Understanding Frozen Shoulder: Symptoms, Causes, and Treatment

By Lauren Rudolph, MD, FAAPMR, CAQSM

What Is Frozen Shoulder?

Frozen shoulder, also called adhesive capsulitis, happens when the lining (capsule) around your shoulder joint becomes inflamed, thickened, and scarred. This makes the shoulder painful and stiff, and it becomes hard to move your arm — even when someone else tries to move it for you. It usually affects one shoulder at a time.

Who Gets It?

Frozen shoulder affects roughly 2 to 5 out of every 100 people. It is most common between ages 40 and 70, and it happens more often in women than in men. Many women first notice it during the years around menopause (perimenopause and menopause).

Other things that raise the risk include:

• Diabetes (a strong risk factor)
• Thyroid problems, especially an underactive thyroid
• A period of not moving the shoulder — for example after an injury or surgery
• Heart disease and abnormal cholesterol

Why Does It Seem Linked to Menopause?

The hormone estrogen normally helps calm inflammation and protect tissues from scarring. During perimenopause and menopause, estrogen levels drop. Researchers believe this drop may make the shoulder capsule more likely to become inflamed and scarred, which may help explain why frozen shoulder is more common — and sometimes more severe — in women during these years. This is an active area of research, and estrogen loss is thought to be one of several contributing factors rather than the only cause.

What Does It Feel Like? The Three Stages

Frozen shoulder usually moves through three overlapping stages. The whole process often lasts 1 to 3 years, though it varies a lot from person to person.

1. Freezing (painful) stage — about 2 to 9 months. Pain builds up, often worse at night and when lying on that side. The shoulder gradually gets stiffer.
2. Frozen (stiff) stage — about 4 to 12 months. Pain often eases, but stiffness is at its worst. Everyday tasks like reaching overhead, fastening a bra, or reaching into a back pocket become difficult.
3. Thawing (recovery) stage — about 5 months to 2 years. Movement slowly returns.

Most people improve, but recovery can be slow, and some people have lingering stiffness or discomfort even after the process runs its course.

You don’t have to just live with it! We can shorten the course — see treatment below!

How Is It Treated?

The goals of treatment are to relieve pain and restore movement. Most people get better without surgery. Common options include:

• Pain relief: Over-the-counter anti-inflammatory medicines (such as ibuprofen). — But if you don’t want to take medications for this, come see me!
• Exercise: Gentle stretching and exercises to keep and rebuild movement. This is a cornerstone of treatment, especially in the stiff and recovery stages.
• Injection: An injection into the joint can reduce pain and speed recovery, and works especially well when combined with physical therapy. Early injection may shorten how long symptoms last.
• Hydrodilatation (capsule distension): Fluid is injected into the joint to gently stretch and expand the tight capsule. This can improve pain and movement.
• Other options: Shockwave therapy or laser therapy are sometimes used. For people with diabetes, non-steroid options may be preferred to avoid raising blood sugar.

I will often combine the multiple treatments listed above (minus the medications) to get relief faster!

Living with Frozen Shoulder

• Keep moving the shoulder within a comfortable range — total rest can make stiffness worse.
• Use heat before stretching and stay consistent with your exercise program.
• If you have diabetes or a thyroid condition, keeping it well controlled may help.
• Be patient. Recovery is often slow, but the outlook is generally good.