Firstly, "frozen shoulder" itself is a misnomer. It means nothing more than a stiff shoulder. There are numerous reasons for a stiff shoulder. These could be largely degenerative - due to the rotator cuff muscles becoming weak and inflamed, a tear of the ligaments, or nerve compression which could render the rotator cuff or serratus anterior muscle weak or incompetent. A more precise diagnosis as a cause of the stiff shoulder needs to be made. The term "frozen shoulder" is now considered outdated.
In the absence of a tear of the muscle (rotator cuff) or ligaments (labrum), rehab is usually the first choice of treatment. We practice a fairly aggressive rehab program without any heat modality. At our clinic, we advise a two-week supervised phase I rehab program followed by a 4-week phase II home program. A majority of the patients are cured by this time.
In the past and more conservative practices, patients were advised to grin and bear the stiff shoulder for a year after which it was alleged that it would settle down.
If the improvement is not perceived at the end of two weeks, patients are best advised to undergo an MRI scan to rule out alternative pathology which could be more serious in nature such as either a rotator cuff tear (in the elderly) or in extreme cases even malignancy of the tissues around the shoulder.
