Learn about the stages, symptoms and treatment of frozen shoulder syndrome.
Are you having unusual shoulder pain that could be frozen shoulder? Then you should see an orthopedist who specializes in shoulder problems within the first three months after the pain has started, says Sabrina Strickland, MD, an orthopedic surgeon at the Hospital for Special Surgery in New York City. “People wait too long to see their doctor. Initially, the first stage is just painful, and people tend to grin and bear it,” she says. But without prompt treatment, the joint will stiffen and may take up to two years to “unfreeze.”
Usually, frozen shoulder progresses through four stages:
1. Stage 1 (first 3 months): the joint lining becomes inflamed
Symptoms: Constant pain in one shoulder with no obvious cause (like a fall or sports injury). “The pain tends to come out of the blue,” says Dr. Strickland. “Often the first sign is not being able to reach behind you”—for example, it hurts to put on a coat.
Often mistaken for: Tendinitis, bursitis or rotator cuff problem. How to tell the difference? “When your shoulder hurts with certain activities only—like only when you’re driving—that may be tendinitis or a similar overuse injury that may go away with rest.”
Telltale sign: Shoulder pain at nighttime and at rest. If that happens, you should see your doctor, says Dr. Strickland.
Treatment: “Typically, we speed up the healing process with physical therapy and—if we catch it in stage 1 or 2—cortisone injections, which can speed you through even faster.”
2. Stage 2 (months 4-9): the shoulder begins “freezing.”
Symptoms: Continued pain and inflammation; the shoulder capsule (the connective tissue around the joint) begins to shrink and stiffen, making movement more difficult.
Treatment: Same as stage 1, although it might not be as effective at speeding your recovery.
3. Stage 3 (months 10-14): the “frozen stage”
Symptoms: Stiffness but no pain at rest. The shoulder capsule is very tight due to scarring, making it difficult—sometimes impossible—to reach overhead or extend your arm in certain directions.
Treatment: Same as stage 1, although recovery will be slower. Surgery to break up scar tissue may be an option in some cases.
4. Stage 4 (months 15-24): the “thawing stage”
What to expect: The shoulder capsule gradually loosens and movement returns, says Dr. Strickland. “But some people never get back full motion. I tell patients if we can get to 90% of your other side, I’m happy. And depending on how stiff somebody is, they’re pretty happy, too!”
Why surgery is not the best answer
“Even when we do surgery and get full release at the time, it doesn’t mean it will last,” cautions Dr. Strickland. “Shoulders like to stiffen and scar after any surgery.” So before opting for surgery be sure to discuss all the pros and cons with your healthcare provider.