Signs and Symptoms
Frozen shoulder tends to move through three overlapping stages:
- Freezing stage: pain that builds over weeks to months, often worse at night, with gradual loss of motion
- Frozen stage: pain may ease, but the shoulder stays stiff, making it hard to reach overhead, behind your back or across your body
- Thawing stage: motion slowly returns over months
A key sign is that the shoulder is stiff whether you move it yourself or someone else tries to move it for you. That helps distinguish it from a rotator cuff tear, where another person can often lift the arm even when you cannot.
What Causes It?
The exact cause is not fully understood. It is most common between ages 40 and 60 and affects women more often than men.
- Diabetes, which is one of the strongest risk factors
- Thyroid disease and some other medical conditions
- A period of immobility, such as after surgery, a fracture or a stroke
- A previous frozen shoulder on the other side
How We Diagnose It at POPB
Frozen shoulder is diagnosed mainly by examination. Your physician measures how far your shoulder moves on its own and with assistance and compares it to your other side.
X-rays in our office help rule out arthritis or other causes of stiffness. Diagnostic ultrasound or MRI, both available on site, may be used if a rotator cuff tear or another problem is suspected.
Non-Surgical Treatment Options
Most people improve without surgery. Treatment aims to control pain so you can keep working on motion:
- Physical therapy in our office, with gentle stretching and a home program. Therapy is adjusted to your stage, since aggressive stretching during the painful freezing stage can backfire.
- A cortisone injection into the shoulder joint, often guided by ultrasound, which can reduce pain and may be most helpful early on
- Anti-inflammatory medication if appropriate for you
- Good blood sugar control if you have diabetes
Dr. Adelman uses ultrasound-guided injections to place medication precisely, and your therapist and physician share your chart so the plan can change as your shoulder does.
Surgical Options
Surgery is uncommon and is usually considered only when significant stiffness persists after many months of consistent non-surgical care.
Options include manipulation under anesthesia, in which the surgeon moves the shoulder to stretch and release the tight capsule while you are asleep, and arthroscopic capsular release, in which Dr. Wolfson cuts the tight portions of the capsule through small incisions. Both are followed right away by physical therapy to hold on to the motion gained.
Recovery
Without surgery, frozen shoulder often takes 1 to 3 years to fully run its course, although many people get meaningful relief much sooner with treatment. Some people are left with a small loss of motion that usually does not limit daily life.
After a manipulation or capsular release, therapy typically starts within days and continues for several weeks to a few months. Timelines vary from person to person.
Insurance and Cost
Office visits, X-rays, physical therapy, cortisone injections and medically necessary surgery are generally covered by Medicare, most commercial PPO plans and workers' compensation, subject to your deductible and co-pay.
If you have an HMO or managed-care plan, a referral from your primary care physician must be in our office before your visit. Our staff verify your eligibility and benefits when you call.
When to Be Seen
Make an appointment if your shoulder has been getting stiffer and more painful over several weeks, especially if you have diabetes or thyroid disease. Early treatment can help manage pain during the most uncomfortable stage.
If shoulder pain comes with chest pain, shortness of breath or sweating, call 911, because that can be a sign of a heart problem rather than a shoulder problem.
