What's Behind Frozen Shoulder in Cold Months?

Frozen shoulder (adhesive capsulitis) occurs when the lining of your shoulder joint thickens and stiffens, severely limiting your ability to move your arm, with the condition typically resolving over 12 to 18 months through predictable freezing, frozen, and thawing stages.

I'm Dr. Rob Letizia, PT, DPT, owner of Spectrum Therapeutics in Wayne, NJ. "Why does my shoulder feel so much worse now that it's cold outside?" This question comes up constantly during Wayne's winter months.

And while cold weather doesn't actually cause frozen shoulder, winter has a way of making existing shoulder problems more noticeable. Suddenly you're struggling to put on a heavy coat, reach for a seatbelt through layers of clothing, or scrape ice off your windshield.

At Spectrum Therapeutics of NJ, I see a noticeable uptick in frozen shoulder patients during winter. Some are newly diagnosed. Others have been dealing with progressive stiffness and finally reach a breaking point when seasonal demands expose how limited their shoulder has become.

Can Frozen Shoulder Really Be Managed During the Long Recovery?

A patient named Linda from Wayne came to see me last January at her breaking point. She'd been dealing with shoulder stiffness for about four months. But it was winter that exposed how bad things had gotten.

"I couldn't put on my coat this morning," she told me. "I had to have my husband help me. I feel like I've aged twenty years."

Her evaluation revealed classic frozen shoulders. She'd lost significant external rotation. Couldn't reach behind her back. The pain was disrupting her sleep.

She was in the transition between the freezing and frozen stages.

"I need you to fix this," she said. "I have grandchildren I can't even pick up."

I was honest with her about what to expect. "I can't cure this in a few sessions. Frozen shoulder takes 12 to 18 months to resolve. But I can help you manage the pain, maintain function in your neck and upper back, and guide you through each stage so you don't lose more than necessary."

We worked together for eight months. Some weeks were about pain management and gentle mobility. Others focused on more aggressive stretching as her shoulder entered the thawing phase.

By month ten, after her shoulder rehabilitation, she was putting on her own coat. By month fourteen, she was picking up her grandchildren again.

"It was a long road," she told me at her last visit. "But having someone explain what was happening and adjust treatment as things changed made it bearable. I didn't feel like I was just waiting and hoping."

That's what proper frozen shoulder management looks like. Not a quick fix, but guided support through a predictable but lengthy recovery.

Let me explain what's actually happening with this condition and what we can do about it.

What Causes Frozen Shoulder?

The shoulder joint is surrounded by a capsule. A thin lining that's normally supple and flexible, almost like silk. In frozen shoulder, this capsule inexplicably transforms.

It thickens and stiffens until it resembles leather or rawhide. This change restricts movement in all directions.

The frustrating truth is that frozen shoulder usually develops for no apparent reason. It simply happens. While it can follow an injury, the majority of cases arise spontaneously without any clear trigger.

Certain factors increase your risk: age (most common in middle-aged adults 40-60), gender (more prevalent in females), diabetes (particularly when poorly controlled), and thyroid conditions (especially hypothyroidism that isn't well managed).

One important distinction: not all stiff shoulders are frozen shoulders. Stiffness after an injury is common. But it doesn't always involve the same capsular changes seen in true adhesive capsulitis.

This is why proper diagnosis matters. At Spectrum Therapeutics of NJ, we differentiate between conditions that might look similar but require different treatment approaches.

How Do You Recognize the Symptoms?

Frozen shoulder typically progresses through a predictable pattern. Though the timeline varies between individuals.

Stage 1: Freezing (2-9 months) Pain develops gradually, often for no apparent reason. You might feel it from the top of your shoulder down your arm. The pain can be quite pronounced, especially at night.

Stiffness begins creeping in.

Stage 2: Frozen (4-12 months) Pain may actually decrease during this phase. But stiffness becomes the dominant problem. Your range of motion is significantly limited in multiple directions.

Stage 3: Thawing (5-24 months) Motion gradually returns. The shoulder slowly loosens up over months.

The functional limitations are often what bring patients to my Wayne clinic. Common complaints include can't wash or style hair, difficulty reaching for a seatbelt, trouble getting dressed (especially with sleeves), unable to reach overhead or behind the back, and pain that disrupts sleep.

Linda from Wayne couldn't put on her coat one January morning. That's when she knew something was seriously wrong.

Winter makes these limitations more apparent. Heavy coats require more shoulder mobility to put on. Cold weather causes muscles to tighten, which can intensify existing restrictions.

Seasonal activities like shoveling snow or scraping windshields demand arm movements that a frozen shoulder simply cannot perform.

How Do We Diagnose Frozen Shoulder?

Diagnosis relies primarily on your history and physical examination. Along with imaging to rule out other conditions.

During your evaluation, I'll ask about how and when your symptoms started. What activities are affected. How the problem has progressed.

The characteristic pattern of pain followed by stiffness is a strong indicator.

The physical examination reveals limited motion in multiple directions. A key early sign is loss of external rotation. The ability to rotate your arm outward with your elbow at your side.

I compare your affected shoulder to your unaffected one to quantify the restriction.

Linda's evaluation revealed classic frozen shoulder. Significant loss of external rotation and inability to reach behind her back.

X-rays are important but serve a specific purpose: ruling out arthritis. In true frozen shoulder, the X-ray appears normal because the problem is in the soft tissue capsule. Not the bones or joint surfaces.

Misdiagnosing arthritis as frozen shoulder (or vice versa) leads to inappropriate treatment. This is why proper imaging matters.

What Treatment Options Actually Help?

Here's the honest truth about frozen shoulder treatment: no single approach works perfectly for everyone. Management is tailored to each patient's symptoms, stage of the condition, and response to interventions.

Time Is the Most Reliable Treatment

The body typically resolves frozen shoulder on its own over 12 to 18 months. This is the only guaranteed aspect of the condition. Your symptoms will evolve and improve throughout this window.

Though it feels painfully slow when you're living through it.

Physical Therapy for Symptom Management

Physical therapy doesn't cure frozen shoulder in four or five sessions. Anyone who promises that is overselling.

What PT does accomplish is significant: alleviating associated pain, maintaining mobility in surrounding joints like the neck and upper back, improving posture to reduce compensatory strain, providing guided stretching that doesn't aggravate the condition, and teaching you how to manage symptoms at home.

Linda and I worked together for eight months. Adjusting treatment as her shoulder progressed through stages.

At Spectrum Therapeutics of NJ, we work with frozen shoulder patients throughout their recovery journey. The approach evolves as the condition moves through its stages.

Medications for Pain Control

Over-the-counter medications help manage pain but don't change how long the condition lasts. Acetaminophen and anti-inflammatory drugs work better together than either alone. They make the waiting period more tolerable.

Cortisone Injections

Injections can provide significant relief. Particularly when placed directly into the joint. They're most helpful during the painful freezing phase.

The relief is temporary. But it can make physical therapy more productive.

Hydrodilation

This procedure involves injecting fluid under pressure to stretch the tight capsule. Think of it like stretching out a balloon. It's an option for persistent cases that haven't responded to other conservative measures.

Surgical Intervention

Surgery is reserved for severe cases. Cases that have been significantly debilitating for approximately 18 months without improvement from other treatments.

Manipulation under anesthesia involves the surgeon carefully moving the shoulder while you're asleep to stretch and tear the thickened capsule. Intensive physical therapy immediately follows to maintain the motion gained.

Arthroscopic capsular release uses a camera and instruments inserted into the joint. To precisely release the tight tissue before manipulation. This is generally considered the preferred surgical approach.

What's the Long-Term Outlook?

Despite how miserable frozen shoulder feels while you're experiencing it, the long-term prognosis is excellent. The vast majority of patients recover fully. Less than 5% still have significant problems three years after onset.

Most patients are successfully managed by their primary care physician and physical therapist. Without ever needing surgical consultation.

At Spectrum Therapeutics of NJ, we help patients navigate each stage. Adjusting treatment as the condition evolves.

One note on recurrence: frozen shoulder doesn't come back in the same shoulder. However, about 20% of people develop it in their opposite shoulder at some point. This risk is higher for individuals with poorly controlled diabetes or thyroid conditions.

How Do You Manage Frozen Shoulder Through Winter?

Winter presents specific challenges for frozen shoulder patients in Wayne NJ. Here's how to cope.

Dress in layers with loose-fitting outer garments that don't require significant shoulder mobility to put on. Consider coats with zippers rather than pullovers.

Warm up before activities especially anything involving arm movement. Cold muscles make restricted shoulders feel even stiffer.

Modify cold-weather tasks like snow removal. Use a snow blower if possible. Or have someone else handle heavy shoveling. If you must shovel, push rather than lift and throw.

Keep your home warm. Cold environments cause muscle tightening that exacerbates stiffness.

Maintain your exercise routine through the winter months. Reduced activity leads to additional stiffness. Beyond what the frozen shoulder itself causes.

Your Frozen Shoulder Questions Answered

Does cold weather cause frozen shoulder?

No. Despite the name, frozen shoulder isn't caused by cold temperatures. The term refers to the stiffness and "frozen" feeling of the joint. However, cold weather can make symptoms feel worse by causing muscle tightening and making the limitations more apparent during winter activities. Linda from Wayne's limitations became obvious when she couldn't put on her winter coat.

How long does frozen shoulder last?

The natural course of frozen shoulder is typically 12 to 18 months from onset to resolution, though some cases extend to 24 months. Linda from Wayne started seeing significant improvement around month ten and was fully functional by month fourteen. The condition progresses through freezing, frozen, and thawing stages, with symptoms evolving throughout. Physical therapy doesn't shorten this timeline dramatically but helps manage symptoms and maintain function.

Can physical therapy cure frozen shoulder?

Physical therapy doesn't cure frozen shoulder, but it plays an important role in managing symptoms, maintaining surrounding joint mobility, and guiding appropriate stretching. Linda from Wayne worked with me for eight months. Having someone explain what was happening and adjust treatment as things changed made the lengthy recovery bearable. At Spectrum Therapeutics of NJ, we adjust treatment as patients move through different stages of the condition. Most patients benefit significantly from supervised care throughout their recovery.

Will frozen shoulder come back after it heals?

Frozen shoulder does not recur in the same shoulder. However, approximately 20% of people develop the condition in their opposite shoulder at some point. This risk is higher for individuals with poorly controlled diabetes or hypothyroidism. Managing these underlying conditions may reduce the likelihood of developing frozen shoulder on the other side.

What can I expect from physical therapy for frozen shoulder?

Physical therapy for frozen shoulder is a journey, not a quick fix. Linda from Wayne worked with me for eight months as her condition progressed through stages. Early on, we focused on pain management and gentle mobility. As she entered the thawing phase, we became more aggressive with stretching. By month ten, she was putting on her own coat again. At Spectrum Therapeutics of NJ, we adjust treatment as your condition evolves. What works in the freezing stage is different from what helps during thawing. The goal is managing symptoms and maintaining function throughout the 12 to 18 month recovery process.

Ready to Address Your Frozen Shoulder?

Living with frozen shoulder is frustrating, but you don't have to navigate it alone. Proper management makes the months-long recovery significantly more tolerable and helps you maintain function through each stage.

Schedule an evaluation at Spectrum Therapeutics of NJ, 601 Hamburg Turnpike, Suite 103, Wayne NJ. Call (973) 689-7123 or book online. We'll confirm your diagnosis, rule out other conditions, and develop a plan to get you through this.

See you in the clinic,

Dr. Rob Letizia