Frozen Shoulder

Stiffness and Pain of the Shoulder Joint

frozen shoulder
Simple movements can be painful with a frozen shoulder. DNY59 / Getty Images

Frozen shoulder, also called adhesive capsulitis, is a condition that causes restriction of motion and pain in the shoulder joint. The cause of a frozen shoulder is often unknown, but there are certain people who seem to have a higher likelihood of developing this condition. Frozen shoulder causes the capsule surrounding the shoulder joint to contract and form scar tissue. Most people unfamiliar with this condition are surprised by the amount of pain it can cause and the duration symptoms can persist.

However, there is good news, as appropriate treatment can be effective at controlling pain and accelerating the recovery.

Causes of Frozen Shoulder

Most often, frozen shoulder occurs with no associated injury or discernible cause.  However, there are some common themes in many patients who develop this condition.

  • Age & Gender
    Frozen shoulder most commonly affects patients between the ages of 40 to 60 years old, and it is much more common in women than in men.
  • Endocrine Disorders
    Patients with diabetes are at particular risk for developing a frozen shoulder. Other endocrine abnormalities, such as thyroid problems, can also lead to development of this condition. Having a frozen shoulder does not mean you must have an endocrine abnormality, but there is often this association.
  • Shoulder Trauma or Surgery
    Patients who sustain a shoulder injury, or undergo surgery on the shoulder can develop a frozen shoulder joint. When injury or surgery is followed by prolonged joint immobilization, the risk of developing a frozen shoulder is highest.
  • Other Systemic Conditions
    Several systemic conditions such as heart disease and Parkinson's disease have also been associated with an increased risk for developing a frozen shoulder.

No one really understands why some people develop a frozen shoulder. For some unknown reason, the shoulder joint becomes stiff and the capsule that surrounds the shoulder becomes contracted.

The shoulder joint is a ball and socket joint. The ball is the top of the arm bone (the humeral head), and the socket is part of the shoulder blade (the glenoid). Surrounding this ball-and-socket joint is a capsule of tissue that envelops the joint.

Normally, the shoulder joint allows more motion than any other joint in the body. When a patient develops a frozen shoulder, the capsule that surrounds the shoulder joint becomes contracted and tight. The capsule forms bands of scar tissue called adhesions. The contraction of the capsule and the formation of the adhesions cause the shoulder to become stiff and movement to become painful.

Diagnosing Frozen Shoulder

The most common complaint of people with a frozen shoulder is pain.  While they may realize that there is restricted motion, the most common concern is the pain associated with this condition.  Many shoulder conditions cause pain, including rotator cuff problems, and therefore frozen shoulder is one of the most commonly misdiagnosed problems in orthopedics.

  Many people who have signs of a rotator cuff tear actually have a frozen shoulder.

One of the challenges in diagnosis is that people can compensate for a very stiff shoulder joint by moving their shoulder blade and spine. Therefore, people with this condition may be able to lift their arm overhead, despite the fact that their should joint is tightly frozen. Your examiner must carefully assess not only how much your arm can move, but at which joint the motion is taking place. The reason frozen shoulder is often misdiagnosed is that people fail to isolate and determine the amount of movement at the ball-and-socket shoulder joint.

Stages of Frozen Shoulder

Frozen shoulder typically proceeds in predictable stages.  The average patient has symptoms of a frozen shoulder for 12-18 months.  Complete resolution of symptoms of a frozen shoulder can take up to 3 years. The good news is that the most painful, restrictive phase of frozen shoulder is the earliest, and therefore symptoms can improve quickly.  However, it is almost always many months, if not more than a year, for symptoms to resolve.

Treatment of a Frozen Shoulder

Frozen shoulder treatment primarily consists of pain relief and physical therapy. Most patients find relief with these simple steps, although the entire treatment process can take several months or longer.

If simple do not resolve the frozen shoulder, occasionally a patient will need to have surgery. This procedure is called an arthroscopic capsular release. Surgical capsular release of a frozen shoulder is rarely necessary, but it is extremely useful in cases of frozen shoulder that do not respond to therapy and rehab. If surgery is performed, immediate physical therapy following the capsular release is of utmost importance. If rehab does not begin soon after capsular release, the chance of the frozen shoulder returning is quite high.

Recovery from Frozen Shoulder

Most patients who have a frozen shoulder will have slight limitations in shoulder motion, even years after the condition resolves. However, this limit in motion is minimal, and often only noticed when performing a careful physical examination. The vast majority of patients who develop a frozen shoulder will recover their mobility with therapy and stretching alone.


Warner, JJ. "Frozen Shoulder: Diagnosis and Management" J. Am. Acad. Ortho. Surg., May 1997; 5: 130 - 140.

Continue Reading