Orthopedic and movement
Frozen Shoulder (Adhesive Capsulitis)
The complete guide to frozen shoulder: what it is, the stages and how long each lasts, how it is diagnosed, every treatment and what the evidence says about it, exercises to do at home, and when shoulder pain needs a doctor.
- Expert Reviewed
- Evidence Based
- Patient Focused
Frozen shoulder (adhesive capsulitis) is a painful stiffening of the shoulder: the capsule around the joint thickens and tightens, so the arm loses movement whether you move it yourself or someone else moves it for you.1 It affects about 2% to 5% of people, most often women and people aged 40 to 60, and it is far more common with diabetes.1,2,3 It usually resolves over one to three years, though some people keep mild symptoms for years.4,5 Gentle stretching within your pain limits, a home exercise program and a steroid injection have the best evidence; surgery is for the minority who do not improve.6,7,8,9
Frozen shoulder gets better in most people, but slowly: it usually resolves within one to three years, and full recovery can take up to 3 years.1,4 Gentle, frequent stretching that stays within your pain limits works better than forcing the shoulder, and a steroid injection into the joint gives the clearest short-term pain relief.7,8,10 Call 911 if shoulder or arm pain comes with chest pain, shortness of breath or sweating, which can mean a heart attack.11
Key takeaways
- Frozen shoulder means pain and lost movement both when you move the arm and when someone else moves it, and turning the arm outward is often the first movement to go.1,4
- It runs through overlapping stages, freezing, frozen and thawing, over one to three years; the stages describe a typical course, not a timetable.1,2,4
- People with diabetes are about five times as likely to have it, and anyone who develops it without known diabetes should consider a diabetes test.3
- Gentle exercise within pain limits did better than intensive stretching in a two-year study, and home exercise does as well as supervised stretching.4,7
- A steroid injection into the joint has the clearest short-term benefit, best combined with home exercise, but it does not shorten the condition.8,12
- Most people improve without surgery; in a UK trial of 503 people, two operations were no better at a year than physical therapy with a steroid injection.9,13
What is frozen shoulder?
Frozen shoulder, also called adhesive capsulitis, is a painful condition in which the shoulder gradually stiffens and loses movement, lasting more than three months.2 The shoulder joint sits inside a capsule of connective tissue. In frozen shoulder the capsule thickens and becomes stiff and tight, thick bands of tissue called adhesions develop, and there is often less of the fluid that lubricates the joint.1
The result is a shoulder that will not move fully, whether you move it yourself or someone moves it for you.1 That is what separates it from a weak or simply painful shoulder: the block is mechanical, coming from the tight capsule itself rather than from pain alone.4
| Question | Answer |
|---|---|
| Other name | Adhesive capsulitis2 |
| What happens | The shoulder capsule thickens and tightens, and bands of tissue called adhesions form.1 |
| How common | About 2% to 5% of people; about 2.4 in every 1,000 develop it each year.2 |
| Who gets it | Most often people aged 40 to 60, and women more than men.1 |
| Biggest risk factor | Diabetes: 10.8% of people with diabetes develop it, against 2.3% of people without.2 |
| How long it lasts | Usually 1 to 3 years.4 |
| Main treatment | Physical therapy focused on shoulder flexibility.1 |
| Who needs surgery | The minority who do not improve with nonsurgical treatment.9 |
Most of the time there is no clear cause.17 Frozen shoulder is one of many causes of shoulder pain, and a different problem from rotator cuff tendinitis or a rotator cuff tear; the tendinopathy guide covers the tendon problems.14
Frozen shoulder symptoms: how painful is it?
Very, at its worst. The hallmark signs are severe pain and being unable to move the shoulder, on your own or with someone else's help.1 The pain is usually dull or aching, felt over the outer shoulder and sometimes the upper arm, and it is worse early in the condition and when you move the arm.1 It typically comes on slowly, near the top of the arm where the deltoid muscle attaches.2
Pain usually comes first and stiffness follows: in one study, 90.6% of patients developed pain before they lost movement.4 The stiffness can stay for a while even after the pain has eased.10
Turning the arm outward (external rotation) is often the first movement to go, and pain is usually worst at the ends of the range, when the tight capsule is stretched.4 Over time, reaching overhead or behind your back becomes hard.17
Common signs of frozen shoulder
- Shoulder pain that came on gradually, often without an injury2,17
- Achy pain at rest and pain that disturbs your sleep6
- Trouble reaching overhead or behind your back17
- Movement just as limited when someone else lifts or turns your arm1
- Daily activities becoming very difficult as the shoulder stiffens1
Is frozen shoulder pain worse at night?
Often, yes. In the first stage the main complaint is shoulder pain, especially at night, while movement may still be preserved, and night pain tends to build through the freezing stage.4,12 The physical therapy guideline lists achy pain at rest and disturbed sleep among the features of the first stage.6 Night pain is not unique to frozen shoulder, though: rotator cuff tears also cause pain at rest and at night, especially when you lie on that side.16
What are the stages of frozen shoulder?
Frozen shoulder is usually described in three stages, each named for what the shoulder is doing. The AAOS, the professional body for US orthopedic surgeons, gives these typical lengths:1
| Stage | How long it typically lasts | What happens |
|---|---|---|
| 1. Freezing | 6 weeks to 9 months1 | Pain slowly increases, and the shoulder loses range of motion as it does.1 |
| 2. Frozen | 4 to 6 months1 | Pain may ease, but the stiffness remains and daily activities can be very difficult.1 |
| 3. Thawing | 6 months to 2 years1 | Movement slowly improves, back to normal or close to normal strength and motion.1 |
What are the 4 stages of frozen shoulder?
Physical therapists often use a four-stage version, set out in the American Physical Therapy Association's orthopedic guideline, which counts the months from when symptoms began:6
| Stage | Months since symptoms began | What it is like |
|---|---|---|
| 1. Early | Up to 36 | Sharp pain at the ends of movement, achy pain at rest, and disturbed sleep.6 |
| 2. Painful or freezing | 3 to 96 | Movement is gradually lost in all directions because of pain.6 |
| 3. Frozen | 9 to 156 | Pain and loss of motion together.6 |
| 4. Thawing | 15 to 246 | Pain begins to resolve, but significant stiffness persists.6 |
The two schemes do not line up exactly, and both are descriptions, not a schedule.1,6 The stages overlap so much that UK specialists find them of limited use for treatment decisions, and a review of the natural history found no evidence that people pass through the stages to a full recovery without treatment; most improvement came early, not late.2,18
How do you know which stage you are in?
The balance of pain and stiffness is the clue. Pain that is building while movement shrinks means the freezing stage; pain that has eased in a shoulder that stays stiff means the frozen stage; movement that slowly comes back means thawing.1 A physical therapist identifies your stage and how irritable the shoulder is, which sets how hard the stretching should be.6,12
What causes frozen shoulder, and who gets it?
The causes are not fully understood, and there is no clear link to which arm you use most or to your job.1 It can begin with no trigger at all, or after the shoulder has been held still for a time because of surgery, a fracture or another injury.1,17
- Age
Most common between 40 and 60; in demographic studies 84% of patients were aged 40 to 59.1,4
- Sex
More common in women, who make up about 70% of patients.1,4
- Diabetes
The strongest link: 10.8% of people with diabetes develop it, against 2.3% without.2
- Thyroid disease
Thyroid conditions raise the risk, an underactive thyroid in particular.1,19
- A shoulder held still
After surgery, a fracture or an injury, in a cast, or when a stroke stops you using the arm.1,10
- Other conditions
Parkinson's disease, heart disease, Dupuytren's disease, osteoporosis and high blood fats (hyperlipidemia) have all been linked.1,2
- Other operations
Open heart surgery, recent breast surgery, and other heart surgery or neurosurgery.2,17
- Hormones and the neck
Hormone changes such as menopause, and disk disease in the neck.17
- A previous episode
Having had it in one arm makes it more likely in the other.6
Frozen shoulder and diabetes
Diabetes is the most important risk factor. People with diabetes are about five times as likely as people without it to have frozen shoulder; about 13% of people with diabetes have it, and about 30% of people with frozen shoulder have diabetes.3 Using insulin made no difference to the risk.3
It is also more stubborn with diabetes: there is more stiffness, and it lasts longer before the shoulder thaws, with a slower recovery and worse outcomes.1,6 Manipulation under anesthesia works less well, and some stiffness often remains after surgery.1,4
If you have frozen shoulder and diabetes, or might have diabetes
- No diagnosis of diabetes? Ask about an A1C blood test; researchers recommend checking anyone who develops frozen shoulder3
- A high A1C? A plan with your doctor or endocrinologist to improve glucose control can help the shoulder recover faster1
- A steroid injection? Blood sugar often rises within 1 to 3 days and can stay up for about 2 weeks, so check it more often20,21
Frozen shoulder and thyroid disease
Thyroid disease is more common in people with frozen shoulder, particularly an underactive thyroid (hypothyroidism), including its mild, subclinical form. A 2023 analysis of ten studies did not confirm a link with an overactive thyroid, although one large population study had found a slightly higher risk.4,19 Keeping thyroid problems or diabetes under control makes frozen shoulder less likely.17
When should you see a doctor for frozen shoulder?
If your shoulder is painful and stiff and you think it may be frozen shoulder, see your provider for an evaluation; early treatment may help prevent stiffness.17 Some shoulder pain needs care sooner:14
| When | What it is for |
|---|---|
| Now: call 911 | Sudden pressure or crushing pain in the shoulder, especially spreading from the chest to the jaw, arm or neck, or with shortness of breath, dizziness or sweating.11,14 |
| Now: the emergency room | A severe injury that leaves the shoulder very painful, swollen, bruised or bleeding.14 |
| Soon: your provider | Shoulder pain with fever, swelling or redness, red or blue skin, or significant pain even when someone else moves the arm.14 |
| After 2 to 4 weeks | Pain that has not improved with home treatment.14 |
| Anytime: a physical therapist | You can contact a physical therapist directly for an evaluation; every state allows some form of direct access.12,22 |
Who treats frozen shoulder?
Most people start with their primary care provider, who examines the shoulder, starts treatment and refers on when needed.17 Physical therapy is the main treatment, and every physical therapist is trained to treat frozen shoulder.1,12 Hydrodilatation is done by a radiologist, a sports medicine physician or an orthopedic surgeon, and if you have diabetes, your primary care doctor or endocrinologist helps with the glucose control that speeds recovery.1
How is frozen shoulder diagnosed?
Frozen shoulder is diagnosed from your history and an examination, and it is often a diagnosis of exclusion, made once other causes have been ruled out.2,4
- Your history. Your symptoms and how they began, and conditions such as diabetes or thyroid disease that raise the risk.6,17
- Active movement. You move your shoulder as far as you can in each direction.1
- Passive movement. The doctor moves your shoulder carefully in all directions; in frozen shoulder, movement is limited both ways.1
- Outward rotation. A disproportionately severe loss of passive external rotation is the typical finding, with firm, painful end points.2,4
- The capsular pattern. A physical therapist looks for the specific pattern of lost movement that a tight capsule produces.12
- X-rays if needed. To rule out other problems, such as arthritis or calcium deposits.1,17
MRI and ultrasound are not needed to diagnose frozen shoulder, but they can find other soft-tissue problems such as a rotator cuff tear.1 Routine X-rays rarely turn up anything else, but in people over 40 a tumor can occasionally be mistaken for frozen shoulder, one reason the diagnosis is made with care.2
Is it frozen shoulder or a rotator cuff tear?
| Feature | Frozen shoulder | Rotator cuff tear |
|---|---|---|
| How it starts | Slowly, usually without an injury2,17 | Can follow a fall, with intense pain, a snapping sensation and immediate weakness16 |
| Movement | Limited whether you or someone else moves the arm1 | Weakness when lifting or rotating the arm16 |
| Other signs | Outward rotation is often lost first4 | A crackling sensation in certain positions16 |
| Night pain | Common, especially early on4 | Common, especially lying on that side16 |
| Imaging | Not needed for the diagnosis1 | MRI or ultrasound can show the tear1 |
Pain can also be referred to the shoulder from the neck or elsewhere in the body; then there is usually pain at rest that does not get worse when you move the shoulder.14 The neck pain guide covers that side.
How long does frozen shoulder last?
Usually one to three years from start to finish.4 The AAOS says full recovery may take up to 3 years, and MedlinePlus that, even untreated, it often gets better within about 2 years with little lasting loss of motion, though other medical conditions can make it last longer.1,17
- A few weeks
The time it can take for treatment to show progress.17
- Within a year
Physical therapy and anti-inflammatory medicine often restore motion and function.17
- 1 to 3 years
Recovery is not always complete: between 20% and 50% of people may have long-lasting symptoms.4 In a study that followed 223 people for an average of 4.4 years from the start of symptoms, 59% had normal or near-normal shoulders and 41% still had some symptoms; most were mild, and pain was the most common complaint.5 The people with the most severe symptoms at the start did worst in the long run.5
Diabetes makes the course longer, with more stiffness that persists before the shoulder thaws.1,6
Does frozen shoulder heal on its own?
Mostly, but not always fully. UK specialists call it self-resolving.2 Yet a review of studies that followed people who had no treatment found some, but not complete, improvement in movement after 1 to 4 years, with most of the improvement coming early.18 The condition has to run its course, and injections do not shorten it, but treatment eases the pain and keeps the shoulder moving while it does.1,12
Can you speed up frozen shoulder recovery?
Some things help. Steroid injections into the joint improve symptoms faster than the natural course, and in a review of 65 studies, an early injection, within the first year, combined with a home exercise program was linked to better outcomes.2,8 Hydrodilatation speeds short-term improvement in pain and movement.2 With diabetes, better glucose control can speed recovery.1 Forcing the shoulder does not: in a two-year study, people who exercised within their pain limits recovered better, and sooner, than those given intensive stretching.7
Frozen shoulder treatment: what works and what doesn't
Most people with frozen shoulder improve with relatively simple treatments to control pain and restore motion, and physical therapy focused on flexibility is the primary recommendation.1 How well each option works is still debated, so it helps to know what each one can and cannot do.23
| Treatment | What it involves | The evidence |
|---|---|---|
| Education and activity changes | Learning the natural course and adjusting activities to keep pain-free movement.6 | Recommended Recommended in the physical therapy guideline on moderate evidence.6 |
| Gentle stretching | Stretching matched to how irritable the shoulder is.6 | Recommended Exercise within pain limits did better than intensive stretching over two years.7 |
| Home exercise program | Simple stretches done several times a day.10 | Recommended As effective as supervised stretching, or more so.4 |
| Steroid injection into the joint | Cortisone injected directly into the shoulder joint.1 | Short term The only treatment clearly better for short-term pain, for up to about 6 months.8 |
| Hydrodilatation | A large volume of sterile fluid injected to stretch the capsule.1 | Short term Faster short-term gains in pain and movement; added to a steroid injection, little extra.2,8 |
| Supervised physical therapy | Mobilization, heat, ice and other treatments given by a therapist.8 | Uncertain alone Unknown whether it beats the natural course; after an injection it may add a short-term benefit.2 |
| Joint mobilization | The therapist moves the shoulder joint to ease pain and gain motion.6 | An option Recommended on weak evidence.6 |
| Anti-inflammatory medicines (NSAIDs) | Ibuprofen, naproxen or aspirin for pain and swelling.1,10 | Pain only Short-term pain relief early on; in one trial, no gain in movement.4 |
| Oral steroids | A short course of steroid tablets.24 | Short-lived A short-term benefit that may not last beyond six weeks.24 |
| Heat | Moist heat a few times a day, and before exercise.10 | For comfort Used to ease pain and loosen the shoulder before stretching.1,10 |
| Ultrasound, electrical stimulation and laser | Machine-based treatments added to exercise.6 | Uncertain Low-level laser may help; for the others the benefit is unclear.25 |
| Manipulation under anesthesia | Under general anesthesia, the shoulder is moved to stretch or tear the tight capsule.1 | If others fail No better than capsular release or physical therapy at a year, and the most cost-effective.13 |
| Arthroscopic capsular release | Keyhole surgery to cut the tight parts of the capsule.1 | If others fail No better than the alternatives at a year, with more serious complications.13 |
| Shoulder embolization | Blocking small abnormal blood vessels through a catheter.26 | Experimental Mostly single-arm studies so far; reviews call for randomized trials.27,28 |
Steroid injections for frozen shoulder
A corticosteroid injection into the shoulder joint is the treatment with the clearest short-term benefit. In a review of 65 studies with 4,097 participants, it was the only treatment better than the others both statistically and clinically for short-term pain, an advantage that appeared to last up to 6 months.8 Combined with mobility and stretching exercises, it relieves pain and improves function over 4 to 6 weeks more than the exercises alone.6
It has limits. A benefit beyond 3 months has not been shown, and an injection gives no longer-term gain in movement and does not shorten the condition.2,12 An injection given freehand works as well as one guided by ultrasound.2 It is usually given only in the painful early phase, but the evidence does not restrict it to then.8 With diabetes, blood sugar rises for a few days afterward, so monitor it closely.20,21
What is hydrodilatation for frozen shoulder?
Hydrodilatation, also called hydrodistension or arthrographic distension, is offered when other nonsurgical treatment has not worked: a large volume of sterile fluid, often with a steroid, is injected into the joint under imaging guidance to expand and stretch the capsule.1,29 In the best trial, distension with saline and steroid was better than placebo for pain, function and movement at three weeks.29 It improves pain and the ability to lift the arm out to the side more than physical therapy over the short to medium term, though adding it to a steroid injection gave no clinically important extra benefit.2,8 About 14% of people have brief flushing or pain afterward.2
Medicines for frozen shoulder pain
Over-the-counter pain relievers such as ibuprofen, naproxen or acetaminophen can help. Talk with your provider first if you have heart disease, high blood pressure, kidney disease, or a history of stomach ulcers or internal bleeding, and do not take more than the recommended amount.10 Anti-inflammatories (NSAIDs) are generally recommended for short-term relief in the early, painful stage, but in one trial they eased pain without improving movement.4 A short course of steroid tablets can help in the short term, but the benefit may not last beyond six weeks, and symptoms can rebound once the tablets stop.4,24
Is shoulder embolization a treatment for frozen shoulder?
It is an experimental option. The idea is that small abnormal blood vessels (neovascularity) in the inflamed tissue keep the pain going; in embolization, a specialist passes a catheter from the radial artery at the wrist and blocks those vessels.26 The largest trial treated 100 patients at five centers, 76 with frozen shoulder and 24 with rotator cuff tears. Across the group, night pain fell from 6.4 to 1.6 out of 10 and forward elevation rose from 97 to 151 degrees at six months, with no major complications.26 Every patient had the procedure, so in a condition that improves on its own, the trial cannot show how much of that improvement it caused.26,28
Reviews up to mid-2026 call it exploratory: the studies so far are mostly single-arm, and randomized trials are needed.27,28 In a retrospective comparison with keyhole capsular release, embolization relieved pain faster at three months, but there were no differences by six months.30 Two randomized trials are now recruiting, one against steroid injections and one against usual care.31,32
The knee is a cautionary example: embolization for knee arthritis looked promising in uncontrolled studies, then the two most recent of its three sham-controlled trials found no benefit over a sham procedure.33 A sponsored article by a vascular surgeon, The vascular side of frozen shoulder, describes the procedure from the provider's side.
Physical therapy for frozen shoulder: what to expect
Physical therapy focused on flexibility is the primary treatment recommendation, done with a therapist, through a home program, or both.1 Physical therapists often first see people well into the freezing stage or early in the frozen stage, and they match the program to your stage and to how irritable the shoulder is.6,12
- The evaluation. Your history and a measurement of your movement, looking for the capsular pattern, to identify your stage.12
- Education. How the condition usually runs, and how to change activities so you keep the movement you have without pain.6
- Calming a painful shoulder. When it is very irritable: activity changes, heat or ice, medicine and gentle manual therapy rather than hard stretching.6,12
- Stretching as the pain settles. Gentle stretching matched to irritability; overly aggressive stretching early on can make the pain worse.6,12
- Joint mobilization. Hands-on movement of the shoulder joint to reduce pain and increase motion.6
- More stretching, then strength. Once irritability is low, more intense stretching and strengthening for the shoulder and core.6,12
- Back to normal use. Normal shoulder mechanics and a return to everyday, pain-free activities.12
How long is physical therapy for frozen shoulder?
There is no standard length, because physical therapy follows the condition, which usually takes one to three years to resolve.4 These examples give a sense of scale:6,13
| Setting | Length |
|---|---|
| The UK FROST trial | 12 sessions over up to 12 weeks, with a steroid injection13 |
| A trial cited in the US guideline | 12 one-hour sessions over 4 weeks6 |
| The AAOS shoulder conditioning program, a general program | 4 to 6 weeks, unless your doctor or therapist says otherwise34 |
| MedlinePlus | Progress within a few weeks; complete recovery in 9 months to a year, with daily exercise17 |
| When to step up treatment | If there is no progress after about 4 months of physical therapy4 |
| The usual threshold for surgery | No improvement after 6 months or more of physical therapy9 |
Most of the work happens at home between visits: home exercise has done as well as supervised stretching, and the exercises are meant to be done several times a day.4,10
Does physical therapy help frozen shoulder?
It helps most as gentle, regular exercise. Whether supervised physiotherapy on its own beats the natural course is unknown, but after a steroid injection it may add a short-term benefit, and a home exercise program helped substantially in people who had no other treatment.2,8 In a Cochrane review, six weeks of manual therapy and exercise gave less improvement at seven weeks than a steroid injection, but the differences at six and twelve months were not clinically important.35
How to choose a physical therapist for frozen shoulder
What to look for
- Experience treating orthopedic or musculoskeletal problems12
- Board certification, a residency or fellowship in orthopedic or manual physical therapy, or a focus on the arm and shoulder12
- When you call, ask about the therapist's experience with frozen shoulder12
- You can book without a referral in every state, though some states limit treatment without one22
- Medicare Part B covers medically necessary outpatient physical therapy once a provider certifies you need it36
You can find a physical therapist near you in our directory.
Frozen shoulder exercises to do at home
Stretching and range-of-motion exercises are the core of treatment, done gently and often: once an hour, or at least four times a day at first, in short sessions rather than long ones.1,10 Use moist heat first to ease pain and help the shoulder move, and keep each stretch below the point of significant pain.6,10 These six come from OrthoInfo, the AAOS patient site; how many repetitions and sets suit you is for your doctor or physical therapist to set.1,34
Pendulum
A gentle start: the arm hangs freely and swings in small movements.34
- Lean forward and place one hand on a counter or table for support.
- Let your other arm hang freely at your side.
- Gently swing the arm forward and back, then side to side, then in a circle.
The AAOS program: 2 sets of 10, 5 to 6 days a week. Do not round your back or lock your knees.34
Doorway external rotation stretch
Works on turning the arm outward, often the first movement frozen shoulder takes.1,4
- Stand in a doorway and bend the elbow of your affected arm to 90 degrees so your hand reaches the door frame.
- Keep your hand in place and turn your body away from it until you feel a stretch.
- Hold for 30 seconds. Relax and repeat.
OrthoInfo leaves the number of repetitions and sets to your doctor or physical therapist.1
Supine forward flexion
Your good arm lifts the stiff one overhead.1
- Lie on your back with your legs straight.
- Use your unaffected arm to lift your affected arm overhead until you feel a gentle stretch.
- Hold for 15 seconds, then slowly lower it to the start. Relax and repeat.
OrthoInfo leaves the number of repetitions and sets to your doctor or physical therapist.1
Crossover arm stretch
Stretches the back of the shoulder.34
- Relax your shoulders.
- Gently pull one arm across your chest, just below your chin, as far as you can without pain, holding it at the upper arm.
- Hold for 30 seconds, then relax for 30 seconds.
The AAOS program: 4 on each side, 5 to 6 days a week. Do not pull or put pressure on your elbow.1,34
Passive internal rotation with a stick
Works on internal rotation, the movement you use to reach behind your back; you feel it at the front of the shoulder.10,34
- Hold a light stick, such as a yardstick, behind your back with one hand, and lightly grasp the other end with your other hand.
- Pull the stick sideways so the shoulder is stretched to the point of a pull without pain.
- Hold for 30 seconds, then relax for 30 seconds.
The AAOS program: 4 on each side, 5 to 6 days a week. Do not lean over or twist to the side as you pull.34
Passive external rotation with a stick
A second way to work on turning the arm outward; you feel it at the back of the shoulder.34
- Grasp a light stick with one hand and cup the other end with your other hand.
- Keep the elbow of the shoulder you are stretching against your side.
- Push the stick sideways until you feel a pull without pain. Hold for 30 seconds, then relax for 30 seconds.
The AAOS program: 4 on each side, 5 to 6 days a week. Keep your hips facing forward and do not twist.34
Your therapist may add others, such as the wall crawl or rope-and-pulley stretches, and will show you how to do them.10
Exercises and activities to avoid with frozen shoulder
- Hard stretching while it is painful
Overly aggressive stretching in the early stages can make the pain worse.12
- Stretching into real pain
Exercises should be done without significant pain; tell your therapist if they hurt.6,34
- Strengthening too early
Hold off on strengthening, which can aggravate the joint, until your range of motion has returned.10
- Heavy lifting
Do not lift heavy things or do activities that need a lot of shoulder and arm strength.10
Rest is not the answer either. Keeping the shoulder moving within comfortable limits is part of treatment, and moving the shoulder soon after an injury or surgery is one way doctors prevent frozen shoulder in the first place.1,6
Frozen shoulder treatment at home
Much of the care for frozen shoulder happens at home, as a home program between therapy visits or on its own.1
Looking after a frozen shoulder at home
- Moist heat on the shoulder 3 to 4 times a day, and before your exercises10
- Your exercises little and often: every hour, or at least 4 times a day at first10
- An over-the-counter pain reliever if you need one, no more than the recommended amount10
- The clothes and food you use most kept between waist and shoulder height, so you do not have to reach up or behind you10
- Help with cleaning, taking out the garbage and gardening, and no heavy lifting10
- With diabetes, a plan with your doctor to bring your glucose under control1
A frozen shoulder can be wearing for months. If it is making you feel sad or depressed, tell your provider.10
When is surgery needed for frozen shoulder?
Only when physical therapy and other nonsurgical treatments have not relieved the symptoms; most patients improve without it.1,9 A general guideline is little or no improvement, with continuing disability, after 6 months or more of physical therapy, and surgery is usually offered during the frozen stage.1,9 The aim is to stretch and release the tight capsule.1
| Procedure | What is done | What to know |
|---|---|---|
| Manipulation under anesthesia | While you are asleep, the surgeon moves the shoulder to stretch or tear the tight capsule and scar tissue.1 | Usually regarded as safe, but bleeding into the joint, tears of the capsule or labrum and fractures have been reported; it works less well with diabetes.4,17 |
| Arthroscopic capsular release | Through small incisions, pencil-sized instruments cut the tight parts of the capsule.1 | More serious complications than the alternatives in a UK trial: 4%, against none with physical therapy.2,13 |
| Both together | Manipulation and arthroscopy are often combined for the best result.1 | Most patients have good outcomes.1 |
The largest trial, UK FROST, randomly assigned 503 adults to manipulation under anesthesia, arthroscopic capsular release, or early structured physical therapy with a steroid injection. At 12 months none was clinically better than the others; capsular release carried more risk, with 8 serious adverse events against 2 after manipulation, and manipulation was the most cost-effective.13 UK specialists therefore recommend a shared decision before capsular release.2
Frozen shoulder surgery recovery
Physical therapy after surgery is essential to keep the movement the operation gained, and recovery takes 6 weeks to 3 months.1 You may be given pain blocks so that you can do the therapy, and you need to keep it up for several weeks or months to stop the stiffness returning.17 In one series, half of patients had good pain relief within a week of capsular release and 80% within six weeks.4
Long-term results are generally good, with most people having less or no pain and better movement, but some stiffness can remain even years later, especially with diabetes.1 Our guide to recovery after shoulder surgery covers rehabilitation after an operation.
Can frozen shoulder come back?
In the same shoulder it is uncommon, though it can recur, especially if a contributing factor such as diabetes is still present.1 A long-term study of 223 people found no recurrences in the same shoulder, while after arthroscopic capsular release recurrence can reach 11% at one year.4,5 The other shoulder is more at risk:6
| Source | What it found |
|---|---|
| UK care pathway, 2025 | 6% to 17% develop it in the other shoulder within 5 years2 |
| US physical therapy guideline | A 5% to 34% risk for the other arm later, and both shoulders at once in up to 14%6 |
| 223 people followed for 4.4 years on average | 20% reported symptoms in both shoulders5 |
| APTA patient guide | An estimated 20% to 30% get it in the other shoulder as well12 |
After surgery, keeping up physical therapy for several weeks or months helps stop frozen shoulder coming back.9,17
Can you prevent frozen shoulder?
There is no proven way to prevent it, because its cause is not known.12 A few steps lower the risk or limit the stiffness:1,17
Steps that lower the risk
- Moving the shoulder soon after an injury or surgery, as your doctor advises1
- Keeping diabetes or thyroid problems under control17
- Getting shoulder pain that limits your movement checked early, because early treatment may help prevent stiffness17
- Keeping up range-of-motion exercises while you recover from shoulder tendinitis14
What does frozen shoulder treatment cost, and is it covered?
Medicare Part B helps pay for medically necessary outpatient physical therapy, with no yearly limit; after the Part B deductible you pay 20% of the Medicare-approved amount, and a doctor or other provider must certify that you need it.36 Every state allows you to see a physical therapist without a referral in some form, though some attach conditions to treatment without one; check your own plan's rules on visits and referrals.22
Because the results at a year were similar, cost matters when choosing between procedures: in the UK FROST trial, manipulation under anesthesia had the highest probability of being cost-effective, ahead of physical therapy and far ahead of capsular release.13
Frozen shoulder myths and facts
- Myth: push through the pain to free it up
People who exercised within their pain limits did better, and sooner, than those given intensive stretching.7
- Myth: it always goes away completely
Untreated shoulders improved, but not completely, over 1 to 4 years, and 41% of people in a long-term study had some lasting symptoms.5,18
- Myth: you need an MRI to diagnose it
MRI and ultrasound are not required; the diagnosis rests on the history and the examination.1,2
- Myth: it only happens after an injury
Most of the time there is no cause, and it can happen to anyone.1,17
- Myth: surgery is the quickest fix
In a trial of 503 people, two operations were no better at 12 months than physical therapy with a steroid injection.13
- Myth: a steroid injection cures it
Injections relieve pain in the short term, but they do not shorten the condition.8,12
Frozen shoulder recovery goals worth setting
Fasten a bra or reach a back pocket · Put on a coat without help · Reach the top shelf · Sleep on that side · Wash and dry my hair
Improve range of motion · Reduce pain
If your goals read like the second line, ask for them in daily-life terms: the physical therapy guideline asks clinicians to encourage functional, pain-free movement.6
Frequently Asked Questions
How many months does a frozen shoulder take to heal?
Most frozen shoulders resolve over one to three years.4 With physical therapy and anti-inflammatory medicine, motion and function often return within a year, and even untreated it often improves within 2 years.17
Can frozen shoulder be cured?
It usually resolves on its own, though not always completely.2,4 Most people improve with simple treatments, and in a long-term study 59% ended up with normal or near-normal shoulders, while most of the rest had only mild symptoms.1,5
What helps frozen shoulder pain at night?
Night pain is typical early on.4 A steroid injection into the joint gives the clearest short-term pain relief, anti-inflammatory medicine can help, and moist heat may ease pain and stiffness.1,8,10 Pain that is getting much worse even with pain medicine is a reason to call your provider.10
Should I get tested for diabetes if I have frozen shoulder?
It is worth asking. People with diabetes are about five times as likely to develop frozen shoulder, and researchers recommend that anyone who has it without known diabetes consider an A1C test.3
Does a cortisone shot cure frozen shoulder?
No, but it is the treatment with the clearest short-term benefit for pain, for up to about six months.8 It does not give longer-term gains in movement or shorten the condition, so it works best alongside a home exercise program.8,12
Can shoulder pain be a sign of a heart attack?
Yes. Pain or discomfort in one or both arms or the shoulders can be a heart attack symptom, and in women it can happen without chest pain.11,15 Call 911 if shoulder pain comes with chest pain, shortness of breath, sweating, nausea or light-headedness.11
Should I rest a frozen shoulder or keep moving it?
Keep moving it gently. Stretching and range-of-motion exercises are the core of treatment, done often and within comfortable limits.1,10 What to avoid is heavy lifting and activities that need a lot of shoulder strength.10
Do I need a referral to see a physical therapist for frozen shoulder?
Usually not: you can contact a physical therapist directly for an evaluation, and every state allows some form of direct access.12,22 Medicare still requires a doctor or other provider to certify that you need therapy before it pays.36
Will I get full movement back?
Most people get back to normal or near-normal, but not everyone: in a study that followed people for an average of 4.4 years, 59% had normal or near-normal shoulders.5 At 12 to 18 months, mild to moderate stiffness and pain may persist, though many people report little or no disability.6
Related conditions
Conditions and pages that commonly come up alongside frozen shoulder.
Recovery after shoulder surgery
Considered for a minority where symptoms persist beyond the expected course.
Learn more →Tendinopathy
The other common cause of persistent shoulder pain, and a different problem entirely.
Learn more →Neck pain
Shoulder symptoms sometimes originate in the neck. What tells them apart.
Learn more →Persistent pain
The wider picture on long-term pain, and what treatment can realistically offer.
Learn more →Low back pain
The complete guide: causes, the treatments that help and those that don't, and exercises step by step.
Learn more →Sciatica
Leg pain from a compressed nerve root: how long it lasts, what helps, and when it is urgent.
Learn more →Find a physical therapist · Find an occupational therapist · Adult orthopedic therapy · All adult therapy
Sources
- American Academy of Orthopaedic Surgeons, OrthoInfo. Frozen shoulder. Checked October 6, 2026.
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“After a period of worsening symptoms, a frozen shoulder tends to get better, although full recovery may take up to 3 years”; physical therapy “with a focus on shoulder flexibility, is the primary treatment recommendation”; most common between 40 and 60 and in women; diabetes and thyroid conditions raise the risk; the capsule “thickens and becomes stiff and tight. Thick bands of tissue — called adhesions — develop”; the hallmark signs are “severe pain and being unable to move your shoulder — either on your own or with the help of someone else”; freezing “6 weeks to 9 months,” frozen “4 to 6 months,” thawing “6 months to 2 years”; no clear connection to arm dominance or occupation; diabetic patients have “a greater degree of stiffness that continues for a longer time before thawing” and better glucose control “can actually help speed up the recovery”; hypothyroidism, hyperthyroidism, Parkinson’s disease and cardiac disease; moving the shoulder soon after injury or surgery helps prevent it; MRI and ultrasound “are not required to diagnose frozen shoulder”; NSAIDs, steroid injections, hydrodilatation and physical therapy, with the external rotation, supine forward flexion and crossover stretches quoted in the exercise cards; surgery is “typically offered during ‘Stage 2: Frozen’”; after surgery “Recovery times range from 6 weeks to 3 months”; “Although uncommon, frozen shoulder can recur.” - Rupani N, Gwilym SE; BESS Frozen Shoulder Working Group. British Elbow and Shoulder Society patient care pathway: frozen shoulder. Shoulder & Elbow. 2025;17(4):351–363. doi:10.1177/17585732251335955 (PMID 40291049).
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The UK specialist guideline: insidious painful stiffness “which lasts over 3 months”; incidence 2.4 per 1,000 a year and prevalence 2% to 5%; typically women aged 45 to 60; 6% to 17% develop it in the other shoulder within 5 years; incidence 10.8% with diabetes against 2.3% without; other associations include hypothyroidism, Dupuytren’s disease, Parkinson’s disease, osteoporosis, stroke, hyperlipidemia and cardiac or neurosurgery; “considerable overlap between stages” limits their use for treatment decisions; a clinical diagnosis with pain near the deltoid insertion and “a disproportionately severe loss of passive external rotation”; in people over 40 a tumor can be misdiagnosed as frozen shoulder, “albeit with a low incidence”; “a self-resolving pathology”; steroid injections and hydrodistension improve symptoms faster than natural history, with no long-term benefit of injection seen after 3 months and no difference between ultrasound-guided and freehand injection; “It is unknown whether supervised physiotherapy provides any greater benefit than the natural history”; physiotherapy after injection may give a short-term benefit; transient flushing and after-pain in 14% after hydrodilatation; manipulation under anesthesia a viable, cost-effective option; serious adverse events 4% after capsular release against 0% with physiotherapy in UK FROST, so shared decision-making before release. - Zreik NH, Malik RA, Charalambous CP. Adhesive capsulitis of the shoulder and diabetes: a meta-analysis of prevalence. Muscles, Ligaments and Tendons Journal. 2016;6(1):26–34. doi:10.11138/mltj/2016.6.1.026 (PMID 27331029).
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People with diabetes were 5 times more likely than controls to have frozen shoulder; prevalence 13.4% in diabetes; 30% of people with frozen shoulder had diabetes; no difference with insulin; “Screening for DM should be considered in patients presenting with AC,” including an HbA1c test where there is no history of diabetes. - Le HV, Lee SJ, Nazarian A, Rodriguez EK. Adhesive capsulitis of the shoulder: review of pathophysiology and current clinical treatments. Shoulder & Elbow. 2017;9(2):75–84. doi:10.1177/1758573216676786 (PMID 28405218).
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Often “a self-limiting disease that resolves between 1 and 3 years,” but “between 20% and 50% of patients may go on to develop long-lasting symptoms”; “a diagnosis of exclusion”; 90.6% develop pain before loss of motion; external rotation is often affected first, pain is worse at the extremes of motion, and passive motion is lost with firm painful endpoints, “suggesting a mechanical rather than a pain-related restriction”; about 70% of patients are women and 84.4% are aged 40 to 59; stage I pain “especially at night, although they have preserved motion”; one population study found 1.22 times the risk with hyperthyroidism; “Home self-exercise has been shown to be equally effective or superior to supervised stretching-exercise”; escalate “after 4 months of physical therapy” in refractory cases; NSAIDs for short-term pain early on, with one trial showing “no objective improvement in shoulder mobility”; rebound after oral prednisolone; complications reported after manipulation, which is less effective in diabetes; after capsular release, good pain relief in 50% within 1 week and 80% within 6 weeks in one series, and recurrence “up to 11%” at 1 year. - Hand C, Clipsham K, Rees JL, Carr AJ. Long-term outcome of frozen shoulder. Journal of Shoulder and Elbow Surgery. 2008;17(2):231–236. doi:10.1016/j.jse.2007.05.009 (PMID 17993282).
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223 patients followed a mean 4.4 years from onset: 59% had normal or near-normal shoulders and 41% some ongoing symptoms, mostly mild, with pain the most common complaint; 20% reported symptoms in both shoulders, “but there were no recurrent cases”; the most severe symptoms at onset predicted the worst long-term outcome. - Kelley MJ, Shaffer MA, Kuhn JE, et al. Shoulder pain and mobility deficits: adhesive capsulitis. Journal of Orthopaedic & Sports Physical Therapy. 2013;43(5):A1–A31. doi:10.2519/jospt.2013.0302 (PMID 23636125).
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The clinical practice guideline of the orthopedic section of the American Physical Therapy Association: injection with mobility and stretching exercises beats exercise alone for 4 to 6 weeks (strong evidence); education on the natural course, activity modification and stretching matched to irritability (moderate); modalities, joint mobilization and translational manipulation under anesthesia (weak); risk with diabetes, thyroid disease, age 40 to 65, female sex and a previous episode in the other arm; the four stages, up to 3, 3 to 9, 9 to 15 and 15 to 24 months; at 12 to 18 months mild to moderate deficits may persist, “though many patients report minimal to no disability”; 5% to 34% risk for the other arm and up to 14% both at once; diabetes may bring “a protracted recovery and worse outcomes”; treatment by irritability level; “exercises should be performed without significant pain”; a trial of “12 one-hour sessions over a 4-week period.” - Diercks RL, Stevens M. Gentle thawing of the frozen shoulder: a prospective study of supervised neglect versus intensive physical therapy in seventy-seven patients with frozen shoulder syndrome followed up for two years. Journal of Shoulder and Elbow Surgery. 2004;13(5):499–502. doi:10.1016/j.jse.2004.03.002 (PMID 15383804).
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With supportive therapy and exercise within pain limits, 89% had normal or near-normal painless function at 24 months (64% within 12 months), against 63% with intensive stretching and mobilization. - Challoumas D, Biddle M, McLean M, Millar NL. Comparison of treatments for frozen shoulder: a systematic review and meta-analysis. JAMA Network Open. 2020;3(12):e2029581. doi:10.1001/jamanetworkopen.2020.29581 (PMID 33326025).
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65 studies, 4,097 participants: “only the administration of intra-articular (IA) corticosteroid was associated with statistical and clinical superiority compared with other interventions in the short-term for pain,” lasting as long as 6 months; early injection in frozen shoulder of less than a year “should be accompanied by a home exercise program”; physiotherapy (therapist-led mobilization, heat, ice and electrotherapy) ranked least effective at 8 to 12 weeks; home exercise helped most in those with no other treatment; adding distension to an injection was clinically nonsignificant; injecting only in the painful phase “is not backed up by evidence.” - Neviaser AS, Neviaser RJ. Adhesive capsulitis of the shoulder. Journal of the American Academy of Orthopaedic Surgeons. 2011;19(9):536–542. doi:10.5435/00124635-201109000-00004 (PMID 21885699).
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Management “begins with gentle, progressive stretching exercises. Most patients improve with nonsurgical treatment”; failure to improve, with continued disability, “following ≥6 months of physical therapy is a general guideline for surgical intervention”; diligent therapy after surgery is needed to minimize recurrence. - MedlinePlus, US National Library of Medicine. Frozen shoulder – aftercare. Review date June 27, 2026. Checked October 6, 2026.
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“It usually starts with pain, followed by stiffness. The stiffness can be present for a while even when the pain has subsided”; risk with a stroke that prevents use of the arm or a cast that holds it in one position; moist heat “3 to 4 times a day”; ibuprofen, naproxen or acetaminophen, with the cautions quoted on this page; keep clothes and food between waist and shoulder level; “Do not lift heavy things”; exercises “once every hour, or at least 4 times a day, in the beginning,” “more often rather than doing them for a long time,” after moist heat; “Avoid exercises to strengthen your shoulder (that can aggravate the joint), until the range of motion has returned”; the exercises it names include the wall crawl, rope and pulley stretches and reaching behind your back, which a provider or physical therapist demonstrates; call if the pain is much worse despite medicine, after a re-injury, or if it makes you feel sad or depressed. - National Heart, Lung, and Blood Institute. Heart attack: symptoms. Checked October 6, 2026.
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Symptoms include “Pain or discomfort in one or both arms, your back, shoulders, neck, jaw, or above your belly button,” chest pain, shortness of breath, sweating, nausea and light-headedness; “Call 9-1-1 for emergency medical care, even if you are not sure that you’re having a heart attack.” - American Physical Therapy Association, ChoosePT. Physical therapy guide to frozen shoulder (adhesive capsulitis). Expert review November 19, 2017. Checked October 6, 2026.
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“Of the people who have had adhesive capsulitis in 1 shoulder, it is estimated that 20% to 30% will get it in the other shoulder as well”; “You can contact a physical therapist directly for an evaluation”; pain especially at night in stage 2; therapists look for a “capsular pattern” and tailor the program to the stage; “being overly aggressive with stretching in this stage may make your shoulder pain worse”; heat and ice before other treatment; injections “don’t provide longer-term benefits for range of motion and don’t shorten the duration of the condition, they do offer short-term pain reduction”; more intense stretching and strengthening in stage 3, normal mechanics and pain-free activity in stage 4; “to date, there is no known method of prevention”; all physical therapists are prepared to treat it; look for orthopedic or musculoskeletal experience, board certification, or a residency or fellowship. - 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. The Lancet. 2020;396(10256):977–989. doi:10.1016/S0140-6736(20)31965-6 (PMID 33010843).
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503 adults at 35 UK hospitals randomly assigned to manipulation under anesthesia, arthroscopic capsular release, or early structured physiotherapy with a steroid injection (12 sessions during up to 12 weeks): “none of the three interventions were clinically superior” at 12 months; eight serious adverse events with capsular release and two with manipulation; manipulation had the highest probability of being cost-effective. - MedlinePlus, US National Library of Medicine. Shoulder pain. Review date September 2, 2025. Checked October 6, 2026.
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Referred pain from the neck or lungs: “There is usually pain at rest and no worsening of pain when moving the shoulder”; “If you are recovering from tendinitis, continue to do range-of-motion exercises to avoid frozen shoulder”; call 911 for “sudden pressure or crushing pain in your shoulder, especially if the pain runs from your chest to the left jaw, arm or neck, or occurs with shortness of breath, dizziness, or sweating”; the emergency room after a severe injury with a very painful, swollen, bruised or bleeding shoulder; contact your provider for shoulder pain with fever, swelling or redness, significant pain even when someone else moves the arm, pain for more than 2 to 4 weeks after home treatment, or red or blue skin. - National Heart, Lung, and Blood Institute. Heart attacks in women. In addition to chest pain, women are more likely to have symptoms including “Pain in the shoulder, back, or arm”; “These symptoms can happen together with chest pain or without any chest pain.” Checked October 6, 2026.
- American Academy of Orthopaedic Surgeons, OrthoInfo. Rotator cuff tears. Symptoms include “Pain at rest and at night, especially if you are lying on the affected shoulder,” weakness lifting or rotating the arm, and crepitus; tears after a fall “usually cause intense pain. There may be a snapping sensation and immediate weakness in your upper arm.” Checked October 6, 2026.
- MedlinePlus, US National Library of Medicine. Frozen shoulder. Review date October 7, 2024. Checked October 6, 2026.
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“Most of the time, there is no cause for frozen shoulder”; risk factors include menopause, open heart surgery, recent breast surgery and cervical disk disease; over time people cannot reach “over your head or behind you”; x-rays make sure there is no other problem “such as arthritis or calcium deposits”; “It can take a few weeks to see progress. It may take as long as 9 months to a year for complete recovery”; “Left untreated, the condition often gets better by itself within 2 years with little residual loss of motion”; physical therapy and NSAIDs “often restores motion and function of the shoulder within a year”; after surgery, pain blocks, and physical therapy “for several weeks or months” to prevent its return; “Early treatment may help prevent stiffness”; people with diabetes or thyroid problems “will be less likely to get frozen shoulder if they keep their condition under control.” - 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. doi:10.1016/j.physio.2016.05.009 (PMID 27641499).
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“no treatment yielded some, but not complete, improvement in range of motion after 1 to 4 years”; no evidence supported progression through recovery phases to full resolution without treatment, and “most improvement occurred early, not late.” - Chuang SH, Chen YP, Huang SW, Kuo YJ. Association between adhesive capsulitis and thyroid disease: a meta-analysis. Journal of Shoulder and Elbow Surgery. 2023;32(6):1314–1322. doi:10.1016/j.jse.2023.01.033 (PMID 36871608). Ten case-control studies: thyroid disease more common with frozen shoulder, “especially when presenting as hypothyroidism or subclinical hypothyroidism”; an association with hyperthyroidism “was not found.”
- Choudhry MN, Malik RA, Charalambous CP. Blood glucose levels following intra-articular steroid injections in patients with diabetes: a systematic review. JBJS Reviews. 2016;4(3):e5. doi:10.2106/JBJS.RVW.O.00029 (PMID 27500431). All seven studies showed a rise in blood glucose, often within 24 to 72 hours; patients “should be advised to regularly monitor their blood glucose levels for up to a week after injection.”
- Akin-Takmaz S, Babaoglu G, Başar H, Baltacı B. Evaluation of the effects of intraarticular glucocorticoid injections on blood glucose levels in diabetes mellitus and nondiabetes mellitus patients with adhesive capsulitis of the shoulder. Nigerian Journal of Clinical Practice. 2021;24(2):277–281. doi:10.4103/njcp.njcp_198_20 (PMID 33605920).
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Fasting glucose was higher 1 and 7 days after a shoulder injection, most in people with diabetes, and back to baseline by day 15; monitor blood glucose frequently for the 2 weeks after. - American Physical Therapy Association. Direct access advocacy. “As of July 1, 2025, all 50 states, the District of Columbia, and the U.S. Virgin Islands have either provisional or unrestricted direct access to physical therapist services for evaluation and treatment,” though some provisions tied to treatment without a referral persist in a number of states. Checked October 6, 2026.
- Millar NL, Meakins A, Struyf F, et al. Frozen shoulder. Nature Reviews Disease Primers. 2022;8(1):59. doi:10.1038/s41572-022-00386-2 (PMID 36075904). Management options include physiotherapy, steroid injections, anti-inflammatory medicines, hydrodilation and surgery; “however, their effectiveness remains unclear.”
- Buchbinder R, Green S, Youd JM, Johnston RV. Oral steroids for adhesive capsulitis. Cochrane Database of Systematic Reviews. 2006;(4):CD006189. doi:10.1002/14651858.CD006189 (PMID 17054278). Oral steroids give “significant short-term benefits in pain, range of movement of the shoulder and function … but the effect may not be maintained beyond six weeks.”
- Page MJ, Green S, Kramer S, Johnston RV, McBain B, Buchbinder R. Electrotherapy modalities for adhesive capsulitis (frozen shoulder). Cochrane Database of Systematic Reviews. 2014;(10):CD011324. doi:10.1002/14651858.CD011324 (PMID 25271097). 19 trials: low-level laser therapy may help; whether ultrasound, diathermy, TENS and other modalities add to exercise is uncertain.
- Okuno Y, Yasumoto T, Koganemaru M, et al. Transarterial embolization of neovascularity for refractory nighttime shoulder pain: a multicenter, open-label, feasibility trial. Journal of Vascular and Interventional Radiology. 2022;33(12):1468–1475.e8. doi:10.1016/j.jvir.2022.08.016 (PMID 35995121).
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100 patients at 5 institutions, 76 with adhesive capsulitis and 24 with rotator cuff tears, treated through the radial artery; across all patients, night pain fell from 6.4 to 1.6 and anterior elevation rose from 97° to 151° at 6 months; “No patient experienced a major adverse event.” - Allaw S, Khabaz K, Yu Q, Ahmed O. Transarterial embolization for refractory adhesive capsulitis and related tendinopathies: a systematic review and meta-analysis. Journal of Vascular and Interventional Radiology. 2026;37(2):107896. doi:10.1016/j.jvir.2025.10.027 (PMID 41161413). Twelve single-arm studies to March 2025: “Evidence is limited by uncontrolled designs, short follow-ups, and high heterogeneity, highlighting the need for randomized controlled trials.”
- Pelage JP, Aldalmani T, Geevarghese R, et al. Transarterial embolization in musculoskeletal care: an indication-stratified narrative review. CVIR Endovascular. 2026;9(1):127. doi:10.1186/s42155-026-00776-7 (PMID 42828599). Literature to June 24, 2026: “embolization for adhesive capsulitis remains exploratory … the natural history of the disease, small sample sizes, and limited comparative data prevent firm conclusions regarding treatment effect.”
- Buchbinder R, Green S, Youd JM, Johnston RV, Cumpston M. Arthrographic distension for adhesive capsulitis (frozen shoulder). Cochrane Database of Systematic Reviews. 2008;(1):CD007005. doi:10.1002/14651858.CD007005 (PMID 18254123).
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In the trial at low risk of bias, “distension with saline and steroid was better than placebo for pain … function … and range of movement at three weeks”; mainly minor adverse effects, chiefly pain during and after the procedure. - Wang B, Kuan FC, Gean CY, et al. Comparison of therapeutic efficacy between arthroscopic capsular release and transarterial musculoskeletal embolization in patients with adhesive capsulitis of the shoulder. Journal of Shoulder and Elbow Surgery. 2026;35(9):2225–2233. doi:10.1016/j.jse.2026.03.011 (PMID 41903674).
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A retrospective comparison of 40 patients: lower pain scores with embolization at 3 months, but “by 6 months, no significant differences were observed in any outcome measures.” - ClinicalTrials.gov, US National Library of Medicine. Comparison of transcatheter arterial microembolization and corticosteroid injection for treatment of frozen shoulder (NCT07696923). A randomized trial in Taipei comparing embolization with corticosteroid injections; recruiting since August 2026, no results posted. Checked October 6, 2026.
- ClinicalTrials.gov, US National Library of Medicine. Transcatheter arterial embolization using Nexsphere-F for chronic shoulder pain refractory to conservative treatment (NCT07336849). An open-label randomized trial in Seoul comparing embolization with usual conservative care for adhesive capsulitis; recruiting, no results posted. Checked October 6, 2026.
- van Zadelhoff TA, van der Heijden RA, Bierma-Zeinstra SMA, Bos PK, Oei EHG. Perspective: genicular artery embolization for knee osteoarthritis — when the hype doesn’t match the evidence. Osteoarthritis Imaging. 2025;5(4):100376. doi:10.1016/j.ostima.2025.100376 (PMID 42239634). Of three sham-controlled randomized trials, the first was positive and “the most recent two RCTs reported no significant effect of GAE compared to a sham treatment.”
- American Academy of Orthopaedic Surgeons, OrthoInfo. Rotator cuff and shoulder conditioning program. Checked October 6, 2026.
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A general program after injury or surgery, “performed under your doctor’s supervision”; continued “for 4 to 6 weeks, unless otherwise specified”; warm up 5 to 10 minutes; “You should not feel pain during an exercise”; the pendulum, crossover arm stretch and passive internal and external rotation with their repetitions and step-by-step directions, as quoted in the exercise cards. - Page MJ, Green S, Kramer S, et al. Manual therapy and exercise for adhesive capsulitis (frozen shoulder). Cochrane Database of Systematic Reviews. 2014;(8):CD011275. doi:10.1002/14651858.CD011275 (PMID 25157702).
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32 trials: manual therapy and exercise for six weeks “probably results in less improvement at seven weeks” than a glucocorticoid injection (treatment success 46% against 77%), and differences at 6 and 12 months “were not clinically important.” - Centers for Medicare & Medicaid Services. Physical therapy services (Medicare.gov). Checked October 6, 2026.
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Part B “helps pay for medically necessary outpatient physical therapy”; “After the Part B deductible, you pay 20% of the Medicare-approved amount”; your doctor or other provider “must certify that you need it”; “There’s no limit on how much Medicare pays for your medically necessary outpatient therapy services in one calendar year.”
Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider about your individual situation. Seek urgent medical attention for any of the symptoms listed above.