FROZEN SHOULDER

Frozen shoulder: causes, progression, and treatment options

What is a frozen shoulder?

Frozen shoulder is one of the most common shoulder disorders. It occurs when the joint capsule adheres and shrinks . This leads to severe pain and a significant restriction of movement.

There are two forms:

• Primary (idiopathic) frozen shoulder: without identifiable cause, occurring spontaneously.

• Secondary frozen shoulder: as a result of an injury, surgery or shoulder disease (e.g. fracture, impingement).

What is a frozen shoulder?

Frozen shoulder is a shoulder condition in which the joint capsule becomes inflamed, stuck together, and shrinks. Severe pain and limited mobility are typical. It progresses through three phases: freezing (pain), frozen (stiffness), and thawing (slow improvement).

Course of frozen shoulder: the three phases

1st Phase – Freezing (“Freezing Shoulder”)

• Inflammatory-like changes in the joint capsule

• Very painful , especially when raising the arm or at night

• Protective posture increases stiffness

• Duration: approx. 4 to 9 months

2nd phase – Frozen shoulder

• Joint capsule shrinks and sticks together

• Mobility severely restricted, arm barely movable

• Pain usually subsides

• Duration: average 4 months

3rd Phase – Thawing Shoulder

• Inflammation subsides, mobility slowly increases

• Pain significantly reduced

• Recovery takes months to years, sometimes residual stiffness remains

Causes and risk factors

• Injuries: fractures, tendon ruptures, shoulder dislocations

• Operations: e.g. after rotator cuff suture or stabilization

• Shoulder diseases: impingement, osteoarthritis

• General diseases: diabetes mellitus, thyroid problems, metabolic disorders

• Age and gender: often between 40 and 60 years, slightly more common in women

Diagnosis: How to diagnose frozen shoulder

The diagnosis is based primarily on:

• History: typical phases of the disease

• Clinical examination: limited mobility in all directions

• Imaging: X-ray to rule out other causes, MRI to detect inflammation and capsular changes

Treatment of frozen shoulder

Conservative treatment options

Pain therapy

• Medications such as ibuprofen or diclofenac (tablets or ointments)

• Goal: Pain relief and improved mobility

Cortisone injections

• Injections directly into the joint, often in combination with an anesthetic

• Reduce inflammation and relieve pain

• Caution with frequent use (tendon risk)

Cortisone tablets

• Can be effective in certain cases

• Only under medical supervision, due to possible side effects (e.g. in diabetes)

nerve block

• In rare, very painful cases

• Numbing the shoulder nerves to temporarily eliminate pain

Physiotherapy & physical therapy

• Gentle stretches and mobilization by therapists

• First passive movements, later active exercises

• Examples: Swinging with the arm , light stretching exercises

X-ray stimulation & embolization

• In persistent cases, low dose X-ray stimulation can be used

• Has an anti-inflammatory effect, relieves pain and can support the healing process

• During embolization , small vessels of the joint capsule are specifically closed

• Both methods show heterogeneous results in studies

Surgical and interventional procedures

Arthroscopic capsular splitting

• Arthroscopy with incisions in the shrunken capsule

• Effective for persistent shoulder stiffness

• Advantage: minimally invasive and precise

Manipulation under anesthesia

• Shoulder is carefully moved under general anesthesia

• Goal: Loosen adhesions, improve mobility

• Usually 2–3 treatments necessary, results heterogeneous

• Complications such as bone fractures and nerve injuries have been described

Prognosis: How long does a frozen shoulder last?

• The entire process can take 1.5 to 3 years .

• Many patients regain full shoulder mobility.

• In some cases, a slight restriction remains.

• Early diagnosis and individually tailored therapy are crucial .

  
  

Conclusion: Frozen shoulder is painful, but treatable

Although frozen shoulder is a long-term condition, it is curable in the vast majority of cases . With a combination of pain management, physical therapy, and modern techniques, the shoulder can be restored to mobility.

👉 Make an appointment now – we will accompany you back to mobility with experience and modern treatment methods.