Frozen shoulder, technically known as adhesive capsulitis, affects up to 300,000 Americans each year. Often starting with no obvious cause, the condition can be painful and debilitating, affecting quality of life by making everyday tasks impossible, interfering with sleep, and adding stress to important functions like driving, household chores, and physical occupations.

Three phases

Frozen shoulder typically moves through three phases. The first phase, often called “freezing,” is the most painful as the joint capsule, normally a thin and supple sheathing around the shoulder joint thickens and hardens as it becomes inflamed. 

The second, or “frozen” phase is when the joint can no longer perform normal ranges of motion due to the capsule’s stiffening. Lifting the arm overhead, reaching behind the back, or rotating the forearm out to the side are typically the most impaired motions although in many cases, the whole upper quadrant of the torso as well as down the arm can be involved with pain. 

The third or “thawing” phase is when the joint capsule finally begins to heal as range of motion is restored and pain goes away. As mysterious as the onset of frozen shoulder often is, the thaw may be equally as inexplicable. While up to 95% of cases will eventually resolve on their own with the aid of conservative interventions, it can be a long road back.

Causes and symptoms

Frozen shoulder can mimic arthritis, but an X-ray can tell the difference.

With up to 70% of those affected by frozen shoulder being women aged 40-60, preliminary research is showing a correlation with menopause, but scientists say more studies are needed to determine direct causation. Another suspected cause is lack of movement in the shoulder area over an extended period of time. This can happen after a surgery or long illness or from a sedentary lifestyle. Frozen shoulder is sometimes associated with injury or trauma, but not necessarily. Frozen shoulder can mimic arthritis, but an X-ray can tell the difference in the type and location of the inflammation.

Stubborn shoulder pain with decreasing range of motion and increasing stiffness should take you to your primary care provider who will take a history and do a physical exam. If a frozen shoulder diagnosis is made, the next step will likely be a series of visits with a physical therapist. Even though the condition would most likely resolve on its own eventually, it could take several years to get normal function back and most of us would prefer to speed up the process. 

Treatment

It may not be practical or affordable to see a PT for months or in some cases years, but starting with a PT’s expertise will likely net you an individualized program for a home-based routine that is designed to address your specific symptoms. If progress stagnates, a return to the PT for a reassessment may be necessary but professional help will bring results more quickly.

Once resolved, it is extremely rare to get frozen shoulder again in the same joint.

When physical therapy plus homework doesn’t work, there are alternatives. Corticosteroid injections can reduce stubborn inflammation, but should be used sparingly as tissue damage can occur. In less than 5% of cases, a surgical procedure may be needed to break up the stubborn hardening of the joint capsule. Once resolved, it is extremely rare to get frozen shoulder again in the same joint, but you could be vulnerable to getting it in the other shoulder. 

The shoulder is one of the most mobile joints in the body. Lack of strength in the muscles that surround the joint and move the arm and shoulder blade turn that mobility into weakness. Our nearest primate relatives, chimpanzees, need both the remarkable articulative strength to swing from the trees, as well as significant stabilizing strength required to support the upper body as they move about on the ground. This style of locomotion, called “knuckle walking”, puts the shoulders into a weight-bearing role seldom experienced past childhood in modern humans. When we evolved to be truly bipedal, we no longer needed certain shoulder functions, and so we sacrificed the ability of the shoulder to support those actions. As modern life has made us generally less active, the shoulder has retained its exceptional articulation, but now lacks the strength to manage it in many tasks.

Prevention

Hanging and the pull-up can go a long way toward keeping the shoulder strong.

Little kids on the playground don’t think twice about swinging from the bars and children also do a lot of crawling as they play. With as many as ten percent of us suffering from frozen shoulder at some point in our lives, it’s no wonder that exercises that help us reclaim some of our ancestral abilities are trending these days. Hanging, and its dreaded cousin the pull-up, can go a long way toward keeping the shoulder strong and capable in overhead ranges of motion. Push-ups of various forms can restore upper body strength to our former knuckle-dragging ways. Working towards these abilities can begin with simple range of motion exercises that gradually incorporate resistance aimed at ultimately enabling you to channel your inner ape.

A solid shoulder routine performed 2-3 times per week can go a long way toward prevention of frozen shoulder, or is certainly good insurance against getting it again, on either side. From “shouldering the burden” to ” you can cry on my shoulder”, we perceive our shoulders to be broad and reliable, capable of weathering any stress we assign to them. Whether you’ve suffered through adhesive capsulitis or are seeking to prevent it, be sure to take good care of this beautiful joint, and don’t get a chip on your shoulder.

Ann Constantino, submitted on behalf of the SoHum Health’s Outreach department.