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General Health and Wellness 

Frozen Shoulder:
Understanding and Managing a Sticky Situation

Imagine trying to put on your jacket, scratch your back, or reach for the top shelf—only to feel like your shoulder has turned into concrete. That’s frozen shoulder, also called adhesive capsulitis. It may sound like a winter sports injury, but it has nothing to do with snow and everything to do with stiffness.

 

The good news? With the right care and a little patience, most people regain function and get back to daily life without surgery.

What is Frozen Shoulder?:

​Frozen shoulder is a condition where the capsule of the shoulder joint becomes thickened, tight, and inflamed, leading to pain and a significant loss of motion. It most commonly affects people between 40–60 years old and is more common in women (Zuckerman & Rokito, 2011).

Who is at Risk?:

  • Diabetes: Up to 20% of people with diabetes may develop it (King et al., 2017).

  • Thyroid disease: Both hyper- and hypothyroidism are linked to higher risk.

  • Post-surgery or injury: Periods of immobilization (like after rotator cuff surgery or fracture).

  • Other conditions: Heart disease, Parkinson’s disease, and stroke survivors also show higher incidence (Hand et al., 2008).

Phases of Frozen Shoulder Progression:

  • Freezing phase (2–9 months): Increasing pain, especially at night, and gradually decreasing movement.

  • Frozen phase (4–12 months): Pain may lessen, but stiffness is severe—like moving through wet cement.

  • Thawing phase (5–24 months): Gradual return of movement and function.

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👉 Once you enter this cycle, it can feel like there’s no way out—but the truth is, you have to go through each phase. The shoulder almost always follows this progression, though treatment can make the ride smoother and shorter (Hand et al., 2008; Kelley et al., 2013).

What Causes It?:

The exact cause isn’t fully understood. Most experts believe it involves inflammation inside the shoulder joint, leading to scarring and tightening of the capsule. Think of the capsule like a drawstring bag that slowly shrinks and squeezes the joint. Risk increases if the shoulder is kept still for long periods, such as after injury or surgery (Zuckerman & Rokito, 2011).

Treatment Options:

1. Physical Therapy (PT)

Physical therapy is the first-line treatment and plays the biggest role in recovery.

  • What PT does:

    • Gentle joint mobilization to loosen the capsule.

    • Stretching and mobility drills tailored to tolerance.

    • Strengthening of the rotator cuff and scapular stabilizers.

    • Education on pacing, activity modification, and home exercise.

  • Evidence:
    A Cochrane review found that PT combined with home exercises speeds recovery and improves function compared with “wait and see” (Page et al., 2014).

    • With PT: Many patients regain function within 6–12 months.

    • Without PT: Recovery may take 12–36 months and often with more persistent stiffness (Hand et al., 2008).

 

2. Corticosteroid Injection

  • Best timing: Early in the freezing phase, when inflammation and pain are highest.

  • Effect: Provides faster pain relief and helps patients tolerate stretching and therapy (Sun et al., 2018).

  • Limitations: Less effective in later “frozen” phase when stiffness—not inflammation—is the main issue.

 

3. Medications

Over-the-counter NSAIDs (like ibuprofen) can reduce pain and allow more comfortable stretching.

 

4. Other Medical Procedures

  • Hydrodilatation (joint distension): Injecting saline and steroid to stretch the capsule—shown to provide quicker short-term relief.

  • Manipulation under anesthesia (MUA) or arthroscopic release: Reserved for severe, non-responsive cases.

Self-Care Exercise Routine:

(Do daily unless otherwise instructed. Use heat for 10 minutes before starting.)

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  1. Pendulum Swing
    Lean forward, let your arm hang, swing in small circles.

    • 1–2 minutes.

  2. Wall Walk (Flexion)
    Walk your fingers up the wall as high as you can without sharp pain.

    • Hold 10 seconds, repeat 10 times.

  3. Cross-Body Stretch
    Gently pull the arm across your chest.

    • Hold 20 seconds, repeat 5–10 times.

  4. Towel Stretch (Internal Rotation)
    Hold a towel behind your back and gently pull upward with the other arm.

    • Hold 15–30 seconds, repeat 5–10 times.

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What to Do (and Not Do):

✅ Do:

  • Apply heat before stretching.

  • Stay consistent with gentle exercises.

  • Keep the rest of your body active.

 

❌ Don’t:

  • Forcefully push into pain.

  • Completely rest the arm.

  • Expect overnight recovery—it’s a marathon, not a sprint.

Conclusion:

Frozen shoulder is frustrating, but not forever. With consistent PT, timely cortisone injections when needed, and smart self-care, most people regain function and return to daily activities. Think of it as a long thaw—it may be slow, but spring always comes.

Scientific References:

  • Hand, C., Clipsham, K., Rees, J. L., & Carr, A. J. (2008). Long-term outcome of frozen shoulder. Journal of Shoulder and Elbow Surgery, 17(2), 231–236. https://doi.org/10.1016/j.jse.2007.05.009

  • Kelley, M. J., Shaffer, M. A., Kuhn, J. E., Michener, L. A., Seitz, A. L., Uhl, T. L., ... & McClure, P. W. (2013). Shoulder pain and mobility deficits: adhesive capsulitis. Journal of Orthopaedic & Sports Physical Therapy, 43(5), A1–A31. https://doi.org/10.2519/jospt.2013.0302

  • King, T., Jones, G., & Kok, J. (2017). The association between diabetes and shoulder disorders: a review of the literature. Current Diabetes Reviews, 13(3), 266–270. https://doi.org/10.2174/1573399812666160606104945

  • Page, M. J., Green, S., Kramer, S., Johnston, R. V., McBain, B., Chau, M., ... & Buchbinder, R. (2014). Manual therapy and exercise for adhesive capsulitis (frozen shoulder). Cochrane Database of Systematic Reviews, 2014(8), CD011275. https://doi.org/10.1002/14651858.CD011275

  • Sun, Y., Lu, S., Zhang, P., Wang, Z., & Chen, J. (2018). Steroid injection versus physiotherapy for patients with adhesive capsulitis of the shoulder: a PRISMA systematic review and meta-analysis of randomized controlled trials. Medicine, 97(31), e11405. https://doi.org/10.1097/MD.0000000000011405

  • Yang, J. L., Chang, C. W., Chen, S. Y., Wang, S. F., & Lin, J. J. (2007). Mobilization techniques in subjects with frozen shoulder syndrome: randomized multiple-treatment trial. Physical Therapy, 87(10), 1307–1315. https://doi.org/10.2522/ptj.20060079

  • Zuckerman, J. D., & Rokito, A. (2011). Frozen shoulder: a consensus definition. Journal of Shoulder and Elbow Surgery, 20(2), 322–325. https://doi.org/10.1016/j.jse.2010.07.008

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