Adhesive capsulitis, also known as frozen shoulder, isn’t especially common, but those whom it does affect can be left with debilitating pain and a limited range of motion for months, even years. Frozen shoulder hinders both your active and passive range of motion, meaning that movement is restricted both when you try to move on your own as well as when someone else, such as your doctor, tries to move your arm for you.
“In the shoulder, we have rotator cuff muscles, and tendons and ligaments within the joint itself, all encapsulated with connective tissue,” says Lance Johnson, MD, a family medicine physician at Scripps Clinic Encinitas, specializing in sports medicine.
“The main culprit behind frozen shoulder is essentially this connective tissue. Inflammation leads to fibrosis or scarring, to the extent where the joint capsule contracts on itself. When that happens, the joint is not able to move as freely as it should.”
Dr. Johnson says that frozen shoulder’s progression can be broken down into three stages:
The freezing stage
Shoulder pain and limited range of motion begin. Shoulder pain can be moderate to acute and may be severe enough to disrupt sleep. On average, this stage lasts 1 to 3 months.
The frozen stage
The shoulder becomes stiffer, but the pain lessens. This can extend from 9 to 15 months.
The thawing stage
Pain continues to improve and range of motion gradually returns.
“When patients come see me in the office, they typically present with pain and significant stiffness of the shoulder joint,” Dr. Johnson says.
It’s not known what causes frozen shoulder, but certain factors can raise a person’s risk, including age and sex (it’s most common in people ages 40–60 and affects more women than men), diabetes, autoimmune disease, thyroid issues and prior injuries or surgeries that required the shoulder to remain immobilized for a significant period of time.
For most people, frozen shoulder resolves itself over time even without treatment, but medical intervention, pain relievers and physical therapy can significantly shorten the recovery process. Surgery for frozen shoulder is a last resort.
“We just have to make sure that the patients are diligent with these stretches and exercises,” says Dr. Johnson. “This is not going to be a big turnaround in a matter of days or weeks. It can take several months of doing physical therapy before they can gain full function of that shoulder joint.”