What is Frozen Shoulder, Anyway?

You were swimming, gardening, playing pickleball, softball, tennis, dusting, hanging blinds, lifting weights, wiping tiles over the sink. Now your shoulder hurts. You take an over-the-counter painkiller and take a break from activities. But when you go back to it, you realize you can’t move your shoulder at all, and now the pain is severe. 

It turns out that taking that break may have made things worse.

“To prevent the sensation of pain, your brain says, ‘Aha! It hurts if you try to move it, so don't move it,’” says orthopedic surgeon William Levine, MD, co-director of Columbia’s Center for Shoulder, Elbow, and Sports Medicine.

“Suddenly, after weeks or months, you can’t move your arm away from your body, put on a bra, or reach the first shelf, let alone the second shelf.”

It’s called frozen shoulder, and defrosting it is a real pain. We spoke to Levine, who heads Columbia’s Department of Orthopedic Surgery, to learn more about frozen shoulder, what to do, and how to prevent it.

Frozen Shoulder 101

Frozen shoulder isn’t just pain or stiffness. It starts with inflammation in the shoulder joint and progresses to the point where you can’t move your shoulder at all. Here are a few facts about frozen shoulder:

• It affects more women than men
• It’s most common in people ages 40 to 60
• It happens more frequently and more painfully to people who have diabetes
• It usually affects one shoulder at a time, but it can affect the other shoulder (half of people who have frozen shoulder on one side will later have it on the other side)

Based on his research and experience, Levine believes some people get frozen shoulders due to genetics. But, he adds, we know as much today as we did 25 years ago when his career began. It is still unknown why more women than men get frozen shoulder.

How Frozen Shoulder Happens

Frozen shoulder is caused by inflammation, which causes pain and stiffness in the shoulder joint and limits and then prevents motion.

After inflammation, you don’t move your shoulder much because your brain tells you not to. As the weeks pass, you develop scar tissue. Now, your shoulder joint doesn't move.

“The scar tissue is like two strips of Velcro stuck together,” says Levine. “You need to detach them to move.”

When You Should Go to the Doctor

If you have not seen any improvement after two weeks of frozen shoulder, you should go to a doctor. But the good news is that, according to research by Levine and his team, nine out of ten people who have frozen shoulder do not need surgery.

The bad news: recovering from frozen shoulder takes a long time.

The initial goal is to see improved movement within six weeks. It can take as long as six or nine months to get back to normal, says Levine. “You’re not disabled for that long, but it may take that long to regain full range of motion.”

You’ll start with physical therapy, exercise at home, and anti-inflammatory medication. At first, this combined treatment works quickly to decrease pain and increase range of motion.

Unfortunately, it takes a long time to see improvement. And you need a partner or friend to help.

A physical therapist teaches the patient and their plus-one how to stretch at home. You can do them alone, but it's hard, especially in the beginning, because it's so painful. If you live alone or do not have someone who can regularly help you, you're probably going to PT more frequently, five times a week instead of three, which is the typical physical therapy regimen. If the range of motion is not improved after six weeks, an ultrasound-guided cortisone shot is an option.

If you are no better or have lost mobility after four months, you are likely in the 10% non-responder group, according to Levine, and it’s time to think about surgery.

“We know after four months if medication, therapy, and home exercises are enough. You do not have to wait years to find out you do not respond to this type of treatment,” says Levine.

Frozen Shoulder Surgery

Frozen shoulder surgery is an ambulatory arthroscopic procedure done with a regional anesthetic. You go home the same day you have surgery. The surgeon puts a tiny camera in your joint to see the problem and fix it without having to make a huge cut, and then peels apart the scar tissue to allow the shoulder to move. All in all, it only takes about 40 minutes.

But treatment doesn’t end there.

After surgery, Levine makes a video of the person’s complete range of motion. Why? To help in recovery if the person’s brain is stuck thinking the shoulder is still frozen. Levine has seen how videos help people to understand how much motion they have so they can fully stretch, exercise, do physical therapy, and heal completely.

“If you don't take advantage of the motion you regained, your body and brain will try to conspire against you once again, and your frozen shoulder will come back,” says Levine. “When it comes to frozen surgery, my job as a surgeon is by far the easiest part of the partnership. Your job is to maintain that motion. That is the hard part, but it’s worth it to be able to move.”