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Frozen shoulder (adhesive capsulitis) is a painful stiffening of the shoulder caused by inflammation and thickening of the joint capsule. It typically begins with pain, followed by progressive loss of motion, especially the ability to rotate the arm outward, before gradually “thawing.” Dr. Andrew Dold, a board-certified, fellowship-trained sports medicine surgeon in Frisco, Texas, treats frozen shoulder with a conservative-first approach: an injection, plenty of physical therapy and, only when needed, a manipulation or release.

On this page:Who gets it · Stages · Diagnosis · Treatment · Procedures · FAQs · Research
At a glance

  • Most common in middle age (average onset around 53), more often in women and in people with diabetes
  • Most people improve over time, but recovery can take a year or more
  • An early injection (cortisone or PRP) plus a home exercise and therapy program is the foundation of treatment
  • Manipulation under anesthesia, with or without arthroscopic release, is reserved for stiffness that does not improve
  • Surgery is rarely needed

Who gets frozen shoulder?

In a long-term study, the average age at onset was 53 and women were affected about 1.6 times as often as men; 20% eventually had symptoms in both shoulders.1 People with diabetes are about 5 times more likely to develop frozen shoulder, and about 30% of people with frozen shoulder have diabetes, so screening for diabetes is worth considering.2 Frozen shoulder can also follow an injury, surgery or a period of immobilization.

Stages

  • Freezing (painful) stage: increasing pain, often worse at night, with gradual loss of motion
  • Frozen (stiff) stage: pain may ease, but the shoulder is very stiff
  • Thawing stage: motion slowly returns

Diagnosis

Frozen shoulder is diagnosed by examination: both active and passive motion are limited, especially outward rotation, which helps distinguish it from a rotator cuff tear (where passive motion is usually preserved). X-rays rule out arthritis and calcific tendinitis. An MRI is not usually needed unless another problem is suspected.

Treatment: start conservative

Frozen shoulder often improves on its own, but slowly. In a study of 269 shoulders followed for an average of 4.4 years, 59% had normal or near-normal shoulders, 41% had some ongoing symptoms (mostly mild) and 6% had severe pain and loss of function. Patients with the most severe symptoms at the start did worst.1 Treatment aims to speed recovery and control pain. Dr. Dold’s approach:

  • An injection into the shoulder joint with either cortisone or PRP
  • Lots of physical therapy and a daily home stretching program
  • Pain control so that you can keep moving the shoulder

Of all the treatments studied, an early cortisone injection into the joint has the strongest evidence: a 2020 meta-analysis of 65 studies found it was the only treatment with clearly better short-term pain and function, and that adding a home exercise program improved results further. It appears most effective in frozen shoulder of less than a year’s duration.3 PRP is a newer option. A 2024 network meta-analysis found that both cortisone and PRP injections improved pain and function at 12 weeks compared with physical therapy alone, and only PRP improved range of motion, although the authors cautioned that the studies were small and varied.4 A meta-analysis comparing PRP with cortisone found similar improvement at 3 months, with somewhat better internal rotation after PRP.5 Dr. Dold has published a systematic review of PRP6 and will discuss whether cortisone or PRP is the better choice for you.

When the shoulder does not improve

If pain and stiffness persist despite injections and therapy, Dr. Dold may recommend:

  • Manipulation under anesthesia (MUA): while you are asleep, the shoulder is gently moved through its range to stretch and release the tight capsule.
  • Arthroscopic lysis of adhesions and capsular release: through small incisions, the tight capsule and scar tissue are released, usually combined with manipulation.

Physical therapy starts right away after either procedure to keep the motion gained. The UK FROST trial, which randomized 503 patients, compared manipulation, arthroscopic capsular release and early structured physiotherapy with a steroid injection. At one year, all three groups had improved, and none was clinically better than the others; capsular release had more serious complications, and manipulation was the most cost-effective.7 This supports Dr. Dold’s approach of starting with injection and therapy and reserving procedures for patients who do not improve. Open surgery is rarely needed.

More from the research

Here is more of what the research shows about frozen shoulder and its treatment.

Waiting alone may not be enough

Many people improve over time, but a systematic review found little evidence that frozen shoulder always resolves completely on its own. People with diabetes are more likely to develop it and tend to recover more slowly. This is why active treatment, rather than simply waiting, is usually recommended.

Non-surgical options

A cortisone injection outperforms manual therapy and exercise alone in the short term, and specific therapy techniques such as joint mobilization are supported. Hydrodilatation (stretching the capsule with fluid, usually with cortisone) may speed early recovery, although its added benefit is small in some analyses.

When the shoulder stays stiff

The UK FROST trial compared early structured physiotherapy with an injection, manipulation under anesthesia and arthroscopic capsular release. None was clearly better at 12 months, and manipulation was the most cost-effective. Meta-analyses find manipulation and arthroscopic release give similar results, with a higher risk of serious complications after release, so the choice is individualized.

Why see Dr. Dold

  • Board certified by the American Board of Orthopaedic Surgery, with subspecialty certification in Sports Medicine
  • Sports medicine and arthroscopy fellowship at NYU Langone / Hospital for Joint Diseases; orthopedic residency at the University of Toronto
  • Fellow of the American College of Surgeons (FACS), the American Academy of Orthopaedic Surgeons (FAAOS), the American Orthopaedic Association (FAOA) and the Royal College of Surgeons of Canada (FRCSC)
  • Author of a SLAP repair book chapter (Springer, 2017) and research on shoulder suture anchors (KSSTA, 2013)
  • Team physician and surgical consultant to Rugby Canada; has cared for professional athletes from the NFL, NBA, NHL, MLS, PGA Tour and Major League Rugby
  • D Magazine Best Doctors (Collin County), 2019–2026 · Rated 4.9 on Google

Frequently asked questions

How long does frozen shoulder last?

It varies, and recovery can be slow. In a long-term study with an average follow-up of 4.4 years, 59% had normal or near-normal shoulders, while most of the rest had only mild symptoms.1

Is a cortisone shot helpful for frozen shoulder?

Yes. An early cortisone injection into the joint has the strongest evidence for short-term pain relief, especially when combined with a home exercise program.3

Can PRP help frozen shoulder?

Early studies suggest PRP injections improve pain and function similarly to cortisone and may improve motion, but the studies are small.4,5

Will I need surgery?

Rarely. Most patients improve with injections and therapy. Manipulation or arthroscopic release is reserved for stiffness that does not improve, and in a large trial neither was clearly better than structured physiotherapy with an injection.7

Is frozen shoulder linked to diabetes?

Yes. People with diabetes are about 5 times more likely to develop it.2

Can it happen in the other shoulder?

It can. In one long-term study, 20% of patients had symptoms in both shoulders, although no shoulder froze a second time.1

Considering surgery? Read about shoulder arthroscopy in Frisco, the minimally invasive procedure Dr. Dold uses for rotator cuff, labral and biceps problems.

Research cited on this page

  1. Hand C, Clipsham K, Rees JL, Carr AJ. Long-term outcome of frozen shoulder. J Shoulder Elbow Surg. 2008;17(2):231-236. PubMed
  2. Zreik NH, Malik RA, Charalambous CP. Adhesive capsulitis of the shoulder and diabetes: a meta-analysis of prevalence. Muscles Ligaments Tendons J. 2016;6(1):26-34. PubMed
  3. Challoumas D, Biddle M, McLean M, Millar NL. Comparison of Treatments for Frozen Shoulder: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020;3(12):e2029581. PubMed
  4. Berner JE, Nicolaides M, Ali S, et al. Pharmacological interventions for early-stage frozen shoulder: a systematic review and network meta-analysis. Rheumatology (Oxford). 2024;63(12):3221-3233. PubMed
  5. Lum ZC, Guntupalli L, Huish EG. Outcomes of platelet rich plasma injections in the adhesive capsulitis of the shoulder. J Orthop. 2023;48:42-46. PubMed
  6. Dold AP, Zywiel MG, Taylor DW, Dwyer T, Theodoropoulos J. Platelet-rich plasma in the management of articular cartilage pathology: a systematic review. Clin J Sport Med. 2014;24(1):31-43. PubMed
  7. Rangan A, Brealey SD, Keding A, et al. Management of adults with primary frozen shoulder in secondary care (UK FROST): a multicentre, pragmatic, three-arm, superiority randomised clinical trial. Lancet. 2020;396(10256):977-989. PubMed
  8. Wong CK, Levine WN, Deo K, et al. Natural history of frozen shoulder: fact or fiction? A systematic review. Physiotherapy. 2017;103(1):40-47. PubMed
    A systematic review found little evidence that frozen shoulder reliably passes through stages to complete recovery without treatment.
  9. Eljabu W, Klinger HM, von Knoch M. Prognostic factors and therapeutic options for treatment of frozen shoulder: a systematic review. Arch Orthop Trauma Surg. 2016;136(1):1-7. PubMed
    A review found spontaneous recovery is possible and non-surgical programs work for most patients, though diabetes and other risk factors predict a slower course.
  10. Dyer BP, Rathod-Mistry T, Burton C, et al. Diabetes as a risk factor for the onset of frozen shoulder: a systematic review and meta-analysis. BMJ Open. 2023;13(1):e062377. PubMed
    A meta-analysis confirmed that people with diabetes are more likely to develop frozen shoulder.
  11. Tang S, Tan X. Does the intervention for adhesive capsulitis in patients with diabetes differ from that for patients without diabetes?: A systematic review. Medicine (Baltimore). 2024;103(46):e40238. PubMed
    Treatment helped frozen shoulder whether or not patients had diabetes, but results tended to be somewhat worse in people with diabetes.
  12. Page MJ, Green S, Kramer S, et al. Manual therapy and exercise for adhesive capsulitis (frozen shoulder). Cochrane Database Syst Rev. 2014;2014(8):CD011275. PubMed
    A Cochrane review found manual therapy and exercise may not work as well as a cortisone injection in the short term.
  13. Nakandala P, Nanayakkara I, Wadugodapitiya S, et al. The efficacy of physiotherapy interventions in the treatment of adhesive capsulitis: A systematic review. J Back Musculoskelet Rehabil. 2021;34(2):195-205. PubMed
    A review found some physical therapy techniques are strongly supported for pain, motion and function in frozen shoulder, while others are not.
  14. Costantino C, Nuresi C, Ammendolia A, et al. Rehabilitative treatments in adhesive capsulitis: a systematic review. J Sports Med Phys Fitness. 2022;62(11):1505-1511. PubMed
    A review found joint mobilization and radial shock wave therapy appeared effective, while therapeutic ultrasound did not.
  15. Catapano M, Mittal N, Adamich J, et al. Hydrodilatation With Corticosteroid for the Treatment of Adhesive Capsulitis: A Systematic Review. PM R. 2018;10(6):623-635. PubMed
    Hydrodilatation combined with cortisone may speed recovery of pain-free motion, with most benefit in the first 3 months.
  16. Saltychev M, Laimi K, Virolainen P, et al. Effectiveness of Hydrodilatation in Adhesive Capsulitis of Shoulder: A Systematic Review and Meta-Analysis. Scand J Surg. 2018;107(4):285-293. PubMed
    A meta-analysis found hydrodilatation had only a small, clinically insignificant added effect.
  17. Poku D, Hassan R, Migliorini F, et al. Efficacy of hydrodilatation in frozen shoulder: a systematic review and meta-analysis. Br Med Bull. 2023;147(1):121-147. PubMed
    A 2023 meta-analysis found hydrodilatation improved outer rotation in the longer term and may be a lower-cost alternative to manipulation under anesthesia.
  18. Huang YH, Kuo YC, Hsieh LF, et al. Efficacy of Combination Therapy (Hydrodilatation and Subdeltoid Bursa Injection With Corticosteroid, Mobilization, and Physical Therapy) vs Physical Therapy Alone for Treating Frozen Shoulder: A Randomized Single-Blind Controlled Trial, Phase I. Arch Phys Med Rehabil. 2024;105(4):631-638. PubMed
    A randomized trial found a combination of hydrodilatation with cortisone and joint mobilization gave better results than physical therapy alone, lasting at least 6 months.
  19. Schiltz M, Beeckmans N, Gillard B, et al. Randomized controlled trial of suprascapular nerve blocks for subacute adhesive capsulitis. Eur J Phys Rehabil Med. 2022;58(4):630-637. PubMed
    In a randomized trial, three suprascapular nerve blocks were no better than saline injections for subacute frozen shoulder.
  20. Brealey S, Northgraves M, Kottam L, et al. Surgical treatments compared with early structured physiotherapy in secondary care for adults with primary frozen shoulder: the UK FROST three-arm RCT. Health Technol Assess. 2020;24(71):1-162. PubMed
    The UK FROST trial compared early structured physiotherapy with a cortisone injection, manipulation under anesthesia and arthroscopic release; none was clearly better, and manipulation was the most cost-effective.
  21. Zhao Y, Yang T, Feng C, et al. Arthroscopic Capsular Release Versus Manipulation under Anesthesia for Refractory Frozen Shoulder: A Systematic Review with Meta-Analysis. Orthop Surg. 2024;16(7):1517-1529. PubMed
    For frozen shoulder that did not respond to other care, arthroscopic release and manipulation gave similar improvements, but release carried a higher risk of severe complications.
  22. Xiao Y, Tang H, Meng J, et al. Similar outcomes between arthroscopic capsular release and manipulation under anesthesia for frozen shoulder: A meta-analysis. Asian J Surg. 2024;47(10):4287-4294. PubMed
    A 2024 meta-analysis found similar pain and motion outcomes after arthroscopic release and manipulation under anesthesia at 3 to 12 months.
  23. Forsythe B, Lavoie-Gagne O, Patel BH, et al. Efficacy of Arthroscopic Surgery in the Management of Adhesive Capsulitis: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials. Arthroscopy. 2021;37(7):2281-2297. PubMed
    A network meta-analysis found no single treatment better for all outcomes; surgery after failed conservative care ranked highest for motion.
  24. Gallacher S, Beazley JC, Evans J, et al. A randomized controlled trial of arthroscopic capsular release versus hydrodilatation in the treatment of primary frozen shoulder. J Shoulder Elbow Surg. 2018;27(8):1401-1406. PubMed
    In a randomized trial, arthroscopic release gave better shoulder scores at 6 months than hydrodilatation, though both groups improved.
Ready to get it checked? Request an appointment online or call 469-850-0680. Our staff will contact you by phone and text within an hour of your request (during business hours, Monday–Friday, 8 am–5 pm). Walk-in visits are welcome Monday, Wednesday and Friday, 8:30–10:30 am at 6700 Dallas Parkway, Suite 100, Frisco, TX 75034. We see patients from Frisco, Plano, McKinney, Prosper, Little Elm, The Colony, Allen, Dallas and across North Texas. Same-day appointments available. Dr. Dold accepts most major insurance plans, including Medicare and Tricare. Please call 469-850-0680 to confirm your coverage.

Request an AppointmentCall 469-850-0680

Medically reviewed by Andrew P. Dold, MD, FAOA, FAAOS, FACS, FRCSC. Last reviewed October 2026. This page is general information, not medical advice. Individual results vary.