This was a question from my husband. He needed some exercises for frozen shoulder because I figured out his shoulder pain and stiffness was from adhesive capsulitis. This condition is also known as frozen shoulder.
He was having quite a bit of pain that had been gradually building and then his shoulder began to get really stiff. His range of motion was very limited and it was not improving with tendonitis treatment. Then it finally dawned on me. My husband is between the ages of 40 and 60. His uncle had frozen shoulder three times and his dad had it twice. There is some limited evidence of a genetic predisposition to frozen shoulder. I felt like a light bulb had just turned on. Even though my husband was a very healthy, active man in his late 40s, he had primary (idiopathic) frozen shoulder.
So what is frozen shoulder?
Frozen shoulder is a condition characterized by a gradual increase in pain and then later stiffness in the shoulder joint. It’s symptoms include:
- Pain at the shoulder
- Pain with shoulder movement
- Night pain
- Stiffness at the shoulder and decreased range of motion
- Normal x-ray
The stages of frozen shoulder
It comes on gradually and it’s progression is divided into stages.
- Freezing – This is the stage where your shoulder movement stays relatively normal but the shoulder becomes very painful to move. Frozen shoulder is a very painful condition. It is not uncommon for patient to cry in physical therapy because the pain is so high. This is not the case with most other shoulder conditions.
- Frozen – In this stage the pain begins to lessen but the shoulder becomes very stiff. It becomes difficult to perform everyday activities.
- Thawing – The shoulder begins to improve in movement in this stage. The progression is slow and not everyone’s motion will return to what it was prior to having frozen shoulder.
The whole process can take 18 months to 3 years to completely recover.
The types of frozen shoulder
There are two different types of frozen shoulder, primary frozen shoulder and secondary frozen shoulder. Primary frozen shoulder occurs spontaneously without any specific trauma or event. Secondary frozen shoulder occurs after a trauma or surgery to the shoulder. My husband had primary frozen shoulder because he had not experienced any type of shoulder accident, event, or surgery. I probably see slightly more secondary rather than primary in the clinic. This could be for a couple of different reasons.
- Patients with primary frozen shoulder may not seek treatment for the condition. This could be because they didn’t have insurance, their deductible or copay was too expensive, they were too busy, or it didn’t interrupt their life enough to seek treatment.
- Those with secondary frozen shoulder are probably already in physical therapy to help rehab from their injury or surgery.
Secondary frozen patients tend to do very well and recover from frozen shoulder faster than the primary ones. This is probably because it is caught early on before it has had a chance to progress. Primary frozen shoulder patients tend not seek medical intervention until the shoulder is very stiff and they are having difficulty performing everyday tasks.
Frozen shoulder risk factors
Frozen shoulder is not well understood. It is thought that the joint capsule and other tissue around the joint become inflamed and thickened. This prevents joint movement. It is unclear why some people develop it and some people do not. There are some known risk factors that make some more susceptible to it than others. These include:
- Female sex
- Between the ages of 40-59
- Preceding trauma to the shoulder
- Prolonged immobilization to the shoulder
- Diabetes
- Hypothyroidism
- Hyperthyroidism
- Parkinson’s
- Heart disease
- Autoimmune disease
My husband only had one risk factor on this list – his age. This is one of the reasons why it took me so long to diagnose his shoulder problem. He did not fit the profile of someone with frozen shoulder.
How to treat frozen shoulder
A corticosteroid injection from an orthopedic physician will help with pain and inflammation in the shoulder. However this would not address the loss in motion, strength, and function. For that, one would need to go to a physical therapist. A physical therapist is essential to provide manual therapy for improved joint and soft tissue mobility. Also a physical therapist can provide proper guidance in developing strength within the gradually increasing shoulder mobility.
Exercises to help improve motion and decrease stiffness
You can perform exercises at home to help with mobility. The most important exercises to do are ones that increase motion and decrease the stiffness in all directions of the shoulder. The video below reviews exercises that you can do at home. I would recommend getting a pulley to hang over the door. This is one of the most helpful exercises to do and seeing the pulley will remind you to do it.
Using ice and heat
I typically advice using ice with inflammatory conditions. However heat can feel really good and help decrease the discomfort of stretching exercises if done right before. I would suggest using a heating pad to warm up the shoulder for 10-15 minutes and then perform your exercises. Ice is good after performing exercises or some other activity that irritates the shoulder. Ice with an ice pack for 15-20 minutes after activity to help decrease pain and inflammation.
Manipulation under anesthesia
This is a procedure that can be performed if other conservative measures like physical therapy have failed. This is a procedure performed in a hospital setting. The patient is fully anesthetized while the physician moves the affected arm through all the planes of motion to break up all the scar tissue around the joint. This would be too painful for the patient to tolerate awake.
This seems like it would be a straight forward solution to resolve one’s frozen shoulder. However it is not. It takes about a week for the swelling and the pain to decrease after a manipulation. Also, in my experience, most patients receive only modest gains in motion after the procedure. Plus it has risks. These include:
- Arm fractures
- Shoulder dislocation
- Rotator cuff tears
- Labral tears
- Blood clots
- Nerve damage
This procedure should be considered if absolutely no progress is being made in physical therapy. However, if my patient is showing progress (no matter how slow) in physical therapy, I would not advise a manipulation.
Again?!
I figured out that my husband had frozen shoulder in the summer of 2020. We spent a lot of time outside with our neighbors during the first year of the pandemic. We have a large park beside our street where all of our kids would play. My husband and some of the other neighbors made up a game that involved throwing and catching a football. This later turned into a frisbee game. The frozen shoulder began a month or two after these games began. This was quite a bit more movement than my husband’s shoulder was used to during pre-pandemic times. I believe this triggered his frozen shoulder. He is right handed and was throwing with his right arm. He had right-sided frozen shoulder. This did eventually resolve and my husband is now able to move his right shoulder with full motion and no pain. Interestingly enough, he developed frozen shoulder in his left shoulder 2 years later. Up to 17% of people who have had frozen shoulder get it in the other shoulder within 5 years.
In review
- Frozen shoulder is a condition characterized by pain and stiffness in the shoulder
- It can take up to 3 years to clear up on its own
- Seek medical intervention, including physical therapy, if you suspect that you have frozen shoulder
- Use heat to help get the shoulder moving and ice to decrease inflammation when it is irritated
- Perform mobility exercises several times per day
- Don’t be surprised if you get it again
As always, If you have questions about the content of this post or any other musculoskeletal questions, please e-mail me.
Additional resources
https://www.statpearls.com/articlelibrary/viewarticle/21982/
https://www.physio-pedia.com/Frozen_Shoulder
https://www.choosept.com/guide/physical-therapy-guide-frozen-shoulder-adhesive-capsulitis