By Shawn Steets, PT, DPT, Physical Therapist
Virtua Physical Therapy and Rehabilitation—Voorhees

Frozen shoulder is another term for a condition formally known as adhesive capsulitis of the shoulder.

• The capsule is the strong connective tissue that surrounds the ball-and-socket, 360-degree-rotating shoulder joint.
• The -itis refers to its inflammation.
• When frozen shoulder happens, it means that the inflamed capsule of connective tissue adheres to, or sticks to, the top end of the upper arm bone.

The shoulder is so important in the function of doing daily tasks. Therefore, these adhesions can cause intense stiffness and pain while doing the simplest things. Often, my patients come to me after having kept their shoulder immobile for far too long. They use the other arm to compensate for the painful one, and this often makes the frozen shoulder worse.

To overcome the frustration of this condition, you have to physically push past the pain to recover from it.  

What causes frozen shoulder?

The root cause of frozen shoulder isn’t always known. Because of that, it’s primarily defined by and treated for its symptoms. However, people with the following issues or conditions seem to be more likely to develop this problem:

• Recent surgery or recent injury
• Autoimmune disorders including rheumatoid arthritis
• Diabetes (especially if it’s uncontrolled)

What if I’m not sure my shoulder is frozen?

It can be hard to tell that you’re developing a frozen shoulder. People affected by it generally move through four stages.

• The first stage (pre-freezing) usually lasts 1-3 months. This is when you first start to notice pain, often at night when turning over in bed.
• In the second stage— the freezing stage—your arm and shoulder are stiffer. You likely can’t reach your back pocket, or lift your arm up over your head. This stage can last 3-6 months or longer.
• In the third stage, which can go on for up to a year, your shoulder is officially frozen. At this point, you’ve probably seen your doctor for pain treatment.
• In the fourth stage, the thawing process, most doctors recommend that you see a physical therapist.

How do you "thaw" a frozen shoulder?

After you see your doctor for a diagnosis, treatment, in general, includes 3 sessions a week with a physical therapist for 10-12 weeks. The goal is to initiate the “thawing” stage, which can take up to 2-3 months. In between sessions, as with all physical therapy, it’s important to do the exercises prescribed by your therapist. This helps you maintain and advance the healing process.

Home exercises include the following, which together address the three basic shoulder movements that become inhibited during freezing:

1. Doorway stretch
   Stand in a doorway and put the hand of your affected shoulder on the top of the door frame, or as high as you can reach. Then try to step through the opening, as far as you can go without hurting yourself. Return to starting position.
2. Broomstick flexion
   Grab a broom, or an item with similar dimensions, like a mop, cane, or long stick. Hold it with both hands, and raise your hands as high above your head as they can go. Lower arms back down.
3. Broomstick abduction
   Use the same tool and hold it out with both hands. Face forward while rotating the stick all the way to your right side, and then to your left.

Hold each stretch for 20-30 seconds and repeat it 5-6 times, twice a day. You’re encouraged to stretch into the pain, without going beyond a 6 or 7 on a pain scale of 1-10. Most of my patients also take ibuprofen or naproxen as needed for pain while their shoulder thaws.

If recovery from a frozen shoulder sounds like a tough journey, that’s because it usually is. There’s no instant or easy cure, but there is hope for a complete recovery. You can get your range of motion back, and the sooner you see your doctor, the sooner you will return to reaching, pushing, and pulling the way you always have.