Frozen shoulder: how long it lasts, who gets it and what actually helps

Frozen shoulder, called adhesive capsulitis by clinicians, is a painful stiffening of the shoulder joint. The tissue around the joint becomes inflamed, then tightens and shrinks [6]. The hallmark is a shoulder that hurts and will not move far, even when someone else tries to move it for you.

Who gets it

• Age and sex: it is most common between about 40 and 65, and in women [1] [5].
• Diabetes: this is the strongest known link. In a review of 18 studies, people with diabetes were about 5 times more likely to have frozen shoulder, and about 13% of people with diabetes had it [3]. Studies that followed people over time found a smaller but still real increase in risk [4]. About 30% of people with frozen shoulder have diabetes [3].
• Other links: thyroid disease [1] [5], and an injury or surgery that keeps the arm still [6].
• The other shoulder: between 5% and 34% of people later develop it in the other shoulder [1].

Because of the diabetes link, the authors of the large review suggest considering a diabetes check in people with frozen shoulder [3].

How long does it last?

Frozen shoulder is often described in stages: a painful “freezing” phase, a stiff “frozen” phase and a gradual “thawing” phase. The orthopedic surgeons’ patient guide puts freezing at about 6 weeks to 9 months, frozen at 4 to 6 months and thawing at 6 months to 2 years, with full recovery taking up to 3 years [5]. In practice the stages overlap a lot and are of limited use for treatment decisions [2].

Does it go away on its own? Mostly, but not always completely. MedlinePlus says that, left untreated, it often gets better by itself within 2 years [7]. But a systematic review found no good evidence that it reliably resolves fully without treatment, and found that most improvement happens early rather than late [8]. In a study of 223 people followed for an average of 4.4 years:

• Normal or near-normal shoulder59%
• Some ongoing symptoms, mostly mild41%

Source: Hand et al., Journal of Shoulder and Elbow Surgery, 2008 [9]. 269 shoulders in 223 people. Of those with ongoing symptoms, 94% described them as mild.

People with the worst symptoms at the start tended to have the worst long-term outcome [9], and people with diabetes may recover more slowly [1]. A fair summary: most people get much better, but many keep some mild pain or stiffness for years.

What helps

A steroid injection, combined with exercise, has the strongest evidence for faster relief. The physical therapy guideline gives its top grade to a steroid injection into the joint plus mobility and stretching exercises, for better pain relief and function in the first 4 to 6 weeks than exercise alone [1]. A review of 65 studies found an injection into the joint was the only treatment that was clearly better in the short term, especially in the first year of symptoms, and recommended pairing it with a home exercise program [10].

A Cochrane review shows the size of that early difference compared with six weeks of manual therapy and exercise alone:

At 7 weeks	Steroid injection	Manual therapy and exercise
Pain improvement, 0 to 100 scale	58 points	32 points
Function improvement, 0 to 100 scale	39 points	14 points
People reporting success	77%	46%
People reporting side effects	53%	56%

Source: Page et al., Cochrane review, 2014, based on one trial of about 107 people [11]. Differences were not clinically important by 6 and 12 months.

Physical therapy still has a role, and gentle seems better than aggressive. The physical therapy guideline recommends education about the natural course of frozen shoulder, adjusting activities, and stretching matched to how irritable the shoulder is [1]. In a study of 77 people, gentle exercise within pain limits did better over 2 years than intensive stretching and mobilization: 89% vs. 63% reached normal or near-normal function [12]. That study did not describe random assignment, so it is not conclusive. The UK shoulder society’s 2025 pathway is honest that it is unknown whether supervised physical therapy alone beats the natural course, and it recommends offering physical therapy after an injection [2].

Hydrodilatation, an injection that stretches the joint capsule with fluid, gave at least a short-term improvement in disability and better outward rotation than a steroid injection alone, but its clinical value remains unclear [14].

Surgery is considered when symptoms persist despite non-surgical care [5]. The largest trial, UK FROST, compared two procedures with early structured physical therapy plus a steroid injection in 503 adults:

• Keyhole surgery to release the capsule40.3
• Manipulation under anesthesia38.3
• Physical therapy plus steroid injection37.2

Source: Rangan et al., The Lancet, 2020 [13]. None of the differences was large enough to be clinically important.

None of the three approaches was clinically better than the others at a year, and the keyhole surgery had more serious side effects (8 vs. 2 with manipulation) [13]. In other words, most people do not need surgery to get a good result.

What you can do now

The NHS suggests [6]:

• Keep moving your shoulder gently, since keeping it still can make the pain worse
• Do the exercises your clinician gives you, rather than making up strenuous ones, such as with gym equipment
• Use a heat pack wrapped in a towel for up to 20 minutes at a time
• Take pain relief as directed, starting with acetaminophen

Gentle home stretches, such as rotating your body away from a doorway with your elbow bent or using your good arm to lift the stiff one overhead while lying down, are commonly prescribed; ask your therapist how many to do [5]. Physical therapy usually lasts at least 6 weeks [6].

See a clinician if pain and stiffness do not go away or make it hard to move your arm [6], or if shoulder pain lasts more than 2 to 4 weeks despite home care [15].

Call 911 for sudden pressure or crushing pain in the shoulder, especially if it spreads to the chest, jaw, arm or neck, or comes with shortness of breath, dizziness or sweating: it can be a heart attack [15]. Go to the emergency room after a severe injury with a very painful, swollen, bruised or bleeding shoulder [15]. Shoulder pain with fever, swelling or redness also needs prompt medical attention [15].

The takeaway

• Frozen shoulder is most common in midlife, in women and in people with diabetes.
• It usually improves over 1 to 3 years, but many people keep mild symptoms.
• A steroid injection with home exercise gives the fastest early relief.
• Gentle exercise within pain limits seems to work better than forcing the stretch.
• Most people do not need surgery, and the large trials found no clear advantage for it at a year.

You can start physical therapy in Utah without a referral. If your shoulder is painful and getting stiffer, an evaluation can confirm the cause, coordinate with your doctor about an injection if it makes sense and build a plan that respects how irritable your shoulder is.