Quick answer: Frozen shoulder (adhesive capsulitis) usually improves on its own, but slowly. It typically moves through three stages, and full recovery can take one to three years [1]. Most people regain near-normal shoulder function, although a meaningful minority have some lingering, usually mild, symptoms years later [2]. Early treatment, especially a steroid injection paired with home stretching, can shorten the most painful phase [3].
What Is Frozen Shoulder?
In frozen shoulder, the capsule that surrounds the shoulder joint becomes inflamed, thickened, and tight. The result is pain and a loss of motion that affects both how far you can move the arm yourself and how far someone else can move it for you [1, 4]. That second feature, the loss of passive motion, is what distinguishes frozen shoulder from a rotator cuff tear, in which the shoulder is weak but usually can still be moved by someone else.
Who Gets It?
Frozen shoulder most often affects people between 40 and 60, and women more often than men [1]. In a long-term study of more than 200 patients, the average age at onset was 53 [2].
Diabetes is the strongest known risk factor. A meta-analysis found that people with diabetes are about five times more likely to develop frozen shoulder, and roughly 13% of people with diabetes will have it at some point. Conversely, about 30% of people with frozen shoulder have diabetes [5]. Thyroid disease and a period of immobilization after injury or surgery are also associated with it [1].
The Three Stages
Frozen shoulder classically progresses through three phases [1]:
- Freezing (about 6 weeks to 9 months): Pain steadily increases and motion is gradually lost. Night pain is often worst during this phase.
- Frozen (about 4 to 6 months): Pain may ease, but stiffness remains and daily activities can be difficult.
- Thawing (about 6 months to 2 years): Motion slowly returns.
Does Frozen Shoulder Go Away on Its Own?
For most people, yes, eventually. In the long-term study mentioned above, 59% of patients had normal or near-normal shoulders at an average of more than four years after symptoms began. The other 41% had some ongoing symptoms, but these were mild in the vast majority. Only 6% had severe, lasting pain and loss of function. Patients with the most severe symptoms at the start tended to have the worst long-term outcome [2].
So while "it will get better on its own" is generally true, waiting it out can mean a year or more of pain and limited function. Treatment aims to make that period shorter and more tolerable.
How Is It Diagnosed?
Diagnosis is mostly clinical. Your surgeon will compare how far you can move your arm with how far it can be moved for you; in frozen shoulder, both are restricted [1]. X-rays help rule out arthritis, which can look similar on exam. An MRI or ultrasound isn't required for the diagnosis but can identify other problems such as a rotator cuff tear [1].
Which Treatments Actually Help?
Steroid injection plus a home exercise program. In a large review of randomized trials, an injection of corticosteroid into the shoulder joint was the only treatment that clearly outperformed others for short-term pain and function, especially when given within the first year of symptoms. Adding a home program of simple stretches appeared to add benefit over the following months [3].
Physical therapy. Gentle, progressive stretching is the foundation of treatment, and most patients improve without surgery [1, 4]. Aggressive, painful stretching early in the freezing phase is generally not helpful.
Hydrodilatation. If symptoms don't respond, injecting a larger volume of sterile fluid into the joint can stretch the tight capsule [1].
Managing contributing conditions. If you have diabetes, improving blood sugar control can help the shoulder recover [1].
Surgery. Surgery is usually considered only when symptoms persist despite at least six months of therapy [4]. The two main options are manipulation under anesthesia and arthroscopic capsular release. In the UK FROST trial of more than 500 patients, neither manipulation nor capsular release was clinically superior to early structured physiotherapy with a steroid injection at one year. Capsular release carried higher risks, while manipulation was the most cost-effective option [6]. This is why surgery is reserved for patients who are not improving with nonsurgical care.
Frequently Asked Questions
Can frozen shoulder come back?
Recurrence in the same shoulder is uncommon, but about 1 in 5 patients develop it in the other shoulder at some point [2].
Should I keep moving my shoulder if it hurts?
Yes, within reason. Gentle daily stretching helps preserve motion, but forcing the shoulder through severe pain during the freezing phase can aggravate inflammation. A physical therapist can help you find the right intensity.
Is frozen shoulder the same as a rotator cuff tear?
No. Both cause pain and difficulty lifting the arm, but frozen shoulder restricts motion even when someone else moves the arm. A shoulder specialist can usually tell the difference on exam. Learn more about rotator cuff tears.
When should I see a specialist?
If shoulder stiffness and pain have lasted more than a few weeks, are affecting sleep, or aren't improving with home care, an evaluation can confirm the diagnosis and get effective treatment started sooner. See also: Shoulder Pain at Night: Causes and Treatment.
Getting Help for Frozen Shoulder
Frozen shoulder is frustrating, but it is very treatable. Dr. Tej Joshi evaluates and treats frozen shoulder at NYU Langone offices in Manhattan, Lake Success, and Bay Ridge, Brooklyn.
References
- American Academy of Orthopaedic Surgeons. Frozen Shoulder. OrthoInfo. orthoinfo.org
- Hand C, Clipsham K, Rees JL, Carr AJ. Long-term outcome of frozen shoulder. J Shoulder Elbow Surg. 2008;17(2):231-236. PubMed 17993282 · doi:10.1016/j.jse.2007.05.009
- 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 33326025 · doi:10.1001/jamanetworkopen.2020.29581
- Neviaser AS, Neviaser RJ. Adhesive capsulitis of the shoulder. J Am Acad Orthop Surg. 2011;19(9):536-542. PubMed 21885699 · doi:10.5435/00124635-201109000-00004
- 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 27331029 · doi:10.11138/mltj/2016.6.1.026
- 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 33010843 · doi:10.1016/S0140-6736(20)31965-6