Frozen Shoulder

Frozen Shoulder Overview

The shoulder is the most mobile joint in the human body offering the greatest range of motion. Certain work or sports activities can put great demands upon the shoulder, and shoulder injuries can occur when the shoulder exceeds movement capacity or the individual structures are overloaded. Frozen shoulder (adhesive capsulitis), also called a “stiff shoulder,” is a condition that can cause a great deal of shoulder discomfort and a limitation of shoulder movement for the patient. In most cases, frozen shoulder results in a complete loss of function and motion of the shoulder. The pain and discomfort, as well the loss of shoulder movement, can become so severe that almost all normal and daily activities become difficult, if not impossible, to do.

Adhesive capsulitis is the technical term used to describe the thickening and tightening of the soft tissue in the capsule (joint lining) of the shoulder joint. This leads to contractures and scarring which results in the loss of motion. Over time, because of the shoulder pain, the shoulder is moved less and less and the stiffness becomes worse. The loss of motion can result in other types of problems such as labral tears or impingment and rotator cuff problems.

What are the types of frozen shoulder?

There are two types of frozen shoulder:

Primary adhesive capsulitis: Primary adhesive capsulitis occurs when a patient experiences a gradually slow loss of shoulder motion for no apparent reason. It is most common in middle-aged women and is often mis-diagnosed as rotator cuff disease or impingement. The underlying cause of this condition is unknown, but is felt to be inflammatory. It can be EXTREMELY painful. Additional possible causes include changes in the immune system or hormonal imbalances. Diseases such as diabetes mellitus, and some cardiovascular and neurological disorders may also be contributing factors. Primary adhesive capsulitis may affect both shoulders (although this typically does not happen at the same time) and may be resistant to non-surgical treatment. Surgery can effectively help in more severe cases.
Secondary adhesive capsulitis: Secondary (or acquired) adhesive capsulitis develops from a known cause, such as stiffness following a shoulder injury, a fracture within the shoulder region, a previous unrelated shoulder surgery, or a prolonged period of immobilization. This condition may require surgical intervention when it is more severe.

What are the symptoms of frozen shoulder?

The major symptoms of frozen shoulder are pain and loss of motion. The onset of symptoms may be gradual or sudden, depending on the cause of the condition. Frozen shoulder typically develops in three distinct phases. Each of these stages can last a number of months.

Freezing Stage: During the freezing phase, the shoulder becomes inflamed and becomes more and more painful. This is sometime difficult to distinguish from shoulder impingement because in the early stages shoulder motion is still preserved. As it progresses, motion becomes restricted. Over time, shoulder stiffness gets progressively worse and shoulder motion will continue to be lost.
Frozen Stage: Once the freezing phase ends, which may require several months, the shoulder remains stiff but the pain is much less. Gradually over time the stiffness will decrease.
Thawing Phase: For a classic primary adhesive capsulitis, this phase occurs after 8-12 months and may take 6 months for the shoulder to return to normal. Some patients never enter this phase and many patients with secondary or acquired frozen shoulder never enter this phase.

Are you experiencing symptoms of frozen shoulder?

There are two ways to initiate a consultation with Dr. Millett:

You can provide current X-rays and/or MRIs for a clinical case review ($250).

You can schedule an office consultation with Dr. Millett.

Request Case Review or Office Consultation

what is the treatment for frozen shoulder?

Non-Surgical

Physical therapy plays a role for most patients in the treatment of frozen shoulder. Regardless of the frozen shoulder phase, an orthopedic physical therapy program can be implemented and very successful in restoring shoulder motion and reducing pain. In addition to therapy, anti-inflammatory medication and steroid injections can be helpful in reducing the pain, swelling, and stiffness. This program usually results in gradual improvement, although it may take several months.

Surgical

Some individuals will require surgery. In these cases, arthroscopic surgery is likely to be used to release tight areas and remove scar tissue so that mobility will be restored. Arthroscopic surgery is a minimally-invasive shoulder procedure where tiny incisions are made to limit creating additional damage and scarring. In some more severe cases (such as after a fractures) an open surgical approach may be needed. Careful and appropriate anesthesia and coordinated rehabilitation are also essential to make sure the pain is well controlled and range of motion is preserved after surgery.

If you would like additional information on a stiff shoulder, or more resources on frozen shoulder treatment options, please contact the orthopedic office of Dr. Peter Millett, serving patients in Vail, Aspen and the surrounding Denver, Colorado communities.

Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!