It's unclear what causes a shoulder to "freeze" but experts do know that adhesive capsulitis, which restricts mobility in the arm, is five times more common in women and most likely to occur during mid-life-between the ages of 40 and 60.

The shoulder joint is made up of bones, ligaments and tendons that are encased in a capsule of connective tissue. If that capsule becomes inflamed, it causes thickening and tightening around the shoulder joint, which in turn restricts movement. Over time—as the shoulder cavity stiffens and becomes painful—you may be unable to raise your arm over your head, have trouble hooking your bra behind you, blow drying your hair and even reaching for your seatbelt. Lack of movement unfortunately worsens the problem. For some people, the worst pain occurs at night and disrupts normal sleeping patterns.

The Causes of Frozen Shoulder

For many, the cause of the problem is unexplainable, though people who have had a rotator cuff injury; surgery (notably breast, open-heart and other shoulder procedures); stroke or cervical disc disease are at increased risk of developing a frozen shoulder. People with diabetes, cardiovascular disease, Parkinson's, Tuberculosis and certain thyroid conditions also seem to be predisposed to this condition.

Diagnosing and Treating a Frozen Shoulder

Frozen shoulder typically develops in three stages, which can cumulatively last up to 24 months:

Stage 1 is the most painful stage when any movement involving the shoulder hurts and limits motion.

Stage 2 is the "frozen" period when pain may diminish but the shoulder becomes stiffer and range of motion noticeably more compromised.

Stage 3, the final or "thawing" stage, occurs when the range of motion begins to improve and the pain subsides.

Without treatment, the shoulder will eventually heal itself and become functional again however full range of motion won't be restored. In most cases, proper treatment returns full functionality to the shoulder within a year.

When to See a Doctor for Frozen Shoulder

If you are experiencing shoulder pain that limits your motion, seek help from a doctor as soon as possible. To prepare for your appointment, jot down the answers to the following questions:

  • When did the symptoms begin?
  • What activities cause the most pain?
  • Have you ever injured your shoulder and if so, how?

The answers to these questions can assist your health care provider in making an accurate diagnosis.

During the physical exam, the doctor will likely check for pain and with his trained eye, evaluate how your shoulder moves. You will likely be asked to perform the following movements:

  • Lifting arms straight up in the air over your head
  • Reaching behind your back with the back of your hand stretching toward the opposite shoulder
  • Reaching straight out in front of you
  • Reaching across your chest to touch the opposite shoulder.

An x-ray can show arthritis, which is also painful, but if the doctor suspects a rotator cuff injury, or other structural problem he will mostly likely recommend an MRI. An MRI doesn't reveal a frozen shoulder but it does reflect inflammation that may be related to the problem.

Treatment for Frozen Shoulder

Once diagnosed, treatment can take 12 to 18 months and involves both pain management and physical therapy in order to preserve as much range of motion as possible. Over-the-counter medication can help lessen pain and inflammation, but your doctor may prescribe stronger doses. During physical therapy, the shoulder joint is manipulated, stretched and strengthened with exercises that promote proper movement and range of motion. The physician may also recommend periodic steroid injections to promote the healing process and restore movement.

If these remedies aren't successful, arthroscopic surgery to remove scar tissue and adhesions from inside your shoulder joint can be performed.

With treatment—and time—you'll eventually get back to your regular routine and enjoy participating in the activities you love.

Dave Grancagnolo, DPT, reviewed this article.


Ben W. Kittredge, IV, MD
Commonwealth Orthopaedics

The National Institute of Health