Skip to main content

Health condition · Clinically reviewed

Frozen shoulder, painful, stiff, and treatable with the right plan.

Adhesive capsulitis moves through three phases over one to three years. Physiotherapy, injections and, where needed, hydrodilatation or keyhole release restore movement.

Jump to treatment
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE, BOA and peer-reviewed shoulder society sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including hydrodilatation, image-guided steroid injection and arthroscopic capsular release.

Key facts

Frozen shoulder at a glance.

The essentials in plain English, what it is, who it affects, and how it is treated in the UK today.

  • What it is

    Adhesive capsulitis, a painful inflammation and thickening of the glenohumeral joint capsule that stiffens the shoulder.

  • How common

    Affects roughly 2 to 5 per cent of the general population, more often women, with a peak between the ages of 40 and 60.

  • Types

    Primary (idiopathic, no clear trigger) and secondary (linked to diabetes, thyroid disease, injury, surgery or immobilisation).

  • Three stages

    Freezing (painful), frozen (stiff) and thawing (recovery), typically running over one to three years in total.

  • The hallmark

    A striking loss of external rotation, with both active and passive movement equally limited on examination.

  • Treatment

    Analgesia, targeted physiotherapy, image-guided steroid injection, hydrodilatation and, in refractory cases, arthroscopic capsular release.

Why this guide matters

A phased plan, not endless waiting.

Frozen shoulder is a self-limiting but often prolonged condition. Matching treatment to the current phase is what shortens the pain and restores movement.

  • Diagnosis is largely clinical

    History and a careful shoulder examination confirm the diagnosis. Imaging is used to exclude other causes, not to make the diagnosis on its own.

  • Injections change the freezing phase

    Image-guided steroid injection and hydrodilatation are highly effective in the painful early phase and can shorten months of suffering.

  • Surgery is reserved, not first

    Arthroscopic capsular release helps a small group who remain stiff and painful after good non-operative care. It is not a first-line treatment.

How the diagnosis is made

From painful shoulder to a clear plan.

The steps a UK GP or shoulder specialist will normally follow, in order, so you know what to expect and why each one matters.

  1. 01

    Assessing

    History and timeline

    A careful story of onset, night pain, progression and any diabetes, thyroid or shoulder-surgery history that raises suspicion.

  2. 02

    Assessing

    Shoulder examination

    Testing active and passive range of movement in every plane, with particular attention to external rotation and abduction.

  3. 03

    Assessing

    Distinguishing from cuff tears

    In frozen shoulder both active and passive movement are lost. In a rotator cuff tear passive movement is often preserved.

  4. 04

    Confirming

    Plain X-ray

    Usually normal in frozen shoulder, but useful to exclude glenohumeral arthritis, calcific tendonitis and other bony causes of stiffness.

  5. 05

    Confirming

    MRI or ultrasound

    Not always needed, but can show a thickened, inflamed capsule and rule out coexisting rotator cuff or labral pathology when the picture is atypical.

  6. 06

    Confirming

    Screen the whole patient

    Consider HbA1c and thyroid function, particularly in bilateral or younger cases, since diabetes carries roughly a fivefold risk.

  7. 07

    Planning

    Specialist shoulder review

    A shoulder surgeon or musculoskeletal physician confirms the diagnosis, agrees the stage and plans injections, hydrodilatation or surgery.

Typical timeline: an initial diagnosis and plan within one or two visits, refined with imaging as needed.

Symptoms

What frozen shoulder actually feels like.

Deep, aching shoulder pain that gradually gives way to a striking loss of movement, particularly external rotation, and disturbed sleep.

  • Progressive pain and stiffness

    A gradual onset of deep shoulder pain that slowly gives way to marked stiffness over weeks and months.

  • Loss of external rotation

    The hallmark finding. Turning the hand outwards with the elbow tucked in becomes almost impossible.

  • Loss of abduction and reach

    Lifting the arm sideways and overhead is limited early, often before other movements.

  • Night pain

    Pain that wakes you at night and stops you lying on the affected side is very characteristic, especially in the freezing phase.

  • Global loss of movement

    Both active and passive movement are equally reduced, unlike rotator cuff problems where only active movement is limited.

  • Difficulty with everyday tasks

    Dressing, brushing hair, fastening a bra and reaching a back pocket become frustratingly hard.

  • Slow, three-stage course

    Freezing, frozen and thawing phases run in sequence, together lasting anything from one to three years.

  • Red flag, atypical features

    Sudden severe pain, systemic illness, night sweats or a history of cancer needs urgent review rather than a frozen-shoulder label.

Treatment

How frozen shoulder is treated in the UK.

A stepped plan of education, analgesia and shoulder-focused physiotherapy, with image-guided injection, hydrodilatation and, rarely, keyhole capsular release.

  • Education and reassurance

    Explaining the three-stage course and the expected recovery is powerful. It sets realistic expectations and reduces fear-driven disuse.

  • Simple analgesia and NSAIDs

    Regular paracetamol and, where safe, an oral NSAID can take the edge off pain enough to allow gentle movement and better sleep.

  • Specialist shoulder physiotherapy

    Gentle, stage-appropriate stretching and range-of-movement work with a shoulder-focused physiotherapist. See our physio clinic guide.

  • Image-guided steroid injection

    An intra-articular injection under ultrasound or fluoroscopy is highly effective in the painful freezing phase. See cortisone injection large joint.

  • Hydrodilatation

    Injection of a large volume of saline with steroid and local anaesthetic that distends and gently ruptures the tight capsule.

  • Manipulation under anaesthesia

    Selective option for stubborn cases where a controlled manipulation under a general anaesthetic breaks capsular adhesions.

  • Arthroscopic capsular release

    Keyhole shoulder surgery to divide the thickened capsule in refractory cases where injections and physiotherapy have not restored movement.

  • Optimising comorbidities

    Tightening diabetes control and correcting thyroid disease supports recovery and reduces the risk of recurrence in the other shoulder.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or shoulder specialist knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE Clinical Knowledge Summaries. Shoulder pain and frozen shoulder.

  • British Elbow and Shoulder Society (BESS). Patient guidance on frozen shoulder.

  • British Orthopaedic Association (BOA). Standards for the management of shoulder conditions.

  • Royal College of Radiologists. Guidance on image-guided joint injection and hydrodilatation.

Red flags

When shoulder pain needs urgent attention.

Most frozen shoulder is managed in primary care and outpatient clinics. These are the situations where a specialist opinion should not wait.

  • Sudden severe shoulder pain

    A very acute, unrelenting pain with no clear trigger deserves urgent assessment rather than a frozen-shoulder label.

  • Fever, night sweats or weight loss

    Systemic symptoms alongside shoulder pain can point to infection or malignancy and need same-week review.

  • History of cancer

    Especially breast cancer with prior surgery or radiotherapy. Bony metastases can mimic capsulitis and require imaging.

  • Preceding significant trauma

    A recent fall or dislocation with sudden loss of movement suggests fracture, cuff tear or dislocation, not frozen shoulder.

  • Neurological symptoms

    New weakness, numbness or pins and needles in the arm may reflect a cervical spine or nerve problem and needs neurological review.

  • Bilateral rapid stiffening

    Rapidly progressive stiffness in both shoulders, particularly in a younger patient, warrants a broader medical work-up.

  • Failure to improve after 6 months

    Persistent severe pain and stiffness despite optimal non-operative care is a clear signal for shoulder-surgeon referral.

  • Uncontrolled diabetes

    Frozen shoulder in poorly controlled diabetes tends to be more severe and prolonged. Optimising glucose is part of treatment.

  • Post-breast surgery or radiotherapy

    Stiffness after breast surgery or chest-wall radiotherapy needs early physiotherapy and a low threshold for specialist input.

Living with it

A slow condition, with a clear ladder of help.

Four things that make the biggest difference day to day, gentle movement, protected sleep, respect for the phases and knowing when to escalate.

A quiet reminder

Small, steady stretches beat rare, forceful ones.

Frozen shoulder rewards patience. A few minutes a day of gentle, well-guided movement does more than an occasional intense session.

  1. 01 Movement

    Keep it moving, gently

    Little and often beats occasional heroic stretching. Short, regular sessions preserve the range you have.

  2. 02 Sleep

    Protect your nights

    A pillow under the affected arm and avoiding lying on that side can make the difference between rest and a broken night.

  3. 03 Pace

    Respect the three phases

    Painful phase, stiff phase, thawing phase. Expect months, not weeks, and let the plan match where you are.

  4. 04 Escalate

    Ask for more if stuck

    If pain or stiffness is not improving with physio and simple measures, an injection, hydrodilatation or specialist opinion is the next step.

Frequently asked

Everything we get asked about frozen shoulder.

Quick answers on stages, injections, hydrodilatation and when surgery is warranted.

  • What is frozen shoulder?

    Frozen shoulder, or adhesive capsulitis, is an inflammatory condition in which the capsule of the shoulder joint becomes painful, thickened and tight. It causes progressive pain and a marked loss of movement, particularly external rotation, and typically runs through freezing, frozen and thawing phases over one to three years.

  • How is it different from a rotator cuff injury?

    In frozen shoulder both active and passive movement are limited, because the capsule itself is tight. In a rotator cuff tear the passive movement is often preserved and the pattern of weakness and pain is different. A careful examination and, where needed, an ultrasound or MRI can tell them apart.

  • How long does frozen shoulder last?

    Most people improve substantially over one to three years, but this is highly variable. The freezing phase typically lasts six weeks to nine months, the frozen phase four to twelve months and the thawing phase six months to two years. Treatment can shorten the painful phases considerably.

  • Do steroid injections and hydrodilatation help?

    Yes, particularly in the painful freezing phase. An image-guided intra-articular steroid injection reduces pain and inflammation, and hydrodilatation adds a large volume of fluid that stretches and can gently rupture the tight capsule to restore movement.

  • When is surgery needed?

    Surgery is reserved for shoulders that remain painful and stiff after several months of good non-operative care, including physiotherapy and injections. Arthroscopic capsular release, a keyhole procedure to divide the thickened capsule, is the usual choice, sometimes combined with a manipulation under anaesthesia.

  • Why is diabetes so important?

    People with diabetes have around a fivefold risk of frozen shoulder, and their episodes tend to be more severe, more prolonged and more likely to affect both shoulders. Tightening glucose control is a core part of treatment and reduces the risk of recurrence.

Related content

Keep reading.

Pulse Healthcare concierge

Send us your enquiry

A concierge service for UK private healthcare. We match you with the best vetted clinics and consultants in our network - they then contact you directly.

So we can match you to the right clinician close to you.

We reply to every enquiry within 24 hours (Mon–Fri). Confidential - your details are never shared outside our vetted consultant network.