BY THE OPTIMIST DAILY EDITORIAL TEAM

Imagine reaching behind your back to hook your bra or grabbing something from a high shelf, only to feel a sharp, persistent pain in your shoulder. At first, it seems minor, but over time, the discomfort worsens until moving your arm feels nearly impossible. This frustrating and painful condition is known as frozen shoulder—or adhesive capsulitis—and it is far more common than many people realize.

“I see at least one patient a day who has frozen shoulder, and most have never heard of it before,” says Sara Edwards, MD, an orthopedic surgeon at the University of California San Francisco. Despite its prevalence, especially in women over 40, frozen shoulder remains an under-discussed condition. Here’s what you need to know to recognize it early and take steps toward recovery.

So, what is frozen shoulder?

Frozen shoulder occurs when the joint capsule—the connective tissue surrounding the shoulder—becomes inflamed and thickened. Over time, bands of scar tissue form, and the lubricating synovial fluid that helps shoulder movement diminishes. “It’s like little cobwebs forming in the joint,” Dr. Edwards explains. The result? Extreme stiffness and pain that can last for months or even years.

There are two types of frozen shoulder:

Primary frozen shoulder: This develops without an obvious cause and is most common in middle-aged women.

Secondary frozen shoulder: This occurs after an injury or surgery that prevents the joint from moving properly, leading to immobility and eventual stiffness.

Who is at risk?

Although anyone can develop frozen shoulder, certain groups are more susceptible. Around five percent of the population will experience it at some point, but women between 40 and 60 are four times more likely to be affected than men. “We do have estrogen receptors in our joints, and estrogen has anti-inflammatory effects,” says Dr. Edwards. The drop in estrogen levels during perimenopause could explain why frozen shoulder becomes more common at this stage of life.

Other risk factors include diabetes and thyroid disorders. The exact connection is unclear, but experts suspect that increased inflammation associated with these conditions plays a role.

The three phases of frozen shoulder

Frozen shoulder progresses through three distinct stages, each lasting several months to years:

1. The freezing stage: Pain is the first sign. It typically starts as a dull ache and worsens with movement, especially when reaching overhead or behind the back. Nighttime pain is also common. This phase can last anywhere from six weeks to nine months.

2. The frozen stage: The shoulder becomes increasingly stiff, making simple tasks—like putting on a shirt or washing your hair—challenging. While pain may lessen, mobility remains severely restricted. This stage often lasts four to six months.

3. The thawing stage: Movement gradually returns, though recovery can take anywhere from six months to two years. “The thaw can feel slow—like an iceberg melting,” Dr. Edwards notes.

How is frozen shoulder diagnosed and treated?

Diagnosing frozen shoulder usually involves a physical exam and symptom evaluation. Doctors often order an X-ray to rule out other conditions like arthritis, but the main diagnosis comes from assessing movement limitations. “A hallmark of frozen shoulder is that both you and your doctor will struggle to move the joint,” Dr. Edwards says.

Fortunately, most cases improve with non-invasive treatments. The earlier you address frozen shoulder, the better your chances of recovery.

Treatment options:

Pain management: Over-the-counter anti-inflammatory medications like ibuprofen or naproxen can help.

Physical therapy: Gentle stretching and mobility exercises are key. “Moving within your range of motion every day can prevent further stiffness,” says Gabriella Ode, MD, a sports medicine specialist at the Hospital for Special Surgery in New York City.

Cortisone injections: If pain prevents movement, a steroid injection can provide relief and enable physical therapy.

Hydrodilation: In some cases, injecting sterile water or saline into the joint capsule can create space and improve movement.

Surgery: As a last resort, minimally invasive procedures can release tight spaces in the joint capsule.

Why movement matters

A common mistake is avoiding movement out of fear of pain. “So many patients come in already wearing a sling they bought at the drugstore,” says Dr. Edwards. “But that actually makes things worse.” Keeping the joint moving—even within a limited range—is essential for preventing further stiffness.

For people like Hillary Jackson, a dance teacher who developed frozen shoulder at 48, staying active was critical. “I wanted to move in a joyful way again,” she recalls. By modifying her dance practice and working with a physical therapist, she gradually regained mobility.

Frozen shoulder can be frustrating and painful, but the good news is that with time and the right approach, recovery is possible. If you suspect you have frozen shoulder, seek medical advice early to prevent long-term stiffness. While there is no overnight fix, staying proactive can make daily life easier as your shoulder slowly regains mobility.