Stiffness and pain in the shoulder that won’t go away could be a sign of adhesive capsulitis, or “frozen shoulder.” While there is no quick fix, there are steps patients can take to get relief.
What causes frozen shoulder?
Frozen shoulder occurs when the capsule lining of the shoulder thickens. However, it’s often unclear why this happens.
“We used to think anytime someone would have an injury, like a rotator cuff injury or a trauma, it could induce a frozen shoulder. Now, we’re learning that adhesive capsulitis is a uniquely different form of stiffness,” said Yale Medicine orthopedic surgeon Christopher Schneble, MD, assistant professor at Yale School of Medicine. “Anything that can cause an inflammatory stimulus in the shoulder and start a cascade where inflammation starts to cause fibrosis and thickening inside of the capsule, causing the capsule to thicken, can put someone at risk to develop a frozen shoulder, but it can also develop without an explanatory event or injury.”
Those with certain underlying medical conditions, such as thyroid issues or diabetes, are at greater risk.
“We know the worse someone’s diabetes is, the more poorly controlled it is, the higher the rate (or incidence) of frozen shoulder,” said Dr. Schneble. “High sugars in the blood can lead to inflammation in several different areas.”
Frozen shoulder phases
There are three phases associated with frozen shoulder: freezing, frozen and thawing.
The freezing phase can last for several months. During this time, patients develop pain and slowly lose their range of motion. This then progresses to the frozen phase, where pain will often subside, but patients will still be stiff. Next, during the thawing phase, everything starts to get better, and range of motion improves.
Treatments for frozen shoulder and prevention
A frozen shoulder will eventually often resolve on its own, but patients tend to have quicker recoveries when under the care of a clinician.
For example, regular exercise and physical therapy are important for maintaining shoulder range of motion. Steroid injections can help manage pain and improve function. Other treatments may include hot and cold therapies and the use of anti-inflammatories. In more severe cases, procedures like hydrodilation (attempting to dilate and stretch the capsule with pressurized fluid) might be an option. Fortunately, surgical intervention to release the capsule is rarely needed.
Instead, one of the best things patients can do is address any underlying health conditions.
“Sometimes there’s nothing we can do to prevent a frozen shoulder, and it just happens, but the one thing people often do have within their ability to control is what they eat and how they manage certain medical issues,” said Dr. Schneble. “Keeping cardiovascular health in check is important, as is maintaining control over existing medical issues, particularly diabetes.”
Of course, there can be many causes of shoulder pain unrelated to frozen shoulder. Dr. Schneble says usually minor injuries will improve over time, so if any stiffness or pain worsens, that’s a warning sign to seek medical attention.
