If you’re experiencing stiffness and limited movement, you may be dealing with the painful ailment known as frozen shoulder, which can take months to fully heal without proper treatment. Frozen shoulder is a condition that limits movement in the shoulder joint. It develops in three stages that can last for several months.
Taking over-the-counter painkillers like paracetamol or NSAIDs and doing gentle shoulder exercises can help relieve the pain and reduce swelling. However, if the symptoms persist, it is important to consult an orthopedic specialist.
1. Pain and Stiffness
When a shoulder becomes painful and stiff, it’s important to see a doctor about the condition. Your doctor will ask you about your symptoms and perform a physical exam of your shoulder. He will move your shoulder in different directions to see if you have any pain or stiffness when he moves it. This is called active and passive range of motion. He may also order an MRI to check for other causes of a limited range of motion in the shoulder, such as rotator cuff tears.
Frozen shoulder usually progresses through three phases, but the stages can overlap and can vary in severity from person to person. The first phase is often described as the ‘freezing’ stage, and this is when your shoulder starts to ache and become very stiff. This can last from two to nine months. During this time, the pain can be so bad that it interferes with your day to day activities.
During the ‘frozen’ phase, your pain may decrease but your shoulder will remain stiff. The shoulder will eventually thaw and regain movement over a five to 26 month period.
While your shoulder can get better on its own, it’s important to work closely with your doctor to ensure you’re getting the right treatment. This will likely include a combination of medications (such as regular paracetamol and stronger pain relievers) and physical therapy.
You’ll probably need to focus on exercises that will help stretch the shoulder capsule and regain the normal movement of the shoulder joint. You may also need to apply heat or ice to the affected area. It’s also important to avoid any activities that aggravate the shoulder.
2. Numbness or Tingling
Frozen shoulder affects between two and nine percent of people between the ages of 40 and 60. It is twice as common in women and may develop after a shoulder injury, surgery, or prolonged immobilization such as wearing a sling. Symptoms start gradually and can last for up to three years. There are usually three different stages: a painful stage, known as the ‘freezing’ phase; a frozen and stiff stage that can last between four and nine months; and a resolution or thawing phase when pain gradually eases and movement gradually returns to normal.
The best treatment for frozen shoulder is a combination of medication and physiotherapy. GPs can refer you to an NHS physiotherapist or you can self-refer if you’d rather pay for private therapy. Your physiotherapist will give you exercises and stretches that help to ease the pain. They will also test how far you can move your shoulder to assess your progress.
Most of the time, you won’t need X-rays for your shoulder, but your healthcare professional might use them to rule out other conditions or to identify the type of frozen shoulder you have. A simple movement called passive external rotation is the main test for this condition and it’s shown in this video.
If you don’t get the treatment you need, you can end up with a permanent frozen shoulder. This is a rare event, but it can happen if you don’t seek medical advice. The focus of treatment is controlling pain and restoring motion through physiotherapy, but it can take a long time. Sometimes patients need to have cortisone injections into their shoulder joint to reduce pain and swelling.
3. Loss of Range of Motion
Frozen shoulder can cause pain and stiffness that prevents your shoulder from moving normally. This can make it harder to do everyday activities such as reaching into your back pocket, opening a door or dressing yourself. If you have a severe loss of shoulder movement, see your doctor immediately to avoid permanent damage and get started on treatment.
Your doctor will probably diagnose frozen shoulder by asking about your symptoms and performing a physical exam. You may also have X-rays or an MRI to make sure that other health problems are not causing your pain and stiffness. Most people who have frozen shoulder recover their shoulder motion over time, but it can take up to two years.
Symptoms of this condition start when you have a minor shoulder sprain or injury and stop moving your shoulder as a result. It is also possible to develop a frozen shoulder from prolonged immobilization after surgery, a broken arm or stroke.
Once the pain and stiffness starts, you can improve your symptoms with a combination of over-the-counter or prescription medications, ice packs and targeted exercises that stretch and strengthen the shoulder capsule. Physical therapy can be especially helpful during this phase, although it takes patience and commitment to stick with the program.
If your pain is severe or does not ease with medication, you might benefit from a steroid joint injection. This is a procedure that involves inserting a needle into your shoulder joint and filling it with fluid (usually saline and local anaesthetic). The injection helps to stretch the joint capsule and relieve pain. Your doctor can guide you through this process using X-rays or ultrasound to ensure that the fluid reaches the right area of your shoulder.
4. Poor Sleep
Frozen shoulder (adhesive capsulitis) is a condition that develops when the shoulder joint capsule becomes thick and inflamed, making it tight and restricting movement. It also may have less synovial fluid to lubricate the joint. It’s unclear what causes it, but people with certain medical conditions are more likely to get it, such as rheumatoid arthritis or an immobilizing injury.
The pain and stiffness of frozen shoulder can seriously interfere with daily activities, including sleep. Getting enough quality rest is vital to your health. Poor sleep can lead to depression, fatigue, high blood pressure and heart disease. You should discuss the symptoms with your doctor if they interfere with your ability to sleep or cause you distress.
Symptoms of frozen shoulder often improve after treatment begins. But it can take up to three years for the shoulder to thaw out completely. Pain relief medication, injections to calm inflammation and physical therapy are standard treatments for frozen shoulder. A combination of treatments can accelerate recovery.
For example, a corticosteroid injection into the shoulder joint can help foster a faster recovery, especially when done early in the freezing phase. The injection is usually performed in the office, using ultrasound imaging to ensure the injection is placed correctly.
Another option is a suprascapular nerve block, which can reduce pain and increase mobility in the shoulder. This procedure involves injecting the shoulder with anesthesia.
A shoulder specialist such as Dr. Matthew Pifer can offer a comprehensive evaluation of your pain and symptoms and provide you with state-of-the-art treatment for your frozen shoulder. Call today to schedule an appointment.
5. Unusual Symptoms
Frozen shoulder is a condition that limits how much your shoulder moves. Abnormal bands of tissue build up in the joint (adhesions) and prevent it from moving. This can cause pain and stiffness. If the symptoms get worse, it’s important to see your doctor or a musculoskeletal specialist (orthopedist or physiatrist).
Your doctor will do a physical exam to check how your shoulder moves. They may move your shoulder by hand (called active range of motion) and with help from you (passive range of motion). Your doctor will compare these movements to see how limited your movement is. They might also give you a steroid injection to help ease your pain and stiffness. They typically inject the steroid in the joint capsule. The injection may provide relief for weeks or months. It’s important to keep a diary of your pain and how well the treatment works for you.
If your symptoms don’t improve, your doctor might suggest other treatments. They might recommend medications to manage pain and inflammation, physical therapy, injections, or – very rarely – surgery.
Most people who have frozen shoulder improve with relatively simple treatments to control pain and restore motion and strength. For example, if you have diabetes and the condition is related to your blood sugar control, developing a plan with your doctor and endocrinologist to improve your diabetes management can speed up recovery from frozen shoulder. You can also do exercises to stretch your shoulder capsule to reintroduce movement to the joint. Most people improve with these nonsurgical treatments, and most can return to their normal daily activities. In very rare cases, your doctor might need to perform a procedure called “shoulder manipulation” or arthroscopic surgery to break up scar tissue and reintroduce movement to the shoulder joint.
