Frozen shoulder, also called adhesive capsulitis, refers to stiffness and pain in the shoulder joint – and it usually takes a long time to “thaw out.” Symptoms typically begin slowly, then get worse. Eventually, the symptoms are likely to get better on their own, but that can take up to three years. And yes, recovery does go through three stages: freezing, frozen and thawing. Margaret “Meg” Avilla, PA, a physician assistant at Health First Medical Group Crane Creek, says, “Frozen shoulder occurs when inflammation and scar tissue invade the shoulder joint. “In some cases, it starts with inflammation of the joint and leads to scarring. In other cases, scarring occurs with little inflammation.” Harvard Health newsletter says most often, people with frozen shoulder experience dull, aching pain that increases as the condition progresses and worsens with arm movement. “Interestingly, frozen shoulder is usually not caused by a major trauma but by such everyday things as sports injuries, aging, overuse of the computer, or even sleeping on it the wrong way,” says Avilla. People often confuse bursitis and frozen shoulder, but they are not the same thing. Bursitis is inflammation of the bursa, a fluid-filled sac that provides cushioning and reduces friction between bones, tendons, muscles and joints. It can be caused by repetitive motions, trauma, infection or underlying conditions such as arthritis. Frozen shoulder is characterized by the thickening and tightening of the joint capsule surrounding the shoulder joint. The exact cause is not fully understood, but it can develop after an injury, surgery, or in association with certain medical conditions, including diabetes or thyroid disorders. WebMD says that while it’s not clear why some people develop frozen shoulder, some groups are more at risk. They include: <ul> <li>Women between the ages of 40 and 60.</li> <li>Those unable to move a shoulder for a long time due to a medical condition like a stroke, or surgery that keeps the arm immobilized.</li> <li>Those with reduced shoulder movement due to inflammation from rotator cuff tendinitis or bursitis.</li> <li>People with diabetes, heart disease, thyroid disease and Parkinson’s disease. Avilla says fitness level doesn’t have any meaningful effect on whether a person develops it. “If you’ve exercised your upper body, you may be a little ahead of the game, but this can happen to anyone.” Frozen shoulder typically develops slowly in three stages. Avilla explains what they are.</li> <li>Freezing stage. Any movement of the shoulder causes pain, and your ability to move the shoulder becomes limited. This stage typically lasts two to nine months.</li> <li>Frozen stage. Pain may lessen during this stage. However, the shoulder becomes stiffer. Using it becomes harder. This stage lasts four to 12 months.</li> <li>Thawing stage. Your ability to move the shoulder begins to improve. This stage typically lasts for five to 24 months.</li> </ul> For some people, the pain worsens at night, sometimes disrupting sleep. The two main goals of treatment are to increase motion and to decrease pain. Johns Hopkins Medicine says that to increase motion, physical therapy is usually prescribed. The physical therapist moves the patient’s arm to stretch the capsule. Heat, ultrasound or electrical stimulation may be used as part of the therapy. Occasionally, steroid injections in the joint or the bursa may be indicated. Steroids like prednisone, taken by mouth, may be given to help decrease the inflammation and reduce pain. Avilla explains that physical therapists demonstrate to patients how they can do manual stretching at home, as well. “If the PT doesn’t reach the desired goal, arthroscopic surgery usually comes next,” she says. “The surgeon cleans out adhesions, manipulating the shoulder manually. “Additional physical therapy sessions follow very soon after the surgery.” Cleveland Clinic says that shoulder arthroscopy is minimally invasive surgery on your shoulder joint. Surgeons use arthroscopy to access your joints with tiny cameras and tools through small incisions. This allows them to diagnose and treat joint conditions while causing minimal pain and allowing quicker recovery time. If you have unexplained shoulder pain or an injury that needs repair, your provider might suggest arthroscopic shoulder surgery. Medical information website Healthline reports that low-power laser treatment significantly decreased pain after eight weeks of treatment for frozen shoulder, compared with a placebo group. However, there wasn’t a significant improvement in range of motion during the study period. “You should definitely seek attention within a week or two of noticing shoulder pain,” says Avilla. “Keep your shoulder moving. Treat it with anti-inflammatories. But if you don’t see progress, don’t put off seeing your doctor or medical provider.” Margaret Avilla, PA, received a degree from University of Florida Physician Assistant Program. Her office is located at Health First Medical Group Crane Creek, 2222 S Harbor City Blvd., Suite 420, Melbourne 32901. Call 321-768-9914 for an appointment.