• Health & Wellness

    TUESDAY Q & A: “Frozen shoulder” develops slowly and can take months to heal

Skeletal illustration 'frozen shoulder' (adhesive capsulitis)DEAR MAYO CLINIC: I’ve had pain in my right shoulder for a few weeks that has been getting worse rather than better, even though I’m letting it rest. I have read the term “frozen shoulder” – could that be what I have? What causes it? Should I see my doctor, or will it eventually heal on its own?  

ANSWER: It is possible that you are experiencing a condition known as frozen shoulder (adhesive capsulitis). Although recovery can take several months to a year or more, a variety of treatments may help improve your shoulder joint’s range of motion. Make an appointment to see your doctor. He or she will be able to discuss your symptoms and help determine the cause. 

Your shoulder joint is made up of bones, ligaments and tendons. Surrounding the joint is strong connective tissue called the shoulder capsule. Normally, the capsule and joint are lubricated by synovial fluid. Frozen shoulder occurs when the capsule thickens and tightens around the shoulder joint. Stiff tissue bands (adhesions) may develop, and there may be less synovial fluid in the joint. Usually, just one shoulder is affected.

It’s unclear what triggers the change. Women are affected more often than are men, and it’s also more likely to occur in adults 40 and older. A prolonged period of shoulder immobility or reduced mobility may increase your risk. Immobility may be related to various factors, such as rotator cuff injury, a broken arm, recovery from surgery or a stroke. Your risk may also be greater if you have certain medical problems. Frozen shoulder is five times more common in people who have diabetes. Other conditions that may increase risk include thyroid disease, cardiovascular disease and Parkinson’s disease

Frozen shoulder usually develops slowly, progressing through three stages:

Painful stage — During this period, shoulder pain occurs with any movement and is usually worse at night. Pain is often significant whether your shoulder is at rest or in use, so the tendency is to use the arm less. The joint’s range of motion starts to become limited as your shoulder gradually stiffens.

Frozen stage — Pain may begin to diminish, particularly when the joint isn’t being used. Range of motion decreases noticeably as your shoulder becomes even stiffer. Daily living activities, such as combing your hair or putting on a belt, may become nearly impossible.

Thawing stage — Range of motion in your shoulder begins to improve, but often pain lingers. 

A diagnosis of frozen shoulder can be distressing, especially given the length of time it may take for resolution of the pain and stiffness. Whether treated or not, the majority of frozen shoulders improve on their own over the course of 6 to 12 months, but sometimes it can be up to 18 months. Without treatment, return of motion generally is gradual, but normal, full-range motion may never return. Most people experience improvement from relatively simple treatments.

To help reduce pain and inflammation, your doctor may recommend nonprescription pain relievers, such as aspirin and ibuprofen (Advil, Motrin IB, others). If needed, your doctor may prescribe stronger anti-inflammatory drugs. A corticosteroid injection into your shoulder joint during the first stage may be of particular benefit for pain relief, and some studies suggest that repeated injections in the early stages can help hasten recovery.

Most treatments involve moving and stretching the shoulder — just the opposite of what you might think to do when your shoulder begins to hurt and stiffen. Your doctor may recommend simple exercises that you can begin right away to help prevent further loss of shoulder function. A physical therapist may teach you stretching exercises to help you maintain and eventually regain as much mobility in your shoulder as possible. As the joint thaws, you may be given exercises to help strengthen your shoulder’s rotator cuff muscles and the muscles that stabilize your shoulder blade (scapula).

Some find transcutaneous electrical nerve stimulation (TENS) useful as an alternative approach to pain relief. TENS delivers small electrical impulses through electrodes placed on the shoulder.

If your symptoms remain persistent, your doctor may suggest other procedures. These could include injecting sterile water into the joint capsule to expand the tissue and make more room for joint movement, or arthroscopic surgery to remove scar tissue inside the joint. Aaron Krych, M.D., Orthopedic Surgery, Mayo Clinic, Rochester, Minn.