How To Move Without Pain

Frozen Shoulder Symptoms & Causes

by Meghan Griech, PT, DPT, cert MDT, CKTP

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Frozen Shoulder, aka adhesive capsulitis, is a bit of a mysterious condition. Frozen shoulder most often occurs in people between the ages of 40 and 65 years old, and generally affects women more than men.

A frozen shoulder is characterized by a slow and gradual stiffening of the shoulder, with pain during movement and at night.

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The pain and loss of motion of the shoulder are the most prominent symptoms of a frozen shoulder. The length of the time symptoms occur can be variable, lasting anywhere from a couple of months to a couple of years, but the progression is very predictable.  Frozen shoulder is often broken into three phases. 

The first phase, “freezing” occurs as the shoulder begins to lose range of motion due to an increase in inflamed tissue.  This phase is marked by increasing pain. 

The second phase, referred to as “frozen”, is indicated by decreased pain but the peak of loss of motion. 

The final phase is known as “thawing”, and is signified by a return of motion. 

Although the mechanism as to why frozen shoulder occurs is a mystery, we do know that it results in the capsule of the shoulder, which is strong fibrous connective tissue, becoming inflamed and tightening over time resulting in severe losses of motion.

Research has yet to correlate a specific reason why this happens to the tissues and why only the shoulder joint.

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Common Cause

The exact causes of frozen shoulder are considered idiopathic, aka of unknown cause, yet researchers have found some correlating factors that may predispose some more than others. For example, people with diabetes are five times more likely to develop adhesive capsulitis. Thyroid disorders also have a correlation, with a nearly three times higher risk of developing adhesive capsulitis than those without thyroid issues.
Often adhesive capsulitis affects the non-dominant arm more often than the dominant arm, and there is a high incidence of developing frozen shoulder in the other arm at a later date. 

Other factors may also increase your risk of developing a frozen shoulder:

Age and sex

People 40 and older, particularly women, are more likely to have frozen shoulders.

Immobility or reduced mobility of the shoulder

Prolonged immobility or reduced mobility of the shoulder are at higher risk of developing frozen shoulder. This particular type of frozen shoulder is referred to as “secondary or tertiary frozen shoulder”.  Immobility may be the result of many factors, including:

  • Rotator cuff injury
  • Casted or splinted arm due to fracture
  • Stroke
  • Recovery from surgery

Systemic diseases

People who have certain diseases appear more likely to develop frozen shoulder.  This type of frozen shoulder is referred to as “primary.”  Diseases that might increase risk include:

  • Diabetes
  • Overactive thyroid (hyperthyroidism)
  • Underactive thyroid (hypothyroidism)
  • Cardiovascular disease
  • Tuberculosis
  • Parkinson’s disease

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Adhesive Capsulitis Stages/Common Symptoms

Frozen shoulder typically develops slowly, and in three stages. Each stage can last a couple of months (from 3 to 9 months at each stage) and varies from person to person

Freezing stage. Any movement of your shoulder causes pain, and your shoulder’s range of motion starts to become limited, painful, and difficult to tolerate.  Sleeping is often very limited due to the pain

Frozen stage. Pain may begin to diminish during this stage. However, your shoulder becomes stiffer, and using it becomes more difficult to move and use for daily activities.

Thawing stage. The range of motion in your shoulder begins to improve.

For many people, the pain worsens at night, sometimes disrupting sleep.

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How is it different from other shoulder pains?

Adhesive capsulitis is most often identified by the nighttime pain severity and the striking loss of motion in the shoulder. Shoulder pain that often occurs from overuse, strain, rotator cuff tear tends to come and go with periods of lessened pain. Also overuse, strain injuries generally have a direction of movement that is painful versus a movement that is less or causes no pain. 

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*Disclaimer: All information in this article is intended for instruction and informational purposes. The author(s) are not responsible for any harm or injury that may result.  This information is used to supplement not replace any advice you were provided from your doctor or another medical health professional.  No guarantees of specific results are expressly made or implied with this article.

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