Frozen shoulder can make everyday tasks feel like a Herculean effort. But what exactly is it?
A frozen shoulder, also known as adhesive capsulitis, is a common disorder characterized by pain, stiffness, and limited range of motion. If left untreated, it can worsen over time and significantly impact daily activities
Frozen Shoulder: A Closer Look
Symptoms of a Frozen Shoulder
A frozen shoulder, also known as adhesive capsulitis, is a painful and debilitating condition characterized by stiffness, pain, and limited range of motion in the shoulder joint. Symptoms typically include:
- Gradual stiffness: The shoulder initially feels stiff, but this stiffness gradually worsens over time.
- Aching pain: A dull, aching pain develops, often intensifying as the condition progresses. The pain may be more severe when moving the arm.
- Limited range of motion: The shoulder joint becomes increasingly restricted in all directions.
The Anatomy of a Frozen Shoulder
The shoulder is a complex joint with a wide range of motion. It consists of the glenohumeral joint, where the head of the humerus (upper arm bone) connects to the glenoid cavity (shoulder socket) of the scapula (shoulder blade). Surrounding this joint are ligaments, tendons, and bursae that provide stability and cushioning.
The rotator cuff, a group of muscles and tendons, plays a crucial role in shoulder stability and movement. However, this complex anatomy can also make the shoulder vulnerable to injury and conditions like frozen shoulder.
Normally, the head of the humerus moves smoothly in the glenoid cavity, a depression in the scapula. A shoulder is “frozen” when the capsule protecting the glenohumeral joint contracts and stiffens. Scar tissue (adhesions) may also form between the joint capsule and the head of the humerus.
Frozen shoulder causes
The condition often begins with an injury like a fracture or inflammation of the soft tissues, commonly resulting from overuse injuries such as bursitis or rotator cuff tendinitis. Inflammation leads to pain, which worsens with movement, limiting the shoulder’s range of motion.
When the shoulder is immobilized, the connective tissue surrounding the glenohumeral joint (the joint capsule) thickens and contracts, losing its flexibility. To avoid pain, movement is restricted, causing further contraction of the capsule. This reduces space for the humerus to move, and the joint may lose its lubricating synovial fluid. In more severe cases, scar tissue (adhesions) can form between the joint capsule and the humeral head.
Who is at risk of frozen shoulder?
Several factors can increase the likelihood of developing frozen shoulder, including:
- Lack of therapeutic exercise following tendinitis or injury
- Wearing a sling for extended periods without stretching
- Rotator cuff disorders (approximately 10% of individuals with rotator cuff issues develop frozen shoulder)
- Immobility following a stroke, heart condition, or surgery
- Other health conditions like thyroid disorders or Parkinson’s disease
Frozen shoulder treatment
If you suspect frozen shoulder or are in the early stages of developing it, consult a healthcare provider or shoulder specialist for a physical examination. To evaluate your range of motion, they may ask you to perform specific movements, such as reaching across your chest or down your back (Apley scratch test).
Your provider may take x-rays to rule out other issues like arthritis or dislocation, and an MRI might be ordered to check for rotator cuff tears.
Treatment focuses on pain relief and restoring mobility. A clinician will design a treatment plan, which may include:
- Anti-inflammatory medications, such as aspirin, ibuprofen (Motrin, Advil), or naproxen (Aleve, Naprosyn)
- Applying ice packs or frozen vegetables to the shoulder for 10-15 minutes multiple times daily to relieve pain
- Corticosteroid injections into the shoulder joint or soft tissue
- Physical therapy, which is crucial to treatment, beginning with stretching the joint capsule and progressing to strengthening exercises. A therapist can guide you on how far to push yourself and demonstrate the correct exercises. After learning these, you can continue your exercises at home.
As you work on stretching the shoulder capsule, avoid activities like overhead reaching, lifting, or anything that aggravates the pain. With a consistent exercise regimen, most people (more than 90%) improve without needing surgery.
However, full recovery from a frozen shoulder can take anywhere from several months to two or three years. If progress stalls, revisit your clinician or consult a shoulder expert. Rare cases may require surgery if non-surgical treatments are ineffective.
5 frozen shoulder exercises
Always warm up your shoulder before performing your exercises. The best way to do that is to take a warm shower or bath for 10 to 15 minutes. You can also use a moist heating pad or damp towel heated in the microwave, but it may not be as effective.
In performing the following exercises, stretch to the point of tension but not pain.
Pendulum stretch
(Perform this exercise first.)
- Relax your shoulders.
- Stand and lean over slightly, allowing your affected arm to hang down.
- Swing the arm in a small circle — about a foot in diameter.
- Perform 10 revolutions in each direction, once a day.
- As your symptoms improve, increase the diameter of your swing, but never force it.
- When you’re ready for more, increase the stretch by holding a light weight (three to five pounds) in the swinging arm.
Towel stretch
- Grasp a three-foot-long towel with both hands behind your back, and hold it in a horizontal position.
- Use your good arm to pull the affected arm upward to stretch it.
- You can also perform an advanced version of this exercise with the towel draped over your good shoulder.
- Grasp the bottom of the towel with the affected arm and pull it toward the lower back with the unaffected arm.
- Do this stretch 10 to 20 times a day.
Finger walk
- Face a wall three-quarters of an arm’s length away.
- Reach out and touch the wall at waist level with the fingertips of the affected arm.
- With your elbow slightly bent, slowly walk your fingers up the wall, spider-like, until you’ve raised your arm to shoulder level, or as far as you comfortably can. Your fingers should be doing the work, not your shoulder muscles.
- Slowly lower the arm (with the help of the good arm, if necessary) and repeat.
- Perform this exercise 10 to 20 times a day.
Cross-body reach
- Sit or stand.
- Use your good arm to lift your affected arm at the elbow, and bring it up and across your body, exerting gentle pressure to stretch the shoulder.
- Hold the stretch for 15 to 20 seconds.
- Do this stretch 10 to 20 times per day.
Armpit stretch
- Using your good arm, lift the affected arm onto a shelf about breast-high.
- Gently bend your knees, opening up the armpit.
- Deepen your knee bend slightly, gently stretching the armpit, and then straighten.
- With each knee bend, stretch a little further, but don’t force it.
- Do this stretch 10 to 20 times each day.
Strengthening the rotator cuff
After your range of motion improves, you can add rotator cuff–strengthening exercises. Be sure to warm up your shoulder and do your stretching exercises before you perform strengthening
Outward rotation
- Hold a rubber exercise band between your hands with your elbows at a 90-degree angle close to your sides.
- Rotate the lower part of the affected arm outward two or three inches and hold for five seconds.
- Repeat 10 to 15 times, once a day.
Inward rotation
- Stand next to a closed door, and hook one end of a rubber exercise band around the doorknob.
- Grasp the other end with the hand of the affected arm, holding the elbow at a 90-degree angle.
- Pull the band toward your body two or three inches and hold for five seconds.
- Repeat 10 to 15 times, once a day.
Frozen shoulder can severely impact daily life, but with patience, consistent exercise, and proper treatment, more than 90% of people can regain normal function without the need for surgery. The key to overcoming frozen shoulder is adhering to a long-term, guided rehabilitation plan and seeking professional help when necessary.
