Reaching for a plate from the cupboard is something you probably don’t think twice about. As healthy and active adults, these everyday tasks are seemingly effortless. Unfortunately, for patients with intense shoulder pain, even basic movement can feel impossible. Frozen shoulder syndrome is one of the many conditions responsible for nagging aches, pains, and tightness in this ball-and-socket joint. If you’re suffering from an unknown cause of shoulder pain and tightness, here’s what you need to know about frozen shoulder symptoms.
What is frozen shoulder syndrome?
Frozen shoulder syndrome, also known as adhesive capsulitis, is a condition that can create stiffness and pain in your shoulder. Your shoulder joint is encased in connective tissue that can thicken and tighten around the joint, resulting in discomfort.
While the cause isn’t completely understood, doctors agree that it is commonly seen in people who have had to immobilize their shoulder for a long period of time. This leads to the original onset of pain, which eventually turns into excessive stiffness. As a result, your range of motion in the shoulder joint can become so limited that it feels as if your shoulder is frozen in place.
In extreme cases, patients can’t move their shoulder at all. As time goes on, this lack of movement allows scar tissue to build up, further restricting range of motion.
What are the first signs of frozen shoulder?
Frozen shoulder syndrome occurs gradually over a long period of time.
You will likely first become aware of dull and aching pain. It is usually located over the outer shoulder area and sometimes the upper arm. As the pain intensifies, you may be unknowingly moving your shoulder less and less. You may eventually find that you can’t move your shoulder as you once did. When the pain is severe enough, you may not be able to do anything that involves shoulder movement.
There are some people who are at an increased risk for developing frozen shoulder syndrome. In general, it is most common in patients between the ages of 40 and 60, and occurs in women more often than men.
If you stop using your shoulder due to pain or injury, it will naturally become stiff. This is why patients recovering from medical conditions or procedures that prevent arm movement are at a greater risk. Some of these include those with:
- Requirements to wear a shoulder sling after a surgery, stroke, or injury
- Thyroid disorders
- Cardiovascular disease
- Parkinson’s disease
What are common frozen shoulder stages?
There are three common stages of frozen shoulder syndrome. Each has unique symptoms, as well as a timeline. These are some of the early and advanced signs of each.
In the initial stage, also known as the freezing stage, pain develops in your shoulder any time you move it. As a result, you may stop moving your shoulder as much.
Unfortunately, this only makes the problem worse. The less you move, the more scar tissue will continue to form. The pain during this stage can be severe and will usually increase over time, lasting anywhere from six weeks to nine months.
While the frozen stage can often bring pain relief, it may also mean increased stiffness.
Moving your shoulder will become even more difficult as range of motion diminishes or disappears completely. This stage will typically last anywhere from four weeks to six months.
The thawing stage lasts anywhere from six months to two years as your range of motion starts to improve.
For some, it can eventually return to how it once was. Your pain level may decrease substantially or even completely disappear once inflammation is under control.
The most common frozen shoulder symptoms
The 5 most common symptoms of frozen shoulder syndrome include the following:
- Shoulder pain
- Associated neck pain
- Mobility issues
- Increased pain at night
Let’s take a closer look at each symptom.
1. Shoulder pain
The most obvious and clear sign of frozen shoulder syndrome is pain, particularly in the musculoskeletal tissues and nerves in the shoulder area. This region includes the clavicle, upper humerus, and scapula.
While the pain may start out as dull, it will typically increase over time. The first stage of frozen shoulder syndrome comes with the highest pain levels. This phase can last anywhere from six weeks to nine months.
2. Associated neck pain
Because they’re so closely connected, neck pain often comes with shoulder pain.
The connective tissue that tightens and thickens leading to frozen shoulder also includes the tissue that connects your shoulder to your neck. Because the pain causes most patients to limit movement, this can further aggravate the issue.
While the second stage of frozen shoulder syndrome comes with decreased pain levels, this is when stiffness comes in. This is the stage that gives frozen shoulder syndrome its name.
The frozen feeling makes moving incredibly difficult, and in some cases, completely impossible. This is because the capsule of connective tissue becomes so tight and thick around the shoulder joint that it seems to freeze the shoulder in place.
4. Mobility issues
Patients suffering with frozen shoulder syndrome experience pain that intensifies over time. Suddenly, getting dressed or lifting your arm to reach for something becomes excruciating.
It’s a vicious cycle. This restriction naturally causes most patients to minimize shoulder movement, which only worsens the condition. Scar tissue may begin to develop in the shoulder, effectively “freezing” the shoulder in place.
5. Increased pain at night
In some patients, pain seems to increase during sleep.
When you lay down, the effect of gravity is removed, which allows the shoulder muscles to relax. The lack of movement paired with relaxation of the muscles causes the fluids in your joints to settle. This decreases the flow of blood, allowing the joint to become inflamed.
People also tend to lie on their shoulder while sleeping, which can compress the joint and worsen inflammation.
It is also possible that the lack of distractions at night makes certain patients more aware of their pain while they’re trying to sleep.
How to diagnose frozen shoulder syndrome
If you believe you may be experiencing frozen shoulder syndrome symptoms, you should visit your doctor for a physical exam. There is no definitive test that can diagnose this condition. Instead, your doctor will observe your range of motion, while also taking into account your medical history.
Your doctor will ask you to move in certain ways and assume different positions to check for what prompts your shoulder pain. Your doctor will also evaluate both active and passive range of motions. Active range of motion involves movement that you control. Passive range of motion is when you’re asked to relax your muscles and your doctor moves your arm for you. Both are important in determining whether you are suffering from frozen shoulder.
In some cases, you will receive a numbing injection to make this type of evaluation possible. This is usually done if your pain is so unbearable that it is too difficult to test movement capability.
Imaging tests, such as X-rays, magnetic resonance imaging (MRI), and ultrasound can also be used. They can’t diagnose frozen shoulder syndrome, rather they typically rule out other conditions or injuries that could be causing your pain. If your doctor can confidently say you’re not dealing with another condition, such as arthritis or a torn rotator cuff, it is more likely that you are dealing with frozen shoulder syndrome.
How do you get rid of a frozen shoulder?
A frozen shoulder will typically resolve itself, but this can take anywhere from nine months to years. In the meantime, many patients seek ways to speed up the recovery process. This can reduce the daily struggle of dealing with pain and limited mobility.
Treatment options for frozen shoulder syndrome vary greatly. From natural at-home remedies to interventional methods, there are several approaches your doctor may recommend. Find what works in your particular case. Your doctor will encourage you to attempt as many non-invasive methods as you can before moving on to more interventional approaches.
At-home frozen shoulder treatments
Always talk to your doctor before attempting any treatments. Once approved, at-home treatments may include stretching, exercise, and hot and cold therapy.
By keeping your shoulder healthy and mobile with stretching and exercise, you may be able to alleviate some of your pain and greatly reduce the stiffness you experience. As long as you listen to your body and move slowly, exercises like diagonal shoulder openers and fingertip walks can keep your case of frozen shoulder mild.
Alternating between hot and cold therapy can also reduce shoulder pain significantly. Using a heating pad can reduce stiffness and increase blood circulation. Alternatively, cold therapy is best for reducing acute inflammation that causes pain around the shoulder joint as you ready for another round of stretches.
Complementary and interventional therapies
If you’ve tried at-home approaches with no pain relief, your doctor may recommend a combination of the following treatments:
- Physical therapy: If you’re concerned about working through exercises and stretches on your own, a qualified physical therapist can help. Physical therapists are there to safely and gradually increase the intensity of your regimen for optimal healing. They can also offer guidance on balancing exercises on both sides of the body. This will help you avoid compensating in ways that cause injury to other parts of the body.
- Non-steroidal anti-inflammatory drugs (NSAIDs): Over-the-counter pain relievers such as aspirin and ibuprofen can provide short-term pain relief. This is helpful because it reduces inflammation, enabling you to move freely without pain. As previously mentioned, the more you can keep moving, the better off your shoulder will be. Work with your doctor to determine which medication is best for your specific case.
- Steroid injections: Corticosteroid injections can reduce inflammation and pain to improve mobility. They typically provide relief for several weeks or months, which can help you stay mobile and stick to a physical therapy routine. Consistent exercise can aid in breaking up scar tissue to reduce the stiffness of frozen shoulder syndrome.
- Surgery: In extreme cases, and when no other treatment options have worked, your doctor may recommend surgery. This typically involves an outpatient procedure to remove scar tissue from inside your shoulder joint. Stitches are removed after ten days and postoperative physical therapy is usually necessary. Many patients report having their full range of motion restored after a few months.
How to prevent frozen shoulder
If you’ve recently found relief from frozen shoulder syndrome, you may be afraid of a recurrence. You’ll find comfort in knowing that frozen shoulder rarely develops again in the same shoulder. However, some people do experience it in the opposite shoulder. Fortunately, there are things you can do to prevent this.
One of the most common contributors to frozen shoulder syndrome is a lack of mobility. This may occur while you’re recovering from surgery or an injury, or perhaps you’ve suffered a heart attack or stroke. Whatever the case, it’s important to keep your body moving as much as possible, and under the care of your medical team.
Your doctor may recommend exercises, stretches, and other conditioning techniques to keep your shoulder strong while you are recovering. This can maintain your range of motion and prevent the buildup of scar tissue that could lead to another bout of frozen shoulder syndrome.
Working with a physical therapist can be helpful if you’re concerned about maintaining a healthy exercise regimen that is still within your comfort level.
Do you believe you may be suffering from frozen shoulder symptoms? Contact our pain specialists at Arizona Pain. Our team will help you find the right treatment options for your shoulder pain.