The 4 Stages of Frozen Shoulder

The 4 stages of frozen shoulder include: pre-freezing, freezing, frozen, and thawing. These terms describe the typical progression of the condition from early symptoms to recovery.

A frozen shoulder, also called adhesive capsulitis, is a very common cause of shoulder pain. Frozen shoulder can take a long time to heal, anywhere from 6 months to 2 years.

This article goes over the four stages of frozen shoulder, how long they typically last, and what you can do to relieve pain. It also discusses the prognosis for someone who has frozen shoulder.

Stage 1: Pre-Freezing (1 month to 3 months)

Pre-freezing describes the earliest stage of frozen shoulder. This is when you first start to notice pain in your shoulder. Many people in this stage will first notice the pain at night while changing positions in bed.

As the condition progresses, you may notice pain when you move your shoulder, especially when raising the arm or reaching behind you. You may also find that you have reduced mobility in that shoulder. It may ache even when you are not using it.

Because motion may be only slightly restricted in this stage, early frozen shoulder can be mistaken for a problem with the rotator cuff.

Stage 2: Freezing (10 weeks to 8 months)

The freezing stage is by far the most painful phase of a frozen shoulder. During this phase, the shoulder capsule is inflamed and can become thickened and stiff. As this happens, shoulder movements become increasingly difficult and painful. 

Stage 3: Frozen (4 months to 12 months)

The third 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 neither the patient or another person can move the shoulder.

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 limited, making activities such as washing hair, hooking a bra, or reaching for a seat belt painful or difficult.

Stage 4: Thawing (5 months to 2 years)

In this phase, the capsule of the shoulder joint has become thickened and stiff, but over time it gradually loosens. It is important to stretch the shoulder capsule, even allowing for some discomfort, in order to ensure the shoulder joint mobility continues to recover. 

Not having the extreme pain associated with the freezing of the joint, and seeing gradual gains in mobility make this phase tolerable, albeit frustrating and long.

Treatment of Frozen Shoulder

Frozen shoulder treatment is almost always best accomplished with physical therapy and stretching of the joint. Anti-inflammatory medications, ice and heat application, and alternative therapies can all be helpful to manage the discomfort. Your healthcare provider may also recommend corticosteroid injections to help reduce inflammation.

Surgery can be an option for treating a frozen shoulder, but it is seldom needed. It is usually only considered if prolonged efforts at therapy have failed to improve symptoms. 

Prognosis

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 quick recovery causes more frustration.

That said, there are steps you can take to speed your recovery and reduce the discomfort of a frozen shoulder. Physical therapy can be beneficial, and your healthcare provider 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.

Summary

Frozen shoulder is a condition that causes severe pain and limited mobility in the shoulder. It progresses through four stages and can take up to two years to completely resolve.

Recovering from a frozen shoulder is a long process, typically requiring ongoing physical therapy. Surgery may be considered if physical therapy doesn't seem to be helping, but this is uncommon.