Stages of Frozen Shoulder

The freezing stage is by far the most painful phase of a frozen shoulder. At the beginning of this phase, motion may only be slightly restricted, and that's why early frozen shoulder is often misdiagnosed as a problem with the rotator cuff.

During this phase, the shoulder capsule is thickening and shrinking.  As this happens, shoulder movements become increasingly difficult and painful. 

The second phase of a frozen shoulder is known as the frozen phase.  During this phase, the shoulder is notably stiff. The characteristic examination finding that confirms the diagnosis of a frozen shoulder is that not only can the patient not move the shoulder normally, be someone else trying to manipulate the arm also cannot move the shoulder. In a rotator cuff problem, often a patient can't move their arm normally, but someone else (examiner) can.

The frozen phase is typically much less painful than the freezing phase, but pain can result from seemingly simple activities. Rotation of the shoulder joint is particularly difficult making activities such as washing hair, hooking a bra, or reaching for a seat belt, painful.

The last phase of a frozen shoulder is the thawing phase. In this phase, the capsule of the shoulder joint is thick and tight, but over time it gradually loosens. It is important to stretch the shoulder capsule and even allow for some discomfort to ensure the shoulder joint mobility continues to recover. 

The thawing phase is typically much better tolerated by patients, even though it can take a long time. Not having the extreme pain associated with the freezing of the joint, and seeing gradual gains in mobility, make for this phase tolerable, albeit long.

Frozen shoulder treatment is almost always best accomplished with physical therapy and stretching of the joint. Pain medications, ice and heat application, and alternative therapies can all be helpful to manage the discomfort. 

Surgery can be an option for treatment of a frozen shoulder, but it is seldom needed, and only utilized with prolonged efforts at therapy have failed to allow for improvement in symptoms.  One of the problems with surgery for treatment of frozen shoulder is that surgery is a possible cause of frozen shoulder.  Therefore, it's possible for some patients to get worse after surgery--obviously, that is extremely frustrating.

As you can see, the timeline for recovery from a frozen shoulder can be long and frustrating.  It's important for patients to understand that no matter what, the recovery time is measured in months, if not years. Expecting a recovery that will be quick causes more frustration.

That said, there are steps you can take to speed your recovery and reduce the discomfort of a frozen shoulder. Therapy can be beneficial, and your doctor can suggest treatments to help alleviate pain while you recover.

The good news is, over time, almost all patients will find complete relief of pain, and normal or near-normal range of motion of the shoulder joint.