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.
- 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 best 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 works best 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 superior; 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.
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
Research cited on this page
- Hand C, Clipsham K, Rees JL, Carr AJ. Long-term outcome of frozen shoulder. J Shoulder Elbow Surg. 2008;17(2):231-236. PubMed
- 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
- 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
- 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
- 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
- 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
- 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
Medically reviewed by Andrew P. Dold, MD, FAOA, FAAOS, FACS, FRCSC. This page is general information, not medical advice. Individual results vary.
