Is it Really Frozen Shoulder?

by Elizabeth Snouffer on 05/25/2010

Last January, I wrote about whether or not I had frozen shoulder, and I how I was managing  acute shoulder pain without a firm diagnosis (see that post here).  Reader response was phenomenal.  More people stopped by diabetes 24-7 to read about shoulder pain almost as much as my story on the Islet Sheet.  Even today, I receive hundreds of hits per week for this problem.  Reader response indicates a large number of people are suffering from shoulder pain and may not know why. 

How do you know if you really have Frozen Shoulder?

Previously, the orthopedic team thought I had a slight tear in my rotator cuff with a dose of tendonosis after analyzing my MRI.  We treated my pain as a sports injury.  I was using physiotherapy to manage loss of movement and pain.  I had suspended my training in swimming and quit the tennis team.  This was all meant to be a temporary matter.

That was last February 2010.  My range of motion has decreased by 50-60% since then.  (In February it was about 20%).  Now, the diagnosis is clear:  I have Frozen Shoulder.

Left side - Good Shoulder/arm!

What is Frozen Shoulder?

My doctor, Dr. Benjamin Chow, a specialist in Orthopaedics & Traumatology, shared a publication he wrote for patients under the same title.   Here are a few highlights.

Frozen Shoulder is known as “Adhesive Capsulitis” to the medical community.  It is a poorly understood condition which is characterized by inflammation in the shoulder joint and a thickening of the joint capsule.  It affects about 2% of the general population between the ages of 40 and 60.  It is more common in people with diabetes and usually follows an injury.  So far, I tick all these boxes.  I am 45 and the problem started after a tennis injury in my rotator cuff; I am shocked by the 2% statistic.  This leads me to believe many people are undiagnosed.

Unable to lift my arm, ouch ... it hurts!

Frozen Shoulder Stages
Stage 1: This is the “freezing phase” where acute pain is the predominant symptom.  As pain becomes more severe, the shoulder loses range of motion. This stage lasts up to 9 months.
Stage 2: Called the “frozen phase,” the pain of frozen shoulder lessens and stiffness becomes a more prominent symptom.  This lasts up to nine months.
Stage 3: In this period, the “thawing” occurs.  Pain and stiffness are reduced, but this phase may last up to two years.
Stage 3 does not include complete resolution; permanent loss of external rotation is common.

Diagnosis

According to Dr. Chow, “The cardinal sign of frozen shoulder is loss of external rotation.”  To understand what this means, stand with your back against the wall, bend your arms at the elbow and put them flush against the wall.  This is called external rotation.  If you cannot manage this with your pained shoulder/side – you have one of the most significant symptoms.  What makes diagnosis so difficult?  “Other diagnoses that may be confused, or co-exist, with true frozen shoulder include shoulder impingement syndrome, rotator cuff tear, osteoarthritis of the shoulder joint, infection and tumours and pain referred from the neck.”  Even for me, it wasn’t clear until my range of motion externally started to disappear.

Arrow points to inflamed joint lining - when anti-inflammatories, steroids and physiotherapy don't work - surgery may be an option. (Photo: B. Chow M.D.)

Next steps: Treatment

Frozen shoulder can be resolved on its own – but it can take years and it can permanently damage range of motion for life.

Treatment 1: Anti-inflammatory drugs and gentle physiotherapy.

Treatment 2: If treatment 1 offers no significant improvement, consider a steroid injection.  If however, you use insulin to manage diabetes, be careful and discuss the risks with your doctor.  Steroids often prevent the efficacy of exogenous insulin.

Treatment 3: Surgery.  Arthroscopic Capsular Release is a scopic surgical procedure where the capsule is cut surgically allowing the shoulder to move freely again (as opposed to the old-style procedure where manipulation by the doctor causes a severe tear).  Vigorous post-operative physiotherapy is required if the movement gained during the surgery is to be retained.  If physiotherapy is not utilized, the capsule can quickly become stiff again.

It seems unfair that someone like me with an active lifestyle and an A1c hovering between 6.5 and 7.0 should be a part of the 2%!  Poor “control” has nothing to do with a diagnosis.  I have decided to take the more radical approach.  I am scheduled for surgery very soon, and will let my readers know how it goes.

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{ 25 comments… read them below or add one }

Lee Ann Thill May 26, 2010 at 00:15

One thing to note it that while it’s commonly known as “frozen shoulder”, it can occur in other joints. I developed it in one shoulder, and then a month later, it developed in my other shoulder. I went to 3 or 4 doctors who all misdiagnosed me (i.e. rheumatoid arthritis, fibromyalgia), and wanted to perform unnecessary tests (i.e. bone scan) and prescribe unhelpful meds (i.e. Darvocet) before I figured out what it was on my own, and got myself to a doctor who confirmed my diagnosis as adhesive capsulitis, and confirmed that that’s what had also been plaguing both of my hip joints for 15 years, something for which I had sought treatment in the past, and given up when no one could diagnose it. I too had surgery. I have pretty good range of motion in my shoulders now, 2 years after the fact, but not what it once was. My hips were another story. Just because I’d had it for so long, they were pretty much beyond repair.

My understanding is that early, aggressive treatment is the best course, so hopefully, you’ll be good as new after your surgery. Good luck!

Elizabeth Snouffer May 26, 2010 at 00:21

Thank you Lee Ann for sharing your story. I am concerned that my range won’t ever be the same but living with this pain and waiting for a resolution that might take two years to arrive is just not good enough. I’ll write about my progress post-operatively in about 10 days. E.

Josephine Quah May 26, 2010 at 04:14

Despite your active lifestyle, I can be a 101% sure that if you take a blood analysis, your blood is not at its healthy slightly alkaline ph value, which means your blood circulation is poor! Yes. It may be hard to face but it’s the truth. My dad has frozen shoulder, so i know. He’s currently recovering via a natural therapy; no pills, no surgery, no injections, and not even physio. I bought him a treatment machine which he sat at everyday for 3hrs (yes, simply by sitting and doing nothing else on that machine), and just 3 months down the road, his pain is much alleviated and range of motion largely increased! Not only had it helped my dad, but an uncle of mine who had suffered from more than 10 years of diabetes had had his 15 leveled to 6.5 using the same treatment!! It’s all about the reverting of blood ph and the revitalization of cells and nerves. This kind of therapy machine had been all-the-rage in Japan and Korea with more than 17 years of history. It has many certificates granted by healthcare bodies around the world (UK, USA, Italy, Japan, Korea, China etc), proving it safe to be used with no side-effects, and result-proven. I’d rather pay US$9K for that machine than let my dad go through any surgery. Well, i already see results now!

Sheryl May 26, 2010 at 08:05

I had release of my left frozen shoulder last February 2009. The Winter of 2007 I noticed it was hard to put my arm back through the arms of my winter coat. Went to an ortho and dx with tear in my rotator cuff, given a steroid injection. When I did not get better, I went to a physician who specialized in sports injuries (as I thought he might be more inclined to offer PT). He looked at the imaging and dx the frozen shoulder instead – recommended surgery.

Not wanting surgery I tried 6 months of PT instead. When we figured out that the pain of the PT (it was not gentle) was causing me to have migraines and I had had less than 10% progress in that time I finally agreed to do surgery.

When my MD went in to do the arthroscopic release and manipulation under anesthesia (I have 2 very tiny scars I hardly see now), he said my adhesions and the inflammation were the worst he had seen. He was able to release and get me to the full range of motion while I was on the table. After I was to start daily PT for 2 weeks starting 2 days after surgery. They were again having trouble getting me to the motion they expected post-op at PT. At later post-op visit I was given another steroid injection hoping to calm down the inflammation as my body was fighting the pain they felt and not allowing my arm to be manipulated. Needless to say I went through 6 months of 2 x a week PT after surgery as well.

I now can put my left hand into my left rear pocket. I am starting to be able to go behind my back at my waist level – but NO higher. My left arm when I raise it up goes to the level you see in the movies of someone doing the Hi Hitler motion. I can now put my arm across my body and touch my fingers to my right shoulder.

For the longest time it was ALMOST impossible wash my right armpit. I still have trouble putting my hair back in a scrungie. I am waiting for the THAW time – Ha!

It is actually better than before the surgery. It is still hard to hold the phone to my left ear for long. My purse is lighter.

Still on the 800 motrin 2 x a day, down from 3x a day – this is still over 15 months from surgery – but I have hope to be pain free someday.
Amazingly the part that hurts more is not the shoulder but my bicep. I had overworked it so much with my shoulder not working so the bicep muscle overcompensated and built up a large lump.

Do NOT WAIT FOR THE SURGERY!!!!
I have been told I am at high risk of having a right frozen shoulder.

Good luck with the operation!!!!

Elizabeth Snouffer May 26, 2010 at 08:26

Hi Josephine, please share the name of this machine and any other relevant information so I can do some research. A photo would be great too! Thanks again.

Monique May 28, 2010 at 05:20

Hiya

I know where you are with this – was diagnosed with frozen shoulder following recovery from a right AC stablisation surgery in around August 2009. I had stuffed the shoulder racing my bike – a grade 3 AC separation – plus I broke my back in four places. Fun times.
The worst part of the recovery was by far the frozen shoulder aspect. Like you, I did some research and discovered the recovery times significantly increased for a person with type 1, and found lots more vague information/advice. Health professionals regularly subsituted ‘frozen shoulder’ with ‘diabetic frozen shoulder’. The diabetic frozen shoulder implied a much more serious case.
Fortunately I had on my team a crack shoulder physio who was convinced that my diabetes had nothing to do with it. I had the first hydrodilatation (a course of cortisone into the joint) which hurt like hell (all referred pain into my elbow joint – weird and painful at the same time), but after gaining a bit more movement back it regressed after about 4-6weeks (which I am told can happen). The second round of hydrodilatation we did under anaesthesia – called a Manipulation Under Anaesthesia (MUA). After the cortisone shot the surgeon actually wrenches the shoulder round into all those positions that you cannot currently do, and cracks the shoulder out of the lockness. Following this it was straight into hard core physio stretching to ensure it wouldn’t regress again. This time, it worked. The next option would have been surgery.
Yeah my levels were higher than normal following each dose of cortisone, but a necessary process to work through. Knowing the side effects meant I could anticipate and be watchful for increasing BSLs.
I hope you have something like this (ie, an MUA) on offer instead of surgery – an injection while out of it is a little less intrusive!
My story of the frozen shoulder is here:
http://www.moniquehanley.com/2009/11/movement-at-station.html
All the very best
Monique Hanley
Type 1 diabetic

Elizabeth Snouffer May 29, 2010 at 18:33

I want to thank everyone for your comments! I have taken a turn in my thinking. Based on all of the material above (!) I called a new doctor (sports/orthopedic surgeon) and went to see him. He was against my having surgery for the following reasons: tendons still strong, mobility at 75%, more physio needed and if I am willing maybe even another steroid shot. Mostly he felt my negative energy about the surgery was counter-productive, and that it was too soon. So… I have more work to do but no surgery! Whew!!

Stalybridge Physiotherapist June 7, 2010 at 19:14

A physiotherapist will be able to diagnose your frozen shoulder condition and treat you using treatments such as massage, thermotherapy with warm or cold temperature packs, or transcutaneous electrical nerve stimulation (TENS).

TENs is where small electrical pads (electrodes) are applied to skin over your shoulder, which distribute small pulses of electricity from the TENS machine. The physiotherapist can control the strength of the pulses and how long your treatment lasts, dependant on how severe your condition is.

Pam June 30, 2010 at 13:50

I’m on my 2nd frozen shoulder. My first was in 2005 in my right(non dominant arm). I went to physical therapy which was extremely painful and didn’t help release the arm. My ortho gave me a steroid shot and this made it worse and I developed knots all up and down my back. He wanted to do surgery, but I said no & never went back to see him. Finally, after 3 months of pt, I stopped going and left the arm alone until it started to feel better and then started with stretching exercises. My arm was 98percent better in 12 months – not sure when it was 100%. My left arm has been frozen now since October 09 and was super painful from April to the end of May. During that time I wore a tens unit for several hours a day and used heat when I could. The tens unit takes the edge off of the pain. As a side note, this pain really drained my energy. I know the worst days are over, but I still have 6-9 months to go til I regain my range of motion. This frozen shoulder affects my arm and hand & I don’t have much use of my thumb. It also affects my neck. The right arm affected my back and neck. I have taken tylenol for pain, but only on a few occasions because the tens unit took away much of the pain. I am hoping I never get this again because it is extremely painful.

Steve August 3, 2010 at 04:02

Hiya,

I’ve just had a manipulation on my shoulder to resolve Frozen Shoulder. This is, in hindsight, the second one that I’ve had as my other shoulder was problematical two or three years ago. I now have limited movement in the right shoulder (though not as limited as it might have been had I not been doing Brazillian Jiu Jitsu every week whilst suffering it!)
The left shoulder, the one that’s just been manipulated, is much, much, MUCH better so far. It’s only Monday and the manipulation was Friday, but I can’t believe the level of movement I have right now.

The only issue that I’ve found is that I didn’t take enough notice when the surgeon told me about the cortisone injection that he’d done when he manipulated my shoulder. That’s a significant issue for an insulin controlled diabetic!

Steve

Elizabeth Snouffer August 10, 2010 at 10:55

Hi Steve

Thanks for posting – interesting to hear from someone that the manipulation worked. You are the first person I have heard from or spoken to where it made mobility better and quickly. I would love to know more… steroid injections are manageable but temporary. Thanks again. Elizabeth

Leslie August 25, 2010 at 01:15

Hi Elizabeth,

You and I experienced the same injury, right around the same time. I recently (Aug/2/2010) had the manipulation under anesthesia. The first 45 minutes post manipulation were excruciating, with pain medication administered every 15 minutes till I was somewhat painfree, I also received the cortisone at the same time under anesthesia, thank god. I was originally diagosed with inner partial thickness, and predisposed to impingement. Currently, A great deal of motion has returned, but still find it hard to put my hand behind my back. I am not pain free, and still have deep pain when the arm is over extended. I am happy with the increased motion as a result of the manipulation, but at 49 I am working towards full motion. Good luck in your recovery…

sasha September 1, 2010 at 16:48

After 2 yrs with a frozen right shoulder, lots of physio and a couple of cortisone injection, in the end I was unable to even touch my chin with my right hand, I am right handed ( by now I had learnt to do most thing with my other hand ). I was told I would never get full movement back and that surgery gave me a really good chance , I had impingement and capsule release done in feb2008.
AND YES IT WORKED
About 6months later it started in my left shoulder, had physio a lot quicker this time, (first time I put up with the pain for a long while before going to the doctors) had more injections it eased, only
to flared up with revenge in 2010 and the physio can’t help this time been refer again to see the surgeon say it is likely it has mirror the other side so if they say surgery will help again I will have it done again
I not Diabetic but I am late 40

It amazing how much you use your shoulder like twisting a jar top you only think you use your hand! (I sure it may well happens with all sorts of joint pain but my knowledge is just with shoulder )

Nettie June 18, 2012 at 21:56

I have been diagnosed with frozen shoulder in the left arm since Jan.-Feb. and have gone through PT, injection, herbal remedies, compresses, with no results and only little and temporary pain relief. My doctor told me to return in Aug. for MUA. I’m really looking forward to it, since I live in pain on a daily basis. My shoulder blade is now out of place, it seems, and I have several knots all over my back. There is no way I am waiting for this to resolve on it’s own in 2-3 years! It was great hearing about everyone’s stories and knowing I am not alone.

cathy June 26, 2012 at 18:26

ive had severe pain for 3 months now, worse wen i forget and push or pull on my left arm! when this happens the pain radiates down my left arm to my wrist. this stops me in my tracks and i have to hold the arm until the pain stops. i cannot put my bra on as i cant get my arm even round to towards my back, i get not even as far as my waist.even pulling jeans up is a painful experiance. i cant sleep and wake up in severe pain. its been diagnosed by my physio that i have a frozen shoulder 2 weeks ago. iam booked in for this steroid injection tomorrow and im scared as ive been told and read that its very painful!do they atleast freeze the area?? i also was diognosed with emphasema about 2 yrs ago. my job as a supportworker has me out in all weathers as we are a visiting support service. some days i can be out in rain all day getting to and from visits, my job is also very stressfull. i also get pain in my elbows my left hip and my ankle bones, i can tolorate this, but the pain in my left shoulder and arm is so bad i can only discribe it as like a severe toothache in my arm that is there all the time, and even worse at night!

cathy June 26, 2012 at 18:31

could i add to that please that my left shoulder is sloapin down at left side. it has dropped that much its very noticable. also 4 weeks ago i sufferd a pinched nerve in my neck this lasted 3 days and my chin was stuck near my chest,

Nitin July 12, 2012 at 20:45

Thanks all for sharing ..
I am 36 and I have been struggling with Right Hand Shoulder since Feb 2012, It started slowly and I believe reached Peak by now. I had MRI done and it came out clean, I did PT for almost two monnt, it did not help improve the situation but, kept me active.
I went to Ortho and he suggested Hydroplasty, I have taken appointments and plan to do it soon.
I started going to Acupuncturist, done 2 appointments, too early to say but so far zero improvement.
I am type 2 and I noticed it hurts most when glucose levels higher than normal. If I do stretches and cardio, I feel much better, and less pain, more rotation.
I will post again after Hydroplasty.

Nitin

kendra December 3, 2012 at 11:48

I am a type 1 of 40 yrs now and developed right shoulder issues 1 1/2yrs ago. Went thru 2 injections and 1 yrs of PT with minimal improvement in mobility and much pain. One doc says lets do surgery and then PT another will not do surgery til after more injections and PT. I do not see the point in trying something that has not worked in the past. I told the doc it was frozen shoulder but for the longest time he called it brachial tendonitis even though PT called it frozen. I am fed up with this whole thing and I am not willing to do another yr of painful therapy for nothing.

Kerry January 25, 2013 at 10:06

Thank you for sharing your story. I’m just now in the freezing stage of a currently self diagnosed FS and hearing stories from others certainly helps.

Noticing how old this page is, how is your shoulder today?

Again, thank you for sharing.

jeanette March 4, 2013 at 12:28

hi i have had a frozen shoulder and impigment in my left arm for 4 years i have now got the same in my right arm iv had injections and phis an nothings worked is they any thing i can do cant even dress me sen or get bathed two painfull thankyou

Sarah March 23, 2013 at 03:42

Has anyone had any success with acupuncture?

Gary March 25, 2013 at 09:39

I was diagnosed as having frozen right shoulder approx 6 years ago, however, I have always doubted this as I have never experienced the severe pain that others refer to. What is most noticeable in my lack of range of movement is when I place hand behind back. With left hand I can easily place hand between shoulder blades. Right hand only reaches mid back. Recently I decided to “force” the joint to see if I can improve it. Amazingly, by using a towel behind back and pulling forcibly the right hand up, my ROM is improving. The pain is quite severe but appears to be in the muscles of the front deltoid only, and soon passes when tension released. Anyone else suffer from similar without the initial pain?

GAYLE April 3, 2013 at 22:47

I’m not diabetic. I had right-hand frozen shoulder in my early 30s – couldn’t even lift my arm 8 inches from my body. I went to an ortho doctor who gave me a painful shot of cortizone and sent me to PT. I faithfully did this for several months and continued on my own. I got full range of motion back after 2 years or so. Around age 44 I noticed my left range of motion starting to stiffen. I tried to do my own stretches (like on my other shoulder) – but despite this – I have full out frozen shoulder. Several months ago I had an MRI done on both shoulders. My right showed a rotator cuff tear – but that shoulder is working as I already mentioned after PT, etc. My left should shows a variety of things like a little swelling, tendinitis, old age – but like many of your MRIs – nothing specific. My family doctor gave me a worthless cortizone injection that only lasted about 2 hours. 1 month ago I began PT 2x weekly. I have done everything asked of me FAITHFULLY. Today she measured my progress and I’ve only gained a few degrees of progress. She put me a TENS unit today and it’s the first day in a very long time that I didn’t feel shooting pains down my arm, pain in my neck, etc. I will be getting a TENS unit to keep at home in the next week or so… I can’t wait!!! I am scheduled for an ultra-sounded guided cortizone shot at the end of April… I had to wait because of the stupid shot my family doctor gave me. I don’t know why I keep freezing up – modern medicine doesn’t seem to understand either. But I’m so encouraged to see other people who can related with what I’ve been going through. This is such a depressing condition. Every day is a challenge to get out of bed, take a ashower and try to do something with my hair (almost impossible right now!)… forget shaving the armpits – can’t to them! I’m praying for a miracle though and will continue to faithfully try to get my range of motion back.

Duck October 23, 2013 at 11:34

I have no medical aid left for the year, so I am trying to help myself. I have shoulder pain in both shoulders I have had this for about 9 to 12 months, If I move my arms too much – for instance, behind my back I can only reach my waist. If I raise my arms above the shoulder height I get pain.
I have disc displacement in my neck, so I don’t know whether this is what is causing my shoulder pain by way of a pinched nerve or whether I have frozen shoulder. Does any one know how to tell the difference in the symptoms between the two? I am scared of exercising the shoulders without knowing in case I aggravate the problem. Would very much appreciate some advise, and thanks for the comments on the web site.

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