A frozen shoulder commonly lasts one to three years and moves through three phases: painful, stiff, then thawing. It usually settles on its own eventually, but treatment matters, because the right approach in the right phase reduces the pain and can shorten the stiff phase considerably.
Frozen shoulder, or adhesive capsulitis, is one of the more frustrating musculoskeletal conditions to live with. There is often no injury to point at, the pain is worst at night, and the shoulder gets steadily stiffer for months before it starts improving.
It also gets treated badly quite often, usually by stretching hard at the wrong time. Understanding which phase you are in changes what you should be doing.
What is actually happening in the shoulder
The shoulder joint sits inside a capsule of connective tissue. In a frozen shoulder, that capsule becomes inflamed, thickens and contracts. The joint physically has less room to move in.
That is why the hallmark sign is loss of passive movement. If someone else lifts and rotates your arm, it still will not go past a certain point, particularly rotating outwards. That is what separates it from most other shoulder problems, where someone else can move the arm further than you can move it yourself.
Who tends to get it
- Most commonly between about 40 and 60 years of age
- More common in women
- Much more common in people with diabetes, where episodes also tend to run longer
- Associated with thyroid conditions
- Can follow a period of the arm being immobilised, for example after a fracture or shoulder surgery
- Often starts with no clear cause at all
The three phases
| Phase | Typical duration | What it feels like |
|---|---|---|
| 1. Freezing, the painful phase | 2 to 9 months | Pain builds, often severe and worst at night. Movement reduces gradually. This is when most people first seek help. |
| 2. Frozen, the stiff phase | 4 to 12 months | Pain settles somewhat, but the shoulder is markedly stiff. Reaching behind the back, doing up a bra, reaching a seatbelt or a high shelf becomes difficult. |
| 3. Thawing | 5 to 24 months | Movement returns gradually. Most people regain most of their range, although a small residual restriction is not unusual. |
The phases overlap, and the timeframes vary a lot between people. Diabetic frozen shoulders in particular tend to sit at the longer end.
What helps, phase by phase
The medical side of the pathway runs in a set order. While the shoulder is painful, that is the window for corticosteroid injection, and where pain persists it is commonly two injections about six weeks apart. Hydrodilatation comes after that, once the pain has reduced and stiffness is what is left. The order matters, because hydrodilatation works by stretching the capsule and does more for a shoulder that is stiff than for one that is still acutely painful.
Painful phase
The priority is pain control and keeping whatever movement you have, not forcing new movement.
- Corticosteroid injection. There is reasonable evidence that an injection given early in the painful phase, combined with physiotherapy, gives better outcomes than either on its own. Where the shoulder stays painful, two injections about six weeks apart is the usual course. This is a conversation with your GP or a specialist, and your physiotherapist can write the referral request.
- Gentle range of movement within a tolerable range, rather than pushing into pain.
- Sleep positioning. Night pain is the worst part of this phase. Lying on the other side with the sore arm supported on a pillow in front of you helps most people.
- Pain relief discussed with your GP or pharmacist.
Stiff phase
Now stretching earns its place, because the limiting factor is a contracted capsule rather than inflammation.
- Sustained stretching held for longer periods, done frequently, done daily
- Joint mobilisation by a physiotherapist
- Strengthening of the muscles around the shoulder blade, which lose condition through months of reduced use
- Hydrodilatation is the usual next step once the pain has reduced and stiffness is the main problem. It involves injecting fluid into the joint under imaging to stretch the capsule, and is followed immediately by physiotherapy to use the range it opens up.
Thawing phase
Range comes back, and the job becomes rebuilding strength and confidence so the shoulder does the things you stopped doing a year ago. This phase is often left undone, which is why some people end up with a shoulder that moves but still feels unreliable.
What tends to make it worse
- Hard, aggressive stretching during the painful phase
- Stopping using the arm entirely, which speeds up the stiffening
- Waiting a year before getting it assessed, so the most useful window for an early injection passes
- Assuming it is a rotator cuff problem and treating it as one
When surgery is considered
Most frozen shoulders do not need surgery. Where pain and stiffness persist beyond six to twelve months despite good treatment, a surgeon may discuss manipulation under anaesthetic or arthroscopic capsular release. Both are followed by intensive physiotherapy, and the rehabilitation afterwards is a substantial part of the result.
Getting it assessed
Frozen shoulder is diagnosed clinically. A physiotherapist tests passive and active movement, particularly external rotation, and screens for the other conditions that present similarly, including rotator cuff problems, shoulder arthritis and referred neck pain. Imaging is sometimes used to rule things out rather than to confirm the diagnosis.
Getting a name for it early is worth a lot on its own. Knowing that the shoulder is going to be sore for months, that this is expected, and that it does resolve, changes how people manage it.
Frozen shoulder treatment in Caloundra and across the Sunshine Coast
Fortius Allied Health assesses and treats frozen shoulder at Caloundra, Birtinya, Noosaville and Gympie.
The Caloundra clinic at 41 Bombala Terrace has good availability at present, with appointments from 7am to 5:30pm. No referral is needed for a private appointment, and where an injection or a specialist opinion would help, your physiotherapist will write to your GP.
For people whose frozen shoulder is linked to diabetes, the exercise physiology team also works on blood glucose management through exercise, which is part of the same picture. You can book online or phone 07 5293 6000. If your shoulder pain does not fit this description, the general shoulder pain page covers the other common causes.
Frequently asked questions
How long does a frozen shoulder last?
Frozen shoulder commonly lasts between one and three years if left alone. It moves through a painful phase of roughly two to nine months, a stiff phase of four to twelve months, and a thawing phase of five to twenty four months. Treatment does not make the condition disappear, but it can reduce pain and shorten the stiff phase.
What is the fastest way to fix a frozen shoulder?
There is no quick fix, but early treatment shortens the course. In the painful phase, corticosteroid injection combined with physiotherapy has better evidence than either on its own, and where the shoulder stays painful that commonly means two injections about six weeks apart. Once the pain has reduced and stiffness is what is left, hydrodilatation followed by sustained stretching and joint mobilisation is the usual next step. Aggressive stretching early tends to make it worse.
How do I know if I have a frozen shoulder or a rotator cuff problem?
The distinguishing sign is loss of passive movement. With a frozen shoulder, someone else moving your arm cannot get it any further than you can, and rotating the arm outwards is markedly restricted. With a rotator cuff problem, passive movement is usually much better than active movement. A physiotherapist can tell the difference in one assessment.
Why does diabetes cause frozen shoulder?
People with diabetes develop frozen shoulder considerably more often than the general population, and their episodes tend to last longer and respond more slowly. The likely mechanism involves changes to collagen in the joint capsule associated with long term raised blood glucose. Managing blood glucose is part of managing the shoulder.
Should I keep stretching a frozen shoulder through the pain?
Not in the painful phase. Pushing hard into pain while the capsule is inflamed tends to increase pain and can prolong the episode. Gentle movement within a tolerable range is appropriate early. Firmer stretching becomes useful later, once the shoulder is stiff rather than acutely painful.
How many cortisone injections can you have for a frozen shoulder?
Where a frozen shoulder stays painful, two corticosteroid injections about six weeks apart is a common course. Injections are aimed at the painful phase rather than the stiff phase. Once the pain has reduced and stiffness is the main problem, hydrodilatation is generally the more useful next step. Your GP or specialist makes that decision.
Where can I get frozen shoulder treatment in Caloundra?
Fortius Allied Health assesses and treats frozen shoulder at its Caloundra clinic, 41 Bombala Terrace, and at Birtinya, Noosaville and Gympie. No referral is needed for a private appointment. Appointments run from 7am to 5:30pm. Phone 07 5293 6000.
About Fortius Allied Health
This article is general information and is not a substitute for individual clinical advice. Injections, imaging and surgery are medical decisions made with your GP or specialist. Fortius Allied Health physiotherapists are registered with the Australian Health Practitioner Regulation Agency.
