stages February 16, 2021

Understanding the Stages of Frozen Shoulder

Frozen shoulder syndrome progresses slowly through three distinct stages, each lasting anywhere from weeks, to months, even years.

Those who suffer from this condition know that the pain and reduction in their range of motion makes daily tasks difficult and agonizing. Without proper treatment, frozen shoulder can last for many years, and some people never make a full recovery without outside help.

Being aware of the signs and symptoms of the various frozen shoulder stages helps patients understand their situation and identify their best treatment options.

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What is Adhesive Capsulitis?

While “frozen shoulder” is often used as an umbrella term to discuss a variety of shoulder problems, the specific condition is known as adhesive capsulitis in the medical community.

This causes pain and gradually worsens over time. Frozen shoulder results from adhesions in the shoulder capsule that prevent the arm from moving properly. Adhesive capsulitis leads to limitations of both the active and passive ranges of motion of the affected arm’s shoulder joint. This is due to soft tissue contractures and adhesions in the shoulder that result in a mechanical obstruction.

The resulting pain and severely limited shoulder movement is why daily activities (and even sleep) can become extremely difficult for people with frozen shoulders. Also, it forces people to rely on the unaffected arm for daily tasks, which can cause imbalances and eventually lead to pain in other parts of the body.

What is the Shoulder Joint?

The shoulder is a ball-and-socket joint that allows the arm to rotate or hinge away from the body to perform actions like lifting, pushing and pulling.

Along with an envelope of connective tissue containing synovial fluid around the joint, the humerus (upper arm), scapula (shoulder blade), and clavicle (collarbone) form a structure called the shoulder capsule.

When someone develops frozen shoulder it is because this capsule thickens and contracts, which leads to the formation of adhesions. When these clumps of scar tissue begin to form, the shoulder becomes harder and harder to move. 

In addition, the bursae in the shoulder, which are small pouches of synovial fluid that help reduce the friction between the bones and tendons in the shoulder, can become sticky and cause pain while further restricting the movement of the upper arm.

Between the contraction of the shoulder capsule and the development of adhesions, pain and stiffness quickly result, which leads to less range of motion in the joint.

Risk Factors

Women are twice as likely as men to develop the condition. It usually affects people between the ages of 40 and 60, but it is a possibility at almost any age. Certain health conditions make the development of this syndrome more likely. 

Specifically, it disproportionately affects people that have or have had:

  • Diabetes or Parkinson’s disease
  • Previous shoulder injuries or surgeries 

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The Three Stages of Frozen Shoulder Syndrome

Following its onset, frozen shoulder syndrome progresses slowly through three stages, which are:

  1. Freezing Stage
  2. Frozen Stage
  3. Thawing Stage

Each stage can last anywhere from weeks to years and has a distinct set of symptoms.

Depending on the severity of your pain and symptoms and the particular phase of your frozen shoulder, your doctor will likely prescribe imaging tests, like x-rays or an MRI, to rule out other potential problems with the shoulder joint.

Freezing Stage

The first and most painful stage is the freezing phase, which can last anywhere between two and nine months.

At the outset, the range of motion restrictions are usually minor, which is why it is misdiagnosed so often. At first glance, this stage presents quite like a rotator cuff issue or bursitis to many health practitioners. 

However, the pain and stiffness gradually worsen over time until it reaches the frozen stage. The ineffectiveness of conventional treatments and progressive nature of the symptoms, like range of motion restrictions, are the leading indicators for frozen shoulder.

Frozen Stage

Following the freezing phase, the shoulder joint becomes frozen, which can last anywhere from four to six months, or even up to a year.

At this point, a doctor may have an easier time diagnosing frozen shoulder because of the lack of passive mobility in the shoulder. 

With other shoulder problems, a patient may have a hard time reaching a certain position on their own, like reaching an arm overhead. This is an example of a loss of active range of motion. 

But with frozen shoulder, there is also a loss in the passive range of motion, which means that shoulder mobility cannot be achieved even when a doctor or physical therapist tries to move the affected arm. This is usually due to the adhesions in the shoulder that prevent proper shoulder mechanics, thus the diagnosis.

Most people report that their pain is less severe during this stage. Rotating the upper arm is particularly difficult, making a number of ordinary daily tasks painful and challenging ordeals.

Thawing Stage

The last of the three stages of frozen shoulder is the thawing phase, which may take anywhere from six months to two years.

The shoulder capsule will slowly loosen and range of motion will begin to improve during the final stage. However, in some cases the shoulder may never return to normal without the proper medical intervention.

During the thawing phase, exercises and stretches become much easier, but it remains a lengthy and frustrating journey until you can move your shoulder without pain or stiffness.

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Treatment Options

Many people have trouble getting good medical advice to help alleviate their shoulder pain and stiffness from frozen shoulder syndrome because it remains a poorly understood condition within the medical community.

Physical Therapy and Surgery

Until recently, treatment options were limited to conventional physical therapy in conjunction with the use of pain or anti-inflammatory medication, surgery, or some combination of these treatments. 

Unfortunately, none of these approaches has a particularly good track record when it came to ending symptoms and returning the shoulder motion to normal. Even patients who opt for surgery face many months of exercises to rehabilitate their shoulders, with no guarantee of success.

Manual Capsular Dissection (MCD)

The most effective treatment for frozen shoulders is the MCD procedure. 

Developed by the leading doctor in the field, Dr. Allan Gary Oolo-Austin, this course of therapy is non-invasive and does not require surgery. Instead of an approach based around surgery, the MCD procedure uses highly specific manual manipulations, followed by targeted exercises and movements to stretch the shoulder joint, helping patients make a full recovery quickly. 

This procedure, which can be completed in under an hour, has a 98% clinical success rate at restoring mobility to the shoulder joint and ending shoulder pain.

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