Frozen shoulder (adhesive capsulitis) is a condition in which the capsule around the shoulder thickens and tightens, causing pain and marked loss of movement in every direction [1][2]. Most people improve by themselves within months to a few years; pain control, a cortisone injection in the early painful phase and regular stretching are enough for most, and surgery is rarely needed [1][2][3].
What happens in the shoulder?
The shoulder joint is wrapped in a capsule of connective tissue. In frozen shoulder this capsule first becomes inflamed, then thickens and stiffens, and scar-like adhesions form inside it; the joint's inner volume shrinks so the arm cannot move normally [1][2].
The typical feature is that the shoulder is restricted both when you try to lift the arm yourself and when someone else (for example the doctor) moves it. This separates frozen shoulder from tendon-related pain, where the shoulder hurts but can usually still be moved passively [2].
The three stages
The condition typically goes through three overlapping stages [2]:
- Freezing: pain steadily increases and movement is lost; about 6 weeks to 9 months
- Frozen: pain may ease but stiffness continues and makes daily tasks hard; about 4 to 6 months
- Thawing: movement slowly returns; about 6 months to 2 years
Symptoms
Symptoms start slowly and become clear over weeks [1][2]:
- Shoulder pain, especially pain that is worse at night and interrupts sleep
- Stiffness that makes it hard to raise the arm, take it out to the side or reach behind
- Difficulty dressing, combing the hair or reaching a back pocket
- Restriction of both active and passive movement
Why does it happen?
The exact cause is unknown; inflammation in the tissues around the joint is thought to tighten and shrink the capsule, and it often starts without a clear injury [1]. The risk is higher between 40 and 60 and in women; it is markedly higher in diabetes; thyroid disease, Parkinson's disease and heart disease also raise it, as does keeping the shoulder still for a long time after an injury, fracture or operation [1][2].
Diagnosis
Diagnosis is mostly made from history and examination: how far you can lift the arm yourself is compared with how far it can be moved for you; in frozen shoulder both are restricted [2]. An X-ray does not show the capsule but is requested to exclude other bone problems such as arthritis. MRI or ultrasound can be used if a soft tissue problem such as a rotator cuff tear is suspected [2].
Treatment
The aim is to control pain and keep or regain movement while the condition runs its course; most people improve without surgery [1][2].
- Painkillers and anti-inflammatory medicines; avoiding very painful movements early on [1]
- A cortisone injection into the joint: in the first year of the disease an injection gave better short-term results for pain and function than other treatments, and the benefit increases with home exercises [3]
- Physiotherapy and home exercises: gentle stretching and range-of-movement exercises are the foundation; according to a Cochrane review they may not relieve symptoms as quickly as an injection in the first weeks, but differences at 6 to 12 months are small [4]
- Hydrodilatation: fluid is injected into the joint to stretch the capsule; it may give short-term improvement and its long-term place is not yet clear [2][5]
When is surgery considered?
If marked stiffness continues despite months of non-surgical treatment, moving the shoulder under general anaesthetic (manipulation) or releasing the tight capsule arthroscopically (keyhole) can be considered; physiotherapy continues afterwards [2].
How long does it last?
Frozen shoulder recovers slowly; it can take months or even years, but pain and stiffness usually pass in the end [1]. The whole course can last up to three years in some patients [2]. Physiotherapy programmes usually last at least 6 weeks [1]. After surgery total recovery is usually 6 weeks to 3 months [2].
Forceful movements that clearly increase pain are avoided, while the shoulder is kept moving with gentle exercises; once taught by a physiotherapist, exercises can be done regularly at home [1].
What should not be put down to frozen shoulder
Frozen shoulder develops slowly; the following may suggest a different and more serious problem and need medical help straight away [6]:
- Sudden or very severe shoulder pain
- Not being able to move the arm at all
- A change in the shape of the shoulder or marked swelling
- Tingling, numbness or the arm feeling hot or cold
- Pain that started after a fall or blow
- Fever or general weakness with shoulder pain
- Chest pain or pressure, breathlessness or sweating with shoulder or arm pain (especially in the left arm): this can be a sign of a heart attack; call emergency services immediately (112 in North Cyprus and Türkiye) [7]
Frequently asked questions
- Does frozen shoulder go away by itself?
- In most patients yes; it can take months or even a few years. Treatment helps you get through the period with less pain and better function [1][2].
- How long does it last?
- The freezing, frozen and thawing stages together usually take one to three years; it varies from person to person [2].
- Is it linked to diabetes?
- Yes; the risk is markedly higher in people with diabetes, and the reason is not fully known [1][2].
- Does a cortisone injection help?
- In the early painful phase it has been shown to reduce pain and ease movement in the short term; the best results come with home exercises [3][4].
- Is surgery needed?
- Rarely; it is considered if stiffness continues despite months of suitable treatment [2].
At our clinic we first work out which stage your shoulder is in: in the early, very painful phase we put pain first, in the stiff phase movement.
Sources
- Frozen shoulder. NHS (nhs.uk), 2024. nhs.uk
- Frozen Shoulder. American Academy of Orthopaedic Surgeons (OrthoInfo), n.d.. orthoinfo.org
- Comparison of Treatments for Frozen Shoulder: A Systematic Review and Meta-analysis. JAMA Network Open (Challoumas D, et al.), 2020. pubmed.ncbi.nlm.nih.gov
- Manual therapy and exercise for adhesive capsulitis (frozen shoulder). Cochrane Database of Systematic Reviews (Page MJ, et al.), 2014. pubmed.ncbi.nlm.nih.gov
- Efficacy of hydrodilatation in frozen shoulder: a systematic review and meta-analysis. British Medical Bulletin (Poku D, et al.), 2023. pubmed.ncbi.nlm.nih.gov
- Shoulder pain. NHS (nhs.uk), 2023. nhs.uk
- Heart attack. NHS (nhs.uk), 2026. nhs.uk
This article is general information and does not replace an examination or imaging. If you have symptoms, see a doctor.
More in this area
- Bursitis: what is it, what causes it? Elbow bursitis, symptoms and treatment
- Broken collarbone (clavicle fracture): sling or surgery?
- Shoulder pain and rotator cuff problems: is surgery needed?
- Calcific tendinitis of the shoulder: why it happens and how it is treated
- Dislocated shoulder: what happens after it is put back, and is surgery needed?
- Shoulder pain: what causes it, what helps and who to see
- Tendinitis (tendon inflammation): what causes it and what helps it settle?
- Tennis elbow: what do steroid injections, PRP and surgery add?