Frozen Shoulder - What to Know

When dealing with a frozen shoulder diagnosis, there are many questions that may arise. How long will it take for me to feel better? Will I ever regain my range of motion? Why did this happen in the first place? This post is meant to help provide some answers to the most common frozen shoulder questions while providing an overview of how the diagnostic process and management of the condition are performed. Disclaimer: The information provided in this post is educational and may not apply to every frozen shoulder case. Please consult with your doctor for specifics related to your shoulder.

Question: What is frozen shoulder?

Answer: Frozen shoulder (also known as adhesive capsulitis - although there is debate over whether that name is truly appropriate) is a poorly understood condition that typically involves pain and restricted range of motion of the shoulder. It is commonly classified into three stages:

1. Pain/Freezing Stage

2. Frozen Stage

3. Thawing stage.

It is not understood why frozen shoulder happens in every individual but it is commonly associated with diabetes and hypo- or hyper-thyroidism. It can also occur secondary to trauma or immobility, such as failure to move adequately after an upper extremity surgery.

Question: How long does frozen shoulder last?

Answer: True frozen shoulder on average takes about 30 months to fully resolve. It is believed to be self-limiting by some professionals but with treatment one can commonly overcome frozen shoulder in a shorter time-frame than the 30 month average. It is also important to note that each stage commonly takes months to overcome. The Pain/Freezing stage commonly lasts for 6-9 weeks. The Frozen stage can last 4-6 months, and the Thawing stage can take 6 months to a year. Most people will overcome frozen shoulder with no lasting side-effects but it should be noted that not everyone makes a complete recovery and pain or loss of range of motion can be felt years after the thawing phase has completed.

Question: How is Frozen Shoulder diagnosed?

Answer: There are a mix of clinical tools your doctor can use to diagnose frozen shoulder that include details in your history, physical examination, and imaging. As each patient will present to their doctor in different stages of a frozen shoulder, some of these findings may or may not be present at the time of your exam. In regard to imaging, an X-ray of a frozen shoulder will appear normal.

Ultrasound can be useful in staging frozen shoulder as the pain/freezing stage can produce neovascularity (the body laying down small blood vessels in response to tissue changes) which is readily seen. coracohumeral ligament thickness and thickness at the rotator interval can also be measured with ultrasound and in one study when combined, was found to be 100% sensitive and 87% specific in the diagnosis of frozen shoulder. Dr. Drew routinely performs ultrasounds in office and the examination yields immediate results while being quick, painless and without exposing the patient to radiation.

Clinically, the simplest criteria identified is an equal restriction of passive and active external rotation at the shoulder joint with a clear X-ray. A more expensive option but commonly the gold standard in imaging of soft-tissue, MRI is also very useful in the diagnosis of frozen shoulder.

Question: How is frozen shoulder treated?

Answer: There are many options available to a patient suffering from frozen shoulder. The first option is simply supervised inaction. As stated above, in most cases of frozen shoulder, the condition will eventually run its course. However, this on average can take around 30 months and cause the individual physical pain and psychological stress as their lifestyle may need to be heavily modified during this time.

Conservatively, mobilization and exercises under a guided professional such as a sports chiropractor or physical therapist have been shown to significantly reduce the pain and range of motion restrictions experienced in a frozen shoulder. Other modalities such as shockwave ultrasound, laser light therapy, and diathermy have also been shown to assist in pain management and range of motion.

A shockwave ultrasound treatment utilizing the Piezowave II

Interventionally, corticosteroid injections to the joint capsule are useful, especially when combined with rehab, but even more effective is a technique called hydrodistension in which saline is injected into the joint in an attempt to distend the capsule, thereby increasing range of motion. When combined with manual therapy and rehab exercises, this procedure can be very effective. We pride ourselves on maintaining excellent referral relationships with sports medicine physicians and surgeons. In the event a referral is needed to co-manage your care, we are confident that you will be in good hands.

Occasionally, a patient may require more drastic approaches such as a manipulation under anesthesia (MUA) or a capsular release. Side-effects can occur with either of these procedures, not to mention that they require the use of anesthesia, and it is important to discuss the pros and cons of these more aggressive approaches with your medical doctor.

In Summary: Frozen shoulder is a difficult condition that requires a great deal of patience and a qualified healthcare professional to manage your care. Most cases do resolve fully but someone suffering from frozen shoulder should be educated on the timeline of the condition and the pros and cons of different treatment options so that they can work in conjunction with their healthcare provider to come up with a plan of attack. If you are suffering from frozen shoulder and don’t know where to turn, please reach out to us so that we can help direct you to the care that you need!