Has putting on clothes or reaching for something on a shelf become more difficult? Do you find yourself keeping your shoulder as still as possible to avoid the pain? If so, you may have frozen shoulder syndrome, a difficult and long-lasting but very treatable condition. Read on to learn more about frozen shoulder causes and what you can do to both reduce pain and increase range of motion.
What is frozen shoulder?
Frozen shoulder syndrome, also called adhesive capsulitis, is in many ways a mysterious ailment; the exact reasons why it develops are unknown. What we do know is that the pain and stiffness associated with a frozen shoulder originate in the shoulder joint capsule. This is the group of ligaments, or connective tissues, that attaches your shoulder to your arm. When the capsule becomes stiff or swollen, your shoulder freezes.
Pain caused by frozen shoulder syndrome progresses much differently than shoulder pain caused by other conditions. To start, it has three stages. The first and most painful stage, the freezing stage, is characterized by increasing pain and decreasing range of motion. The freezing stage can last anywhere from six weeks to nine months.
Afterward, you will move into the frozen stage. Your pain will lessen, but immobility and stiffness increases. This stage generally lasts from four weeks to six months. Finally, in the thawing stage, symptoms begin to ease; your pain recedes and range of motion gradually improves. The thawing stage can take as little as six months and as long as two years.
All told, frozen shoulder syndrome takes anywhere from one to three years to run its course. Women are more likely to develop this condition than men, and middle-aged individuals are at greater risk than younger or older individuals.
What causes frozen shoulder? 9 potential causes
Some common, and uncommon, frozen shoulder causes are listed below. But even if you don’t fit the criteria described here, your shoulder can still freeze. As mentioned previously, the science behind frozen shoulder syndrome is still very much a mystery. If you think you may be suffering from this condition, talk to your doctor.
Diabetes occurs when your body either fails to produce insulin, which helps you digest glucose, or cannot properly absorb the insulin it makes. Early symptoms of diabetes include fatigue, weight loss, increased appetite and thirst, and more.
Diabetes can wreak havoc on your body, especially when it’s left untreated. In fact, diabetics are five times more likely to develop frozen shoulder syndrome than people without diabetes.
When you hurt your shoulder, your doctor will often (and correctly) tell you to immobilize it for a while. This is to ensure that you don’t reinjure your shoulder while it’s trying to heal. In some cases, however, this period of immobility can cause your shoulder to freeze.
It doesn’t matter what kind of shoulder injury you have. Any injury may leave you susceptible to frozen shoulder syndrome. This is especially true if you don’t receive proper post-injury treatment. If you have recently recovered from a shoulder injury, it’s important to go to physical therapy and to follow the exact regimen your physical therapist gives you.
3. Thyroid problems
The thyroid is a gland in the front of your neck. When your doctor feels your neck during a physical exam, one of the things they are checking for is swelling in the thyroid gland.
The thyroid’s main job is to produce hormones that give you energy and keep your organs functioning. When your thyroid ceases to function efficiently, it can affect not only your overall health but your shoulder specifically. A 2008 study found that, out of 126 new frozen shoulder patients, 13.5% suffered from a thyroid disorder.
Hyperthyroidism occurs when the thyroid produces too many hormones. Common symptoms include swelling, elevated heart rate and blood pressure, and weight loss. Hypothyroidism is the exact opposite condition: your thyroid doesn’t produce enough hormones. It can result in fatigue, depression, dry skin, and other symptoms.
4. Arthritis and other inflammatory conditions
Arthritis is a painful condition that causes inflamed, stiff joints. It is very common, with over 100 types that affect over 54 million adults in the United States. If it affects the shoulder, arthritis can increase your risk of frozen shoulder syndrome. Your chances of developing arthritis increase with age, but some kinds of arthritis affect even children.
Arthritis is not the only chronic condition that leads to joint stiffness and swelling. Fibromyalgia, lupus, polycythemia vera, and others can affect the shoulders. This in turn increases your chances of developing frozen shoulder syndrome.
The three non-arthritis conditions listed in this section have joint pain in common, but each feels quite different in other respects.
Lupus is a disorder in which your autoimmune system attacks healthy tissue rather than harmful entities like viruses. This leads to a whole host of health problems, including joint stiffness, fevers, depression and anxiety, and poor circulation.
Polycythemia vera is a rare bone cancer characterized by fevers, vertigo, headaches, weight loss, and other symptoms.
5. Cardiovascular disease
Cardiovascular disease is a catchall term for various heart ailments, including heart disease, arrythmia, valve problems, stroke, and others.
One big reason why cardiovascular disease contributes to frozen shoulder syndrome is immobility. Like with shoulder injuries, recovering from cardiovascular disease often involves keeping your arm still for a period of time.
For example, if you’ve had a stroke, you may not be able to move your arm at all. And if you’ve had heart surgery, you will need to take it easy for several weeks, after which you will slowly build up to a normal activity level. Physical therapy can help you recover from both of these circumstances.
Interestingly, according to the same 2008 study mentioned earlier, heart-related conditions like hypertension and high cholesterol were not shown to increase patients’ risk of frozen shoulder syndrome.
Other frozen shoulder causes include the following:
- Hormone imbalance
- Parkinson’s disease
- Dupuytren’s contracture
What are the first signs of frozen shoulder?
One of the first frozen shoulder symptoms people notice tends to be a dull pain or ache that flares up any time they try to move the shoulder. You may also have neck pain and arm pain, because your neck and arm are so close to your shoulder. Sometimes, frozen shoulder symptoms get worse at night, making it difficult to fall asleep.
While reduced range of motion is a hallmark of frozen shoulder syndrome, it is not associated with the early stages of the condition. You probably won’t notice your range of motion decreasing until later on. This is because your range of motion gets worse the longer the scar tissue builds up in the shoulder capsule, and the longer you keep your shoulder still in response to the pain.
If you think you may have frozen shoulder syndrome, make an appointment with your doctor so they can examine and diagnose you. A frozen shoulder test involves multiple parts. First and foremost, you doctor will assess your range of motion by moving the shoulder in different directions. They will ask for your medical history and may even order X-rays. Other tests, such as magnetic resonance imaging (MRI), are rarely used in frozen shoulder cases.
Once your doctor feels comfortable making a diagnosis, they will prescribe treatment. This will likely include some of the remedies listed below.
What are common frozen shoulder treatments?
Frozen shoulder syndrome is frustrating and very painful, but it is treatable. The key is patience. Recovering from a frozen shoulder is a long process. It can take months or even years to regain full, pain-free range of motion. Just remember that even your worst days are progress, bringing you one step closer to recovery.
You should, of course, do your due diligence and research frozen shoulder treatments to see which ones sound like a good fit for your lifestyle. However, be sure to talk to your doctor before starting any frozen shoulder treatments. Not all treatments are safe for all people. Work closely with your physician to devise a plan that’s safe and effective for you.
Stretches and exercise
The really insidious part of frozen shoulder syndrome is that the pain makes you want to move your shoulder as little as possible, and yet regular movement is a critical part of treatment! Not moving your shoulder allows scar tissue to develop. The more scar tissue you have, the more limited your range of motion becomes.
That’s why it’s so important to exercise your shoulder on a regular basis (if approved by your doctor). Start slow and easy, and don’t push yourself too hard. If you feel pain, stop at once. Exercising may be difficult at first, since moving your shoulder is so painful. But stick with it! Frozen shoulder syndrome does get better over time, and your exercise routine will help your shoulder improve quicker.
Massage is another good way to help loosen up a frozen shoulder. You can get professional massages if you have the money and the inclination, but self-massage can help as well.
Teach yourself a few techniques and set aside some time every day to go through them. Many self-massage techniques can be performed with no special equipment, or with the aid of common household items, like a hand towel. Again, check with your doctor before starting massage treatment.
A simple but reliable method of pain relief is the strategic application of heat and cold. Heat therapy works best if you are looking to increase range of motion. Cold therapy is better for decreasing inflammation and swelling. As such, each can provide relief for different frozen shoulder symptoms.
There are many products on the market designed to provide heat or cold therapy. You may certainly use these if you wish, but homemade applications can work as well. Some ice wrapped in a towel or a hot shower will feel very good after a long day!
Medication and injections
Over-the-counter medications can help manage frozen shoulder pain.
If these medicines aren’t strong enough to ease your symptoms, your doctor may be able to prescribe something stronger. In some cases, this involves corticosteroid injections, which reduce inflammation. You can learn more about steroid injections in the following procedure video.
Physical therapy combines several treatment options into an individualized plan. A physical therapist will assess your shoulder and provide guidance on how to make your recovery as smooth as possible.
After the initial appointment or two, you will likely be able to continue many recommended treatments—such as special exercises and stretches—at home by yourself.
If the above treatments aren’t working for you, there are more radical treatments you can try. Hydrodilation, for example, involves injecting fluid into the shoulder, causing the shoulder capsule to swell and loosen up.
In rare cases, surgery may reduce scar tissue and restore mobility. There are two surgical procedures typically performed, either independent of or in conjunction with each other, on frozen shoulder patients: arthroscopy and manipulation.
During an arthroscopy, your surgeon cuts a small incision into the worst of the scar tissue, increasing your range of motion. Manipulation is a procedure during which the doctor anesthetizes you and moves your shoulder around until the accumulated scar tissue tears, allowing freer movement.
Post-surgery, you will have to undergo physical therapy to restore full range of motion. Patients who undergo these surgeries generally see good results. However, these treatments are a last resort to be used only if other treatments have failed. Most people with frozen shoulders recover well with more conservative remedies.
If you live in Arizona and need help managing your frozen shoulder pain, click below to get in touch with one of our pain specialists at Arizona Pain. We can help.