What to expect when you have 'frozen shoulder'

Q: What exactly is a frozen shoulder and can I do anything to speed up the healing process?

A: Everyday, temporary shoulder aches and stiffness are common. Frozen shoulder is different. The shoulder starts to ache, particularly when you move it. Lifting a pan from the stovetop, brushing your hair, scratching your back - they all hurt. So you move your shoulder less. The pain and mobility become substantially worse over time. The condition usually affects just one shoulder.

Pain and loss of mobility of a shoulder can be caused by other conditions, too. Arthritis of the shoulder or an infection in the shoulder joint, for example, can cause similar symptoms.

What is frozen shoulder?

The bones, ligaments, and tendons that make up your shoulder joint are wrapped in a capsule of connective tissue. Frozen shoulder occurs when this capsule thickens and becomes inflamed.

The inflammation and thickening of the shoulder capsule often results from shoulder injury or surgery. A common type of shoulder injury that can lead to frozen shoulder is a tear in the rotator cuff.

Your risk also increases if you have any of several other underlying medical conditions. Examples include diabetes, various autoimmune diseases, or conditions that cause you to use the shoulder less, such as a stroke or Parkinson's disease.

The trademark symptoms include pain and worsening stiffness. At first, the shoulder is painful, but range of motion is still good. As the condition progresses, range of motion begins to decrease. By the time the shoulder eventually becomes "frozen," much of the pain has resolved, but you have difficulty moving your shoulder at all.

The good news is that frozen shoulder resolves on its own - but at a glacial pace. The entire cycle from early symptoms to recovery can last from nine months to two years.

Frozen shoulder has three stages: freezing, frozen and thawing. Here are some things you can do at each stage to move your recovery along, or at least ease discomfort.

Freezing:

This is the slow, gradual buildup of pain and stiffness. Over time, you notice the shoulder losing more of its range of motion as the capsule becomes thicker. During this period, the inflamed shoulder can be quite painful. Occasional steroid injections can help ease the discomfort, but may not speed recovery. Over-the-counter pain relievers, such as acetaminophen (Tylenol) and ibuprofen (Advil), also can help.

Frozen:

The pain begins to lessen, but your range of motion is the most limited. It is still hard to lift your arm overhead. And you often have difficulty with everyday movements, like dressing or reaching into your back pocket. In some cases, arthroscopic surgery may help loosen the joint capsule so it can move more freely.

Thawing:

Stiffness goes away as the shoulder begins to heal. This is when you begin stretching exercises and formal therapy to help restore flexibility and range of motion.

The good news? Once your shoulder heals, frozen shoulder seldom returns.

• Dr. Komaroff is a physician and professor at Harvard Medical School. For questions, go to AskDoctorK.com.