Frozen shoulder: stages, treatment and recovery

Frozen shoulder, or adhesive capsulitis, is a genuine and distinctive condition. The capsule that surrounds the shoulder joint becomes inflamed, thickens and contracts, leaving the shoulder painful and progressively stiff. It is self-limiting, but slow: without treatment the whole process typically takes 12 to 30 months. The right treatment depends on which stage you are in, and getting that right is what makes the biggest difference to how long recovery takes.

The three stages of frozen shoulder

Frozen shoulder progresses through three overlapping stages. The freezing phase, which typically lasts 2 to 9 months, is pain-dominant. Pain builds gradually, is often worst at night, and range of movement starts to reduce. The frozen phase, from 4 to 12 months, is stiffness-dominant. Pain tends to ease but the shoulder loses meaningful range, particularly external rotation. The thawing phase, from 5 to 24 months, is recovery. Range gradually returns, though not always to what it was.

Who gets it?

Frozen shoulder is most common between the ages of 40 and 60, more common in women, and more common in people with diabetes or thyroid disease. It can follow a period of shoulder immobilisation, for example after a fracture or surgery, but often appears without any clear trigger. It is not caused by lifting or a specific injury.

How is it diagnosed?

Frozen shoulder is a clinical diagnosis. The hallmark is loss of both active and passive range in a capsular pattern, with external rotation typically most affected. A physiotherapist will rule out the other things that can mimic it, including rotator cuff pathology, arthritis of the shoulder and referred pain from the neck. Imaging is not routine. It is used when the diagnosis is unclear or when a specific procedure is being planned.

How is it treated?

The right treatment depends on the stage. In the freezing phase, we focus on pain relief and gentle movement within a tolerable range. Aggressive stretching at this point makes things worse. A well-placed intra-articular cortisone injection in this window, combined with physiotherapy, has the best evidence for shortening the pain phase.

As the shoulder moves into the stiffness-dominant frozen phase, sustained low-load stretching and progressive strengthening become the priority. In the thawing phase, we rebuild strength and function so that you finish with a shoulder you can rely on. Hydrodilatation, where the joint capsule is stretched by injecting fluid under ultrasound guidance, and manipulation under anaesthetic are reserved for cases that have not moved with conservative care. The UK FROST trial showed all three approaches, physiotherapy with steroid injection, manipulation under anaesthetic and arthroscopic capsular release, are reasonable options with broadly similar outcomes at 12 months.

When should you see a physiotherapist?

Early. A stiffening, painful shoulder that is worst at night, particularly if you are between 40 and 60, or have diabetes, deserves a proper assessment before it settles into the frozen phase. Our physiotherapy team in Milton Keynes will diagnose the stage you are in, arrange a well-timed cortisone injection where appropriate, and build the right stage-by-stage programme with you. If your shoulder pain is more about weakness and overload than lost range, read our companion piece on rotator cuff and shoulder pain.