How to Thaw a Frozen Shoulder

Understanding Frozen Shoulder/Adhesive Capsulitis

Frozen shoulder is a condition that affects the shoulder joint capsule: a fibrous covering of the synovial lining of the shoulder joint. When the capsule becomes inflamed, pain and significant joint stiffness ensue. Due to these symptoms, the athlete quickly experiences resulting limitation in the shoulder’s range of motion. Older athletes are more prone to suffer from frozen shoulder syndrome, also referred to as adhesive capsulitis, than their younger counterparts.

Restricted movement occurs with respect to both active and passive range of motions:

Active Motion: When the individual moves the joint with his own muscles

Passive Motion: When someone or something else moves the joint without active involvement from the individual

Individuals between the ages of 40 and 60 comprise the majority of those diagnosed with this injury, with women more prone than men. Interestingly, adhesive capsulitis is also more common in individuals previously diagnosed with diabetes. Shoulder pain is usually constant and aggravated by weather changes, keeping the joint in one place for too long, or activities requiring excessive shoulder movements.

Common Causes of Frozen Shoulder

  • Prolonged Immobilization: secondary to a rotator cuff injury, arm fracture, post-surgery immobilization, stroke, etc.
  • Premorbid Status: related to systemic diseases such as diabetes, abnormal thyroid function, tuberculosis, and chronic heart abnormalities
  • Any Shoulder Injury: specifically ailments that produce excessive inflammation such as tendonitis, bursitis, and inflamed rotator cuff muscles/tendons.  The four muscles that form the rotator cuff are the supraspinatus, infraspinatus, teres minor and subscapularis.

The typical course of frozen shoulder syndrome is broken into three phases, spanning almost a year’s worth of time:

1)    The “Freezing” Phase: The individual/athlete slowly develops tolerable pain and stiffness around the shoulder joint. Range of motion reduces almost proportionally to increased levels of pain. Discomfort leads the individual to subconsciously suppress active movement, resulting in a loss of range and strength. The pain is often worse at night, especially when laying on the affected side.

2)    The “Frozen” Phase: This stage’s inception is marked by the end of increasing discomfort, which the athlete subconsciously perceives as a decline in pain. Meanwhile, stiffness and reduced range of motion remain, regular routines are difficult, and muscle wasting (atrophy) becomes more evident. Rotating the arm outwards (external rotation) can become very difficult in this phase, which can last anywhere from about four months to a year.

3)    The “Thawing” Phase: Also called the recovery phase, range of motion in the shoulder starts to improve during this time. Strength and functional capacity gradually return, and this phase typically lasts 2 to 3 months.

Signs and Symptoms of a Frozen Shoulder

  • Increasingly stiff/immobile shoulder with pain around the joint
  • Dull, aching pain that occurs with motion and at rest
  • Shoulder girdle stiffness that restricts full range of motion with both active and passive movement
  • Localized pain felt throughout the outer shoulder area and upper arm
  • Sleep deprivation and possible transient insomnia

Professional Treatment for Frozen Shoulder/Adhesive Capsulitis

  • Intermittent icing with immediate range-of-motion exercises helps decrease pain and regain range of motion while the surrounding tissue is “numb” from the ice.
  • Work directly with a physical therapist, and if prescribed, anti-inflammatory medications can help when taken immediately prior to rehab sessions.
  • Gentle stretching exercises increase shoulder girdle range of motion.
  • Exercise the shoulder joint during activities of daily living (ADLs) to help foster motion.
  • In cases where aggressive rehab is ineffective or range-of-motion limits become excessive, a physician may recommend shoulder joint manipulation (performed under general anesthesia) to break up adhesions/tightness.

Ask the Right Questions Like a Pro

Here’s what smart pro athletes would ask their sports medicine specialist to ensure a fast and safe return to the game they love:

1. Could this be a secondary complication of arthritis or another injury involving my shoulder joint?

2. Do I need an MRI to rule out other possibilities?

3. What is a realistic outcome for my injury?

4. What is the best rehabilitation facility in this area?

5. How soon can I return to my normal activities?

Elite Sports Medicine Tips from Mike Ryan

  • Take Rehab Seriously – Be proactive with your physical therapy, as its success will dictate your shoulder use for the next 1-2 years, period.
  • Know the Formula for Success – Reducing inflammation + reprogramming muscles that move the shoulder joint = treatment victory
  • Don’t Panic – Though our minds sometimes wander to the “Big C,” rest easy knowing a frozen shoulder is rarely associated with cancerous pathologies.
  • Stay Cool Warm Under Pressure – Know that once cured, a frozen shoulder almost never comes back.