What you should know about shoulder pain and frozen shoulder

What are the symptoms of frozen shoulder?

Frozen shoulder is a progressive condition that often starts with pain in the shoulder joint during basic movement. The condition progresses first with increased pain followed by decreasing mobility.

Anyone experiencing pain and or stiffness in one or both shoulders should see their healthcare provider, particularly if the pain persists for more than seven days or stiffness progresses.

There are three phases to the development of frozen shoulder:

Freezing phase (2 – 9 months)

The freezing phase of frozen shoulder starts with a gradual increase in joint pain. Pain will likely spread around the shoulder and become worse at night, making lying on the affected side uncomfortable.

Frozen phase (4 – 12 months)

In the frozen phase, shoulder pain will persist and stiffness will be noticed. Normal day-to-day tasks such as lifting medium weight objects or complex movements will become more difficult. Shoulder muscle deterioration is a risk in the frozen phase, as the shoulder is used less and less to avoid pain.

Thawing phase (5 – 12 months)

If treatment is effective and inflammation is reduced, then the condition will enter the thawing phase. Range of motion will slowly be restored and pain will gradually decrease, although it may re-appear occasionally as mobility returns.

What are the risk factors for frozen shoulder?

Although frozen shoulder can happen to almost anyone, it is most common in adults between the ages of 40 and 60, and women in particular.

Common risk factors for frozen shoulder are:

• Age: being over 40 years of age
• Gender: 70% of people with frozen shoulder are women
• Diabetes: 10%-20% of people with diabetes develop frozen shoulder
• Recent trauma: prolonged immobility resulting from surgery and/or an arm fracture can lead to the shoulder capsule stiffening

Other conditions that can increase frozen shoulder risk include:

• Parkinson’s disease
• Stroke
• Hyperthyroidism or hypothyroidism
• Cardiovascular disease

What are treatments for frozen shoulder

Frozen shoulder can be left untreated, but the pain and stiffness may persist for up to three years. Recovery can be significantly improved with one or more of the following courses of treatment:

• Physiotherapy
• Medication
• Surgery

Physiotherapy

The most common, and often most successful treatment for frozen shoulder is physiotherapy. A trained physiotherapist will focus on stretching the shoulder joint to improve mobility and relieve pressure on the joint. Therapy can take anywhere from a few weeks to nine months depending on age, severity and other contributing conditions. A physiotherapist may also recommend self-directed gentle range of motion exercises that can be performed at home.

Medications

If severe pain and/or stiffness is inhibiting quality of life and physiotherapy alone is not alleviating the condition, there are a number of medications that can help relieve the symptoms of frozen shoulder. Prescriptions can be as mild as anti-inflammatory medication such as aspirin, ibuprofen, or naproxen sodium, through to more significant treatments such as steroid injections directly into the shoulder joint.

Surgery

If physiotherapy does not improve the frozen shoulder symptoms, a doctor may recommend surgery. 

Surgery can range in complexity and invasiveness depending on the severity of scar tissue buildup.

In cases where the buildup is mild but painful, a surgeon can simply manipulate the shoulder through a full range of motion under a general anesthetic to help break up any adhesions.

In cases where there is significant scar tissue buildup, a surgeon may conduct arthroscopic surgery, which involves making a small cut in the shoulder and using a camera to remove scar tissue manually.

Most forms of frozen shoulder surgery are performed on an outpatient basis. Post-operative physiotherapy is typically still required. Most patients will have their full range of motion back within three months.