier it is addressed, the more successful the recovery can be. You want to rule out any other common shoulder injuries in order to properly diagnose a frozen shoulder. With that being said, consulting an orthopedist would be a good start to rule in/out other diagnoses. You can also seek a physical therapist directly who will steer you in the right direction. If the frozen shoulder is concluded you will most likely be recommended to begin physical therapy to initiate the recovery process.
Common Exercises
Some of my favorite exercises to use with patients who have a frozen shoulder are shown in the videos below. Give them a try (as long as you aren't actively experiencing intense pain) and let us know how you do. The most important reason to do these exercises with a frozen shoulder is to help it reach that thawing phase and expedite your healing process!
If you are no longer experiencing shoulder pain and are ready to begin strengthening, check out this video below created by our friend Kendra! If you aren't sure if you're ready to strengthen, check with a Physical Therapist. We will post more videos on shoulder strengthening in the future.
Conclusion
Overall, a frozen shoulder may be a challenge during the rehabilitation process but through time you should start noticing improvements. It is important to take action sooner than later in order to maximize gains and move forward to full recovery. If you have any questions or concerns please do not hesitate to reach out!
“The cold never bothered me anyway”- Idina Menzel
References
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