Frozen Shoulder Treatment
Frozen shoulder is unusual among orthopedic conditions in that it often arrives without an injury to blame. The shoulder simply begins to tighten, the tightening accelerates over months, and patients frequently reach the point of being unable to reach behind their back or fasten a seatbelt before anyone gives the problem a name.
Frozen shoulder rewards a surgeon willing not to operate, and it punishes the reverse. Steven Struhl, MD has treated adhesive capsulitis since entering practice in 1991 and resolves the large majority of cases without surgery. He is board certified in orthopedic surgery and separately in sports medicine, trained at the Massachusetts Institute of Technology, the University of California, San Francisco, and Penn State University, and holds a faculty appointment at NYU School of Medicine.
What Frozen Shoulder Is
The medical term is adhesive capsulitis. The capsule of connective tissue surrounding the shoulder joint becomes inflamed, thickens, and contracts, and bands of scar tissue form inside it. The result is a joint that is mechanically restricted rather than merely painful, which is the distinguishing feature.
That distinction is how it is told apart from a rotator cuff tear. In a cuff tear the shoulder is weak but can usually be moved passively through its range by someone else. In a frozen shoulder it cannot.
The Three Stages of Frozen Shoulder
Frozen shoulder follows a recognizable course, and knowing which stage a patient is in matters, because the correct treatment in one stage is the wrong treatment in another.
- Freezing Stage: pain increases and motion progressively decreases, typically over six weeks to nine months.
- Frozen Stage: pain often eases while stiffness remains at its worst, generally lasting four to six months.
- Thawing Stage: motion gradually returns over a period that can extend from six months to two years.
Aggressive stretching during the freezing stage tends to worsen inflammation and prolong the course, which is one reason a patient pushed hard by well meaning therapy early on can end up worse rather than better.
Frozen Shoulder Causes and Risk Factors
- Diabetes: the strongest known association, with higher incidence and a more resistant course.
- Age And Sex: most common between forty and sixty, and more frequent in women than men.
- After Immobilization: following a fracture, a surgery, or any period the arm is kept still.
- Thyroid And Other Conditions: thyroid disease and certain cardiovascular conditions raise risk.
Frozen Shoulder Treatment
- Guided Physical Therapy: stretching matched to the stage rather than pushed against inflammation.
- Injection Therapy: corticosteroid injection to reduce capsular inflammation, most useful early.
- Manipulation Under Anesthesia: the capsule is released with the patient asleep and muscles relaxed.
- Arthroscopic Capsular Release: the contracted capsule is divided directly through small incisions.
The large majority of frozen shoulders resolve without surgery, though the timeline frustrates patients considerably. Arthroscopic release is reserved for shoulders that remain functionally restricted after conservative treatment has had a fair trial.
Frequently Asked Questions About Frozen Shoulder
How long does frozen shoulder last?
Left entirely alone the full course commonly runs one to three years across all three stages, which is why most patients seek treatment rather than wait it out. Appropriate treatment does not eliminate the condition but generally shortens the course and makes it considerably more tolerable.
Why does diabetes matter so much here?
Diabetes is the single strongest risk factor for adhesive capsulitis. Patients with diabetes develop it more often, frequently in both shoulders over time, and their cases tend to resist treatment. Blood sugar management is a genuine part of the treatment conversation rather than an aside.
Will physical therapy make it worse?
It can, if the stage is wrong. Aggressive stretching during the painful freezing stage tends to increase inflammation and prolong the process, while the same therapy during the frozen and thawing stages is exactly what is needed. Matching intensity to stage is the part most commonly missed.
What is manipulation under anesthesia?
The patient is placed under anesthesia so the muscles fully relax, and the shoulder is then moved through its range to release the contracted capsule and scar bands. It is a short procedure, typically followed immediately by therapy to hold the motion gained.
Can frozen shoulder come back after treatment?
Recurrence in the same shoulder is uncommon once full motion is restored. Developing it in the opposite shoulder is a different matter and happens in a meaningful minority of patients, particularly those with diabetes.
Is frozen shoulder the same as a rotator cuff tear?
No, and the distinction is usually clear on examination. A frozen shoulder is restricted even when someone else moves the arm, while a rotator cuff tear typically allows passive motion but is weak against resistance. The two can coexist.
Schedule a Frozen Shoulder Evaluation in New York City
A shoulder losing motion month over month is worth evaluating early, because the treatment that helps in the first stage differs from what helps in the third, and getting that sequence wrong extends the timeline considerably. Dr. Struhl evaluates adhesive capsulitis at his Manhattan and White Plains offices. Contact the practice to schedule an appointment.
