Breaking Down the Three Phases of Frozen Shoulder

Most shoulder injuries can be traced to an acute trauma or some type of repetitive stress (overuse). But one form of shoulder pain, stiffness, and dysfunction — frozen shoulder — is often idiopathic, meaning it usually comes on for no particular reason.     

At  Sports Medicine Oregon, our board-certified orthopedists know that frozen shoulder can be exceptionally frustrating and limiting to live with for months on end. We also know that early interventional care can help shorten symptom duration and prevent long-term complications. 

Understanding frozen shoulder

The medical term for frozen shoulder is adhesive (scarring) capsulitis (inflammation of the capsule). The joint capsule is a flexible envelope of tissue that surrounds the shoulder’s central ball-and-socket arrangement. 

This resilient sheath has responsive “folds” that expand and contract as you rotate, raise, or extend your arm. If the joint capsule becomes inflamed, however, the resulting irritation and swelling can lead to the development of stiff, band-like scars called adhesions. 

As adhesions build up on the joint capsule over time, its flexible folds gradually become rigid and tight, restricting joint movement and causing pain. This is frozen shoulder. 

Freezing, frozen, and thawing 

While many cases of frozen shoulder are “idiopathic,” the condition is associated with certain risk factors. Frozen shoulder is most common in women, middle-aged adults, and people with thyroid disease, metabolic syndrome, and diabetes. In fact, up to one in five diabetics (20%) develop frozen shoulder at some point.  

Sometimes, frozen shoulder begins with an arm or shoulder injury. Prolonged shoulder/arm immobility — to help heal a broken bone, for example — can lead to joint capsule swelling and scarring, as can chronic inflammation from rotator cuff tendinitis or bursitis.

No matter how it develops, frozen shoulder always progresses through three phases. Let’s take a closer look at each one: 

1. Freezing phase

During the first stage of frozen shoulder — the freezing phase — you experience the gradual onset of shoulder pain at rest. This phase is also characterized by shoulder pain at night that’s intense enough to disrupt your sleep, as well as sharp pain at extremes of shoulder joint motion (i.e., when you reach your arm overhead). 

As the adhesions build up and the pain worsens in this phase, your shoulder slowly loses range of motion. The freezing phase typically lasts between six weeks to nine months. 

2. Frozen phase

The second stage of frozen shoulder, known as the frozen phase, typically lasts between two and six months. While extremes of movement are still painful early on in this phase, shoulder pain overall tends to diminish as joint motion is gradually and increasingly limited. 

Essentially, the frozen phase is characterized by debilitating joint stiffness and restricted motion that can make it very difficult to carry out normal daily activities.  

3. Thawing phase 

The final stage of frozen shoulder, the thawing phase, is marked by spontaneous, gradual improvement in shoulder range of motion until normal strength and pain-free movement is fully (or nearly) restored. This stage can last anywhere from six months to two years. 

Treatment supports recovery  

The main reason frozen shoulder is so frustrating is that its pain and motion-limiting stiffness can interfere with your life for a long time — the problem may run its course in as little as nine months, or it may take three years or longer until your joint is fully “thawed.”      

The good news about frozen shoulder is that it’s not a permanent condition, and most of the time, it resolves itself. The better news about frozen shoulder is that treatment can help shorten the duration of each phase and significantly reduce the risk of long-term issues. 

Anti-inflammatory injections

Most of the time, frozen shoulder responds well to a combination of physical therapy and ultrasound-guided corticosteroid injections. These anti-inflammatory injections help reduce swelling, pain, and stiffness within the joint capsule, allowing for easier motion. 

Progressive physical therapy

Once the joint capsule is less inflamed, physical therapy works to gradually restore range of motion. Flexibility exercises help stretch the joint capsule first, while strengthening exercises help stabilize the entire shoulder as shoulder joint function steadily improves. 

Are you coping with unexplained shoulder pain and stiffness? We can help. Schedule a visit at your nearest Sports Medicine Oregon office in Tigard or Wilsonville, Oregon, today.