Stages of Frozen Shoulder

A frozen shoulder is a very common problem that causes shoulder pain, although many patients with this condition don't realize what the problem is, and what the best treatments are for this condition.

In addition, many patients are surprised to learn about the lengthy healing process (taking anywhere from 6 months to 2 years) that can be required for relief of pain and stiffness caused by a frozen shoulder.

Phase One: Freezing (6 weeks to 6 months)

The freezing stage is by far the most painful phase of a frozen shoulder. At the beginning of this phase, the motion may only be slightly restricted, and that's why early frozen shoulder can be misdiagnosed as a problem with the rotator cuff.

During this phase, the shoulder capsule is inflamed and can become thickened and stiff. As this happens, shoulder movements become increasingly difficult and painful. 

Phase Two: Frozen (4 months to 6 months)

The second phase of a frozen shoulder is known as the frozen phase. During this phase, the shoulder is notably stiff. The characteristic examination finding that confirms the diagnosis of a frozen shoulder is that not only can the patient not move the shoulder normally, but someone else trying to manipulate the arm also cannot move the shoulder. (In a rotator cuff problem, often a patient can't move their arm normally, but someone else [examiner] can.)

The frozen phase is typically much less painful than the freezing phase, but pain can result from seemingly simple activities. Rotation of the shoulder joint is particularly limited, making activities such as washing hair, hooking a bra, or reaching for a seat belt, painful or difficult.

Phase Three: Thawing (6 months to 2 years)

In this phase, the capsule of the shoulder joint has become thickened and stiff, but over time it gradually loosens. It is important to stretch the shoulder capsule, even allowing for some discomfort, in order to ensure the shoulder joint mobility continues to recover. 

Not having the extreme pain associated with the freezing of the joint, and seeing gradual gains in mobility make this phase tolerable, albeit frustrating and long.

Treatment of Frozen Shoulder

Frozen shoulder treatment is almost always best accomplished with physical therapy and stretching of the joint. Anti-inflammatory medications, ice and heat application, and alternative therapies can all be helpful to manage the discomfort. 

Surgery can be an option for treating a frozen shoulder, but it is seldom needed, and only utilized with prolonged efforts at therapy have failed to allow for improvement in symptoms. One of the problems with surgery for treatment of frozen shoulder is that surgery is a possible cause of frozen shoulder. Therefore, it's possible for some patients to get worse after surgery—obviously, that is extremely frustrating.

Prognosis

As you can see, the timeline for recovery from a frozen shoulder can be long and frustrating. It's important for patients to understand that no matter what, the recovery time is measured in months, if not years. Expecting a recovery that will be quick causes more frustration.

That said, there are steps you can take to speed your recovery and reduce the discomfort of a frozen shoulder. Physical therapy can be beneficial, and your healthcare provider can suggest treatments to help alleviate pain while you recover.

The good news is, over time, almost all patients will find complete relief of pain, and normal or near-normal range of motion of the shoulder joint.