Frozen Shoulder: What It Is, What to Expect, and How We Can Help
A plain-language guide to understanding adhesive capsulitis — from diagnosis through to recovery — written for patients by the team at Sports Medicine Institute.
Frozen shoulder is one of the most frustrating conditions we see at Sports Medicine Institute — not because it can't be treated, but because it tends to creep up slowly, is often misunderstood, and can significantly impact your ability to do everyday things. The good news is that with the right care, the vast majority of people do recover.
What Is Frozen Shoulder?
Frozen shoulder — known medically as adhesive capsulitis — is a condition where the capsule of connective tissue surrounding the shoulder joint becomes inflamed, thickened, and stiff. Over time, this causes the capsule to tighten and scar tissue (called adhesions) to develop, progressively reducing how far the shoulder can move.
The shoulder is a ball-and-socket joint. The ball (the top of your upper arm bone) sits inside a socket in your shoulder blade, and the whole joint is enclosed by a flexible capsule. In a healthy shoulder, this capsule is loose enough to allow a wide range of movement. In a frozen shoulder, the capsule contracts and loses its flexibility — sometimes to a significant degree.
The name "frozen" comes from the characteristic loss of movement. The less you are able to move the shoulder due to pain, the stiffer it tends to become — a frustrating cycle that can take considerable time to resolve.
Important: Frozen shoulder is sometimes confused with a rotator cuff injury, bursitis, or other shoulder conditions. These are very different problems that require different treatments. An accurate diagnosis is essential before beginning any treatment, which is why seeing a qualified clinician first matters.
Who Gets Frozen Shoulder?
Frozen shoulder affects roughly 2–5% of the general population and is most commonly seen in people between the ages of 40 and 60. It is more common in women than men.
While it can happen to anyone, there are a number of factors that increase the risk:
- Diabetes mellitus (people with diabetes are x15 more times likely to develop frozen shoulder)
- Thyroid conditions — both underactive (hypothyroidism) and overactive (hyperthyroidism)
- Prolonged shoulder immobilisation, such as following a fracture or surgery
- Previous shoulder injuries, including rotator cuff tears
- Cardiovascular disease and stroke
- Parkinson's disease
In many cases, however, no clear cause can be identified. This is known as primary (idiopathic) adhesive capsulitis. When there is an identifiable cause — such as immobilisation following an injury — it is referred to as secondary adhesive capsulitis.
The Three Stages of Frozen Shoulder
Frozen shoulder typically progresses through three overlapping stages. Understanding these stages helps make sense of what you are experiencing and why treatment looks different at each point in time.
Pain is the dominant symptom, often severe and worse at night. Movement begins to become restricted. This is the most painful stage, and it can come on gradually without an obvious injury.
Stiffness is now the dominant symptom, with a significant loss of shoulder movement in all directions. Pain may ease somewhat, but daily activities such as dressing, reaching, and driving become difficult.
Movement gradually returns and pain continues to improve. Recovery is slow but progressive. With appropriate treatment and rehabilitation, most people regain a functional range of motion.
The full natural course of frozen shoulder — without intervention — can span anywhere from one to three years, and some research suggests that a portion of people never fully regain their pre-injury movement without treatment. This is why early and appropriate management makes a meaningful difference.
How Is Frozen Shoulder Diagnosed?
Frozen shoulder is primarily a clinical diagnosis — meaning it is diagnosed based on your symptoms, your history, and a physical examination rather than through imaging alone.
When you attend Sports Medicine Institute, one of our sports and exercise physicians will:
- Take a detailed history of your symptoms and when they started
- Ask about your medical history, including any relevant health conditions
- Examine both active and passive range of motion in the shoulder
- Assess for pain patterns and identify the direction of restriction
- Conduct screening tests to rule out other causes of shoulder pain
- Order blood tests if an underlying condition such as diabetes or a thyroid disorder is suspected
- Perform an in-house bulk-billed ultrasound and possibly refer for a bulk-billed MRI if needed to exclude other pathology
The hallmark of frozen shoulder on examination is a global restriction of shoulder movement — meaning movement is limited in multiple directions, both when you move the arm yourself and when the clinician moves it for you. This distinguishes it from other conditions where movement may only be restricted in certain directions.
How Is Frozen Shoulder Treated?
The good news is that the large majority of frozen shoulder cases are managed successfully without surgery. Treatment is tailored to the stage of your condition, your level of pain, and your individual circumstances.
Physiotherapy and Exercise
Physiotherapy is a cornerstone of frozen shoulder management at every stage. At Sports Medicine Institute, our highly trained physiotherapists develop an individualised program based on your current stage and your specific movement restrictions.
In the freezing stage, the focus is on gentle movement to prevent further stiffening, pain management strategies, and education about the condition. Importantly, aggressive stretching in this stage can make things worse — our physiotherapists carefully guide you to ensure the right level of activity.
In the frozen stage, a structured home exercise program becomes central to treatment, including range-of-motion exercises and gentle mobilisation techniques. Your physiotherapist may also use hands-on (manual) therapy to assist with joint mobility.
In the thawing stage, the focus shifts to progressive mobilisation and strengthening to restore full function and ensure the surrounding muscles are working well.
Oral Anti-inflammatory Medication
Non-steroidal anti-inflammatory medications (such as ibuprofen or naproxen) can help manage pain during the freezing stage. These are typically used as a short-term measure alongside other treatments and should be discussed with your treating doctor, as they are not appropriate for everyone.
Early Ultrasound-guided Corticosteroid Injection
Corticosteroid (cortisone) injections into the shoulder joint can provide significant pain relief and help reduce inflammation, particularly in the early freezing stage. Evidence supports their use in the first few months of the condition to ease symptoms and allow more effective participation in physiotherapy.
These injections are performed by our sports and exercise physicians, typically under ultrasound guidance to ensure accurate placement.
Later Ultrasound-guided Corticosteroid Injection with Hydrodilatation (Hydrodistension) and Manipulation Under Anaesthesia
When the condition has reached its frozen stage, the option of having an ultrasound-guided cortisone injection can also be combined with Hydrodilatation and Manipulation Under Anaesthesia. Hydrodilatation is a procedure in which a higher volume of local anaesthetic mixed with corticosteroid is injected into the shoulder joint under ultrasound guidance. The aim is to stretch and expand the tightened joint capsule, which can help improve movement and reduce pain — particularly when stiffness is the dominant issue. After the injection, our sports and exercise physicians can perform a gentle Manipulation Under Anaesthesia to accelerate the shoulder moving from the frozen stage to the thawing stage, significantly reducing the overall time of the condition by months or years. Following hydrodilatation, a structured physiotherapy program is important to maximise the benefit of the procedure.
Pain Management
Heat or cold packs before exercise, anti-inflammatory medications, and activity modification to manage pain during the early stages.
Corticosteroid Injection
Administered by our sports and exercise physicians under ultrasound guidance; most beneficial during the freezing stage to reduce inflammation and pain.
Physiotherapy
Individualised exercise programs, manual therapy, and guided rehabilitation throughout all stages — the single most important treatment component.
Hydrodilatation
Joint capsule distension using fluid injection, most useful when stiffness is the dominant issue; followed by physiotherapy to consolidate gains.
Surgery
Surgical intervention — typically in the form of arthroscopic (keyhole) capsular release or manipulation under anaesthesia — is reserved for cases where the condition has not responded to an adequate course of non-surgical treatment. This applies to a small minority of patients. If surgery is indicated, our team will coordinate an appropriate referral to an orthopaedic surgeon.
How Sports Medicine Institute Can Help You
At Sports Medicine Institute, we take an integrated, team-based approach to frozen shoulder. You benefit from having both a sports and exercise physician and a highly trained physiotherapist working together with a consistent understanding of your condition and your goals.
Sports & Exercise Physicians
Our specialist physicians provide an accurate diagnosis, identify any underlying contributing conditions (such as diabetes or thyroid issues), perform corticosteroid injections, and coordinate your overall management plan — including referral for hydrodilatation or specialist review when appropriate.
Physiotherapists
Our highly trained physiotherapists design and deliver individualised rehabilitation programs for each stage of your frozen shoulder, using evidence-based exercise therapy, manual therapy, and education to restore your movement and function progressively and safely.
Having access to both professions under one roof means your care is streamlined — your physiotherapist and physician communicate directly, adjusting your program as you progress through the stages of recovery.
Frequently Asked Questions
Will my frozen shoulder get better on its own?
Frozen shoulder is often described as a self-limiting condition — meaning it may eventually resolve without treatment. However, current evidence suggests that recovery can be slow and, in some cases, incomplete. Without treatment, symptoms can persist for years. Appropriate management significantly speeds recovery and reduces long-term limitation.
How long will recovery take?
This varies from person to person. With appropriate treatment, many people experience meaningful improvement within several months. Full recovery — particularly of movement — can take up to two to three years in some cases. Starting treatment early, completing your physiotherapy program, and staying consistent with home exercises all make a positive difference to outcomes.
Can I still exercise with a frozen shoulder?
Yes, in most cases — but the type and intensity of exercise needs to be carefully guided. Aggressive stretching or heavy overhead loading can aggravate the condition. Your physiotherapist will advise you on what movements are safe and helpful at each stage of your recovery.
Should I be worried if my other shoulder develops frozen shoulder too?
Frozen shoulder can develop in the other shoulder in approximately 6–17% of people, usually within five years of the first episode. This is something to be aware of, and any new symptoms in the opposite shoulder should be assessed promptly.
Is frozen shoulder related to my diabetes?
There is a well-established link between diabetes and frozen shoulder. People with diabetes are at significantly higher risk (x15), and frozen shoulder tends to be more persistent and harder to treat in this group. If you have diabetes and develop shoulder symptoms, it is especially important to seek an early assessment.
```Struggling with Shoulder Pain or Stiffness?
Our team at Sports Medicine Institute is here to help — from accurate diagnosis through to full rehabilitation. The earlier you seek assessment, the better your outcomes are likely to be.
Book an Appointment Call UsThis article has been written for general patient education purposes only. It does not constitute medical advice and is not a substitute for a consultation with a qualified healthcare professional. Individual presentations vary significantly, and treatment should always be tailored to your specific circumstances by your treating clinician. If you are experiencing shoulder pain or restricted movement, please seek a professional assessment. Sports Medicine Institute, Australia.
