How Is Frozen Shoulder Treated?
Our specialist, Dr. Michael K. Shindle, manages frozen shoulder symptoms with targeted exercises and anti-inflammatory medication such as ibuprofen and naproxen. He may also recommend steroid injections along with heat or ice therapy to reduce discomfort and restore movement.
In severe cases, our board-certified surgeon, Dr. Michael K. Shindle, may perform procedures such as manipulation under anesthesia or arthroscopic capsular release to remove tight scar tissue. After the procedure, he will guide you through a structured recovery plan, including range-of-motion exercises, to restore strength, improve flexibility, and support long-term recovery. Call 855-321-6784 to book your appointment with our surgeon at Total Orthopedics and Sports Medicine in West Orange.
What Is the Best Treatment for Frozen Shoulder?
Corticosteroid injections and gentle stretching exercises, such as pendulum swings and wall crawls, help improve movement in patients with frozen shoulder. In fact, an NIH clinical study reports that intra-articular steroid injection used with exercises improves pain and disability. In this research, 52 patients were divided into two groups. One group received exercises alone, while the other group received both steroid injections and exercises. After analysis, the study showed that the second group had significant improvement in movement at 6 weeks and 3 months.
Moreover, Dr. Michael K. Shindle recommends massage therapy along with heat and cold packs to relieve pain. He may also perform joint mobilization, soft tissue manipulation, and guided passive stretching. These options help reduce pain and restore shoulder mobility. However, if symptoms do not improve, he may guide you through advanced surgical options such as Manipulation Under Anesthesia (MUA) and arthroscopic capsular release.
Here are some other treatment options that Dr. Michael K. Shindlemay recommends to improve movement and reduce shoulder discomfort:
Hydrodilatation (Joint Distension)
Hydrodilatation is a minimally invasive procedure that helps improve movement by gently stretching the tight joint capsule. During this procedure, a specialist uses ultrasound or X-ray to place fluid into the affected shoulder joint. The injected fluid includes saline (salt water for stretching), a local anesthetic, and a corticosteroid. Other than that, this process usually takes 15–30 minutes and helps loosen stiff tissue to improve movement.
TENS Units
In some cases, the doctor may recommend TENS units to help reduce pain and improve movement. This device sends low-voltage electrical currents (mild signals) through the skin to target the painful area. These signals help release endorphins (natural pain-relieving chemicals) and block pain signals. As a result, this therapy reduces muscle tension, improves joint mobility, and helps you perform daily activities more comfortably.
Acupuncture
According to NIH research, acupuncture can help reduce pain and improve the range of motion in patients with frozen shoulder. Similarly, a ScienceDirect study reports that acupuncture can support long-term recovery. In this trial, patients received 18 sessions of electroacupuncture over 6–9 weeks and were followed up at 1, 3, and 6 months to track progress. After follow-up, the study reports lasting pain relief and improved passive and active range of motion.
What Causes Frozen Shoulder?
Frozen shoulder develops due to prolonged inactivity, diabetes, or thyroid problems. This condition is also linked to shoulder immobilization after surgery, recent shoulder injury, and severe arm fractures that limit movement. Beyond that, heart disease, Parkinson’s disease, and age over 40, especially in women, increase the risk of stiffness in the shoulder joint. Here is how these factors directly affect the shoulder and limit movement over time:
Prolonged Inactivity (Immobilization)
Prolonged inactivity or immobilization (such as wearing a sling or a stroke) can lead to frozen shoulder (adhesive capsulitis). This happens because the joint capsule (the tissue surrounding the joint) thickens and tightens, which limits movement. Over time, scar tissue (adhesions) forms within the joint and reduces flexibility. At the same time, joint fluid (synovial fluid that helps smooth movement) decreases, leading to increased stiffness and discomfort.
Thyroid Disorders
According to NIH research, hypothyroidism increases the risk of frozen shoulder by 2.69 times. Beyond this, the following thyroid conditions also increase inflammation and lead to frozen shoulder:
- Benign Thyroid Nodules: These are non-cancerous growths in the thyroid gland that can affect hormone balance and raise the risk of frozen shoulder.
- Hashimoto’s Thyroiditis: This autoimmune condition causes long-term inflammation that can lead to joint stiffness.
Rotator Cuff Tear
Rotator cuff injuries, such as tears, tendinitis, or impingement (pinching of tendons), can cause inflammation within the shoulder joint. In such cases, you may limit daily activities, which restricts normal joint movement. This process also leads to adhesion formation and causes stiffness.
Heart Disease
If you have heart disease, it can reduce blood flow to the shoulder joint, which may lead to long-term inflammation (swelling within tissues). For instance, Coronary Artery Disease (CAD) impairs tissue health and slows healing in the shoulder area. Similarly, high blood pressure and high cholesterol can reduce vascularity, leading to shoulder stiffness and chest discomfort over time.
Parkinson’s Disease
Parkinson’s disease can limit smooth joint motion and lead to ongoing tightness in the shoulder joint. As this stiffness increases, decreased movement (akinesia – reduced ability to move) limits daily shoulder activity. In such cases, you may not swing your arm naturally while walking, which can lead to increased discomfort over time.
Moreover, postural changes such as forward shoulder tilt and hyperkyphosis (rounded upper back) can disturb normal joint function and place extra stress on ligaments. In fact, the National Library of Medicine reports that around 40% to 95% of Parkinson’s disease patients experience shoulder pain and discomfort.
Age and Gender
Frozen shoulder, called adhesive capsulitis, is most common in people aged 40 to 65. It is also common in women at menopause because lower estrogen levels (a hormone that supports tissue health) can increase inflammation and affect connective tissues. At the same time, natural aging reduces tissue elasticity (ability to stretch) and limits shoulder movement.
Why Is Frozen Shoulder More Common in Diabetic Patients?
Diabetes increases the risk of frozen shoulder because high blood sugar levels (hyperglycemia) affect the connective tissue through glycosylation (sugar binding to proteins). As this process continues, collagen (a supporting protein in tissues) thickens and becomes less flexible, leading to stiffness in the shoulder. Diabetes also damages small blood vessels and affects the health of the joint capsule. As a result, ongoing inflammation and reduced movement from nerve damage can lead to severe shoulder stiffness.
In fact, NIH research found that about 11% of people with diabetes develop frozen shoulder, with a higher rate in females (13.13%) than males (9.95%). The risk of frozen shoulder also increases with longer duration of diabetes. For example, about 15.24% of people who have had diabetes for more than 10 years develop frozen shoulder. In addition, poor blood sugar control increases the risk of frozen shoulder, with 21.11% of patients affected. In comparison, people with better sugar control show a lower occurrence of this condition.
How Do Doctors Diagnose Stiff Shoulders?
To diagnose frozen shoulder, Dr. Michael K. Shindle reviews your medical history and performs a detailed physical examination. If needed, he orders imaging tests such as X-rays or MRI scans to identify frozen shoulder and other problems like joint damage or tendon injury. During the examination, he may also perform the following tests to confirm the shoulder condition and assess movement limitations:
Range of Motion Assessment:
Our doctor, Dr. Michael K. Shindle, inspects the shoulder from the front, side, and back to check alignment, muscle loss, and visible changes. Then, he performs palpation or physical exam (gentle pressing) to rule out pain from the acromioclavicular joint (joint at the top of the shoulder). After this, we assess the shoulder’s range of motion (ROM) through the following tests to identify movement limits and confirm stiffness patterns:
- Passive External Rotation (Gold Standard Test): The doctor moves your arm outward to check rotation and the passive range of motion.
- Active/Passive Elevation and Abduction: Initially, you lift your arm yourself (active range). Then the doctor moves your arm (passively). If he notices similar restrictions in both active and passive range of motion, it points to a stiff shoulder.
Neer Test
After the assessment, if the doctor notices signs of subacromial impingement syndrome (pinching of shoulder tissues), he may perform the Neer test. In this test, you stand or sit with your arm relaxed at your side, while the doctor holds your shoulder to keep it stable. Then, he turns your arm inward (thumb pointing down) and gently lifts it forward and upward. If this movement causes pain or a sharp pinch, it points to impingement.
In some cases, Dr. Michael K. Shindle may use a diagnostic injection to confirm the exact cause of pain. Once frozen shoulder is diagnosed, he designs a personalized treatment plan. As an experienced Orthopedic Consultant of the New York Football Giants, he also guides you through range-of-motion exercises to improve movement and ensure long-term recovery. Call 855-321-6784 today to book your appointment.
Does Heat or Ice Help Reduce Shoulder Pain?
Yes, you can apply heat and cold packs to manage severe pain and discomfort due to frozen shoulder. Heat therapy helps relax muscles and reduce stiffness before exercise. On the other hand, cold packs help reduce pain and inflammation, especially after activity. However, apply heat and cold packs for 10–15 minutes to avoid skin irritation. You should also wrap them in a thin towel or cloth to protect the skin.
Are Steroid Injections Safe for Shoulder Stiffness?
Yes, steroid injections are a safe and effective short-term option for relieving shoulder stiffness, especially in conditions such as adhesive capsulitis and tendonitis. These injections reduce inflammation and help relieve pain, which improves movement in the affected arm. In fact, an NIH survey reports that about 66% of healthcare providers recommend steroid injections to manage pain and improve shoulder movement.
Similarly, another NIH study on 744 patients treated with steroid injections shows a reduction in pain scores by 1.28 cm within 4 to 6 weeks. This improvement continues with a reduction of 1.00 cm at 12 to 16 weeks and 0.65 cm at 24 to 26 weeks. Beyond this, the research found the following clinical outcomes:
- Improved Movement: Better passive rotation, abduction, and flexion across all time periods
- Functional Recovery: ASES scores improved by 12.20 points at 12 to 16 weeks
- Low Complication Rates: 1.78% facial flushing, 0.71% dizziness, 1.07% chest or shoulder pain, and 0.36% nausea
However, the injection effect is temporary because it does not address the underlying shoulder condition. For this reason, doctors recommend exercises such as guided stretching and controlled movement during recovery. These exercises support joint flexibility, restore normal shoulder function, and ensure full recovery over time.
When Is Surgery Needed for Frozen Shoulder?
Our surgeon, Dr. Michael K. Shindle, recommends surgery if you have severe, persistent shoulder pain even after 6 to 12 months of conservative treatment, such as medications and steroid injections. In such cases, surgery helps release the tight shoulder capsule and improves movement in the affected arm. It also helps relieve pain, restore joint function, and support long-term recovery. Here are common surgical options that Dr. Michael K. Shindle may recommend based on your condition and response to previous treatment:
Arthroscopic Capsular Release
Arthroscopic capsular release is a minimally invasive procedure that treats frozen shoulder through small incisions. In this procedure, surgeons use a camera and fine instruments to target specific tight areas and safely release the joint. Then, he cuts the tight shoulder capsule to improve humeral head
movement and reduce stiffness. In some cases, the shoulder is manipulated under anesthesia to ensure a full range of motion. This approach helps you restore joint function and regain motion within 3 to 6 months. In fact, a Springer retrospective study reports the following improvements in shoulder movement and function after arthroscopic capsular release.
- Pain Reduction: NRS pain score reduced to 2.2 after surgery
- Patient Satisfaction: Most patients reported high satisfaction scores (3.7 out of 4)
- Functional Improvement: CMS improved from 36.9% to 99.9 after recovery.
- Mental Health Improvement: Lower anxiety (2.5) and depression (2.2) scores
- Return To Activity: Patients resumed work in 2 months and sports in 2.5 months
- Low Complication Rate: No major surgical complications reported
Open Capsular Release
If you have post-traumatic stiffness or nerve entrapment, our surgeon may recommend open capsular release. This approach allows direct access to dense scar tissue that cannot be safely treated with minimally invasive methods. As a result, the surgeon carefully removes the thickened tissue to improve joint mobility and reduce shoulder clicking. However, open procedures require a larger incision and need extended rehabilitation time.
Arthroscopic Subacromial Decompression
During arthroscopic subacromial decompression, our surgeons remove inflamed tissue and bone spurs to reduce pressure within the shoulder. This step helps relieve shoulder pain caused by tendon compression during movement. In many cases, Dr. Michael K. Shindle combines this procedure with capsular release to treat stiffness simultaneously.
Can Manipulation Under Anesthesia Improve Shoulder Movement?
Yes, manipulation under anesthesia (MUA) can improve shoulder mobility, especially in cases of frozen shoulder. In this procedure, the patient receives general anesthesia, which relaxes the muscles and prepares the joint for movement. Then, the surgeon stabilizes the shoulder blade and carefully moves the arm in controlled directions to target the tight shoulder capsule. After that, he performs forward lifts, rotations, and cross-body movements to release stiffness and improve flexibility.
Moreover, research published in the Journal of Pain and Therapy reports that shoulder manipulation under anesthesia (MUA) improves function faster than medication-based treatment. In this study, 67 patients in the MUA group completed treatment and showed quicker progress in movement and pain relief. Function scores (CMS) also improved by 44 points in the MUA group, compared with 27.09 points in the medication group, over 12 weeks. Beyond this, pain levels and passive movement improved as early as 1 day after the procedure.
How Long Does It Take to Recover From Frozen Shoulder?
According to our experience, most patients with frozen shoulder regain motion within 9 months to over 2 years. The exact recovery time varies and depends on factors like the stage of the condition, the presence of any medical problems, and age. It also depends on daily lifestyle, such as activity level and proper sleep positioning.
Moreover, research by Dr. Michael K. Shindle et al., published in the SAGE Journal, reports that higher levels of inflammation and tissue damage in the shoulder are associated with slower healing. The study also identified specific biological markers (such as MMP-1 and MMP-9) that increase the risk of delayed recovery.
Beyond this, ignoring symptoms or keeping the arm inactive can delay healing and increase stiffness. For this reason, you should follow the following structured routine to support smooth recovery:
- Maintain Proper Posture: Avoid slumping or hunching forward, as this can tighten the shoulder joint. Instead, keep your shoulder blades gently back and down throughout the day to reduce strain.
- Proper Sleeping Positions: You should sleep on your back or unaffected side, using pillows to support the affected arm.
- Continue Using the Arm Gently: Do not completely immobilize the upper arm bone. Use it for daily activities within your comfortable range of motion to prevent further stiffness.
- Pain Management: Take non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) or naproxen (Aleve), to manage pain.
- Prioritize Gentle Stretching: Perform exercises such as pendulum or towel stretches 1–2 times daily, 5–7 days a week.
- Warm Up Before Exercising: Take a warm shower, or use a damp, heated towel on your shoulder for 10–15 minutes before stretching.
Can’t Move Your Shoulder? Book a Consultation with Dr. Michael Shindle in West Orange!
If you have frozen shoulder, you may struggle with daily tasks like reaching overhead, getting dressed, or lifting objects with your affected arm. As symptoms progress, you may experience disrupted sleep and loss of independence, while also worrying about appropriate treatment options to restore normal shoulder function.
At Total Orthopedics and Sports Medicine, our surgeon, Dr. Michael K. Shindle, carefully reviews your activity level and job requirements to choose the best treatment approach. He also guides you through recovery duration, treatment timelines, and expected outcomes to help you make informed decisions about your care. In addition, we accept all major insurance plans and offer self-pay options. Call 855-321-6784 or visit our clinic for personalized frozen shoulder treatment.
FAQs
Can Frozen Shoulder Heal On Its Own Without Treatment?
Yes, frozen shoulder can heal on its own without treatment. However, recovery is slow and may take 12 to 36 months, depending on the severity of the condition and healing response. For this reason, you should consult your doctor for follow-up guided exercises to support recovery and improve movement.
Why Is Shoulder Pain Worse At Night?
You may experience severe shoulder pain at night due to inflammation, gravity, and inactivity during rest. In some cases, poor sleep posture places extra stress on the shoulder joint and surrounding tissues. Beyond that, lower levels of natural anti-inflammatory hormones, such as cortisol, at night can increase pain.
Can Massage Therapy Relieve Frozen Shoulder Symptoms?
Yes, massage therapy can improve blood flow and help reduce pain in frozen shoulder. It also relaxes tight muscles around the joint, which can ease stiffness and improve comfort. However, it does not address the underlying cause of the condition.
Can Frozen Shoulder Affect Both Shoulders At The Same Time?
Yes, frozen shoulder can affect both shoulders simultaneously. This condition occurs more often in patients with diabetes or thyroid disorders due to metabolic and hormonal changes. In such cases, you should consult our doctor, Dr. Michael K. Shindle, to prevent further stiffness and loss of movement.
Do Muscle Relaxants Help With Stiff Shoulders?
Yes, muscle relaxants such as Cyclobenzaprine and Methocarbamol can help reduce pain and ease muscle spasms in stiff shoulders. These medications relax tight muscles around the shoulder and improve the range of motion. In some cases, they may cause dizziness, so use them under medical guidance.
