A Complete Guide to Frozen Shoulder – Causes, Diagnosis and Treatment


Frozen shoulder refers to stiffening of the shoulder when scar tissue forms around the joint capsule. This causes the capsule to thicken and tighten, therefore, resulting in loss of movement. These movements can be partially or completely restricted and are associated with varying levels of pain.

Frozen shoulder occurs slowly over time, and the actual cause of frozen shoulder is unknown. Some believe it is caused by inflammation of the joint lining or by autoimmune conditions, in which the body’s natural defense system “mistakenly” attacks itself. Other possible causes include:

1) Recent trauma or reaction due to an injury or surgery
2) Immobilization of the arm, such as in a sling, after sustaining a stroke, fracture, or surgery
3) A result of other painful shoulder conditions that may limit you from moving your arm


Frozen shoulder affects about 2% to 5% of the American population, and it is more common in females than males (ratio of 70%:30%). It is typically diagnosed in people over the age of 45, and is present in about 10% to 20% of diabetics. Other less common risk factors include thyroid problems (overactive or underactive thyroid), Parkinson’s disease, and heart conditions. Also, if a person has frozen shoulder in one shoulder, it is estimated that 20% to 30% will get it in the other shoulder as well.


There is no special test or diagnostic test like an x-ray or MRI to confirm the diagnosis of frozen shoulder. However, an x-ray may be performed to rule out other conditions that share features similar to frozen shoulder such as arthritis, tumor, impingement, or bursitis. Frozen shoulder can be commonly misdiagnosed as being a rotator cuff tear. Therefore, a careful and thorough assessment with an extensive medical and surgical history is critical to help rule in or rule out possible diagnoses.


Frozen shoulder can affect the functional use of your arm with overhead activities such as combing your hair or reaching towards a high shelf. For females, you may find it difficult to reach behind your back to fasten your bra. For males, you may be unable to reach into your back pocket to get your wallet or may experience difficulty with putting on your belt.


Your physical therapist’s overall goal is to restore your movement, so you can perform your daily activities. Once the evaluation process has identified the stage of your condition (out of 4 possible stages), your physical therapist will create an individualized exercise program tailored to your specific needs. Exercise has been found to be most effective for those who are in stage 2 or higher.


Frozen shoulder can be categorized into four different stages. Your physical therapist can determine which stage you are in and what treatments are appropriate.

• Stage 1 – “Pre-Freezing” – This is the first stage in which symptoms are present for 1-3 months. Pain is the hallmark feature of this stage, present during the day or at night. You will limit shoulder motion during this period and protect the shoulder by using it less.

• Stage 2 – “Freezing” – This is the second stage in which symptoms are present between 3-9 months. There is a progressive loss of shoulder movement and an increase in pain, especially at night. The shoulder still has some range of movement, but it is limited by both pain and stiffness.

For short-term and immediate pain reduction during stages 1 and 2, your doctor may prescribe anti-inflammatory medications or provide cortisone injections. Your physical therapist may use a combination of modalities (heat and ice packs), hands-on manual techniques, and gentle basic exercises to help reduce pain and stiffness.

• Stage 3 – “Frozen” – The symptoms in this stage last for 9-14 months. You will have a significant loss in movement and a substantial amount of pain at the early part of this stage. Towards the end of this stage, pain reduces and can occur when you move your shoulder to the extremes. Treatment will focus on restoring movement through more aggressive hands-on manual therapy, stretching to increase flexibility, and some strengthening exercises.

• Stage 4 – “Thawing” – The symptoms in this stage last for 12-15 months. Night pain will significantly lessen. You may still have limited range of motion, but there will be some improvements with completing daily activities involving overhead movements. Treatment will be similar to that of stage 3, but will be tailored to address the most restricted and painful types of movements and positions that may affect your sport or job duties. Focus will also be on restoring “normal” shoulder body mechanics to prevent re-occurrence.


Frozen shoulder can be a self-limiting condition with no definitive cause or method of prevention. It may take 1-2 years for full function to return. However, physical therapy is the mainstay of treatment for frozen shoulder compared to other treatments. Physical therapy can help you regain your function and manage your symptoms effectively and safely.

So, if you struggle with shoulder pain that disrupts your routine life, or if you are unable to see results from your current treatment, come visit our team of specialized physical therapists at New York Spine & Sports. Our spine specialists will look beyond the usual diagnosis and provide you with an individualized pain intervention and rehabilitation treatment.

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