Understanding Frozen Shoulder: Symptoms, Causes, and Treatment

By Lauren Rudolph, MD and Laura Schmonsees, DPT

What Is Frozen Shoulder?

Frozen shoulder, also called adhesive capsulitis, happens when the lining (capsule) around your shoulder joint becomes inflamed, thickened, and scarred. This makes the shoulder painful and stiff, and it becomes hard to move your arm — even when someone else tries to move it for you. It usually affects one shoulder at a time.

Who Gets It?

Frozen shoulder affects roughly 2 to 5 out of every 100 people. It is most common between ages 40 and 70, and it happens more often in women than in men. Many women first notice it during the years around menopause (perimenopause and menopause).

Other things that raise the risk include:

• Diabetes (a strong risk factor)
• Thyroid problems, especially an underactive thyroid
• A period of not moving the shoulder (for example after an injury or surgery)
• Heart disease and abnormal cholesterol

Why Does It Seem Linked to Menopause?

The hormone estrogen normally helps calm inflammation and protect tissues from scarring. During perimenopause and menopause, estrogen levels drop. Researchers believe this drop may make the shoulder capsule more likely to become inflamed and scarred, which may help explain why frozen shoulder is more common, and sometimes more severe, in women during these years. This is an active area of research, and estrogen loss is thought to be one of several contributing factors rather than the only cause.

What Does It Feel Like? The Three Stages

Frozen shoulder usually moves through three overlapping stages. The whole process often lasts 1 to 3 years, though it varies a lot from person to person.

• Freezing (painful) stage — about 2 to 9 months. Pain builds up, often worse at night and when lying on that side. The shoulder gradually gets stiffer.
• Frozen (stiff) stage — about 4 to 12 months. Pain often eases, but stiffness is at its worst. Everyday tasks like reaching overhead, fastening a bra, or reaching into a back pocket become difficult.
• Thawing (recovery) stage — about 5 months to 2 years. Movement slowly returns.

Most people improve, but recovery can be slow, and some people have lingering stiffness or discomfort even after the process runs its course.

You don’t have to just live with it! See treatment options below!

How Is It Treated?

The goals of treatment are to relieve pain and restore movement. Most people get better without surgery. Common options include:

• Pain relief: Over-the-counter anti-inflammatory medicines (such as ibuprofen). However, if you don’t want to take medications for this, come see us to discuss alternative options!
• Exercise: Gentle stretching and exercises to keep and rebuild movement. This is a cornerstone of treatment, especially in the stiff and recovery stages.
• Injection: An injection into the joint can reduce pain and speed recovery, and works especially well when combined with physical therapy. Early injection may shorten how long symptoms last.
• Hydrodilatation (capsule distension): Fluid is injected into the joint to gently stretch and expand the tight capsule. This can improve pain and movement.
• Energy medicine: Shockwave therapy or laser therapy are sometimes used. For people with diabetes, non-steroid options may be preferred to avoid raising blood sugar.
• Dry needling: A physical therapist inserts thin needles into tight, tender knots (trigger points) in the muscles around the shoulder to ease pain and allow more movement during therapy. In studies, dry needling used with physical therapy has been associated with short-term improvements in pain, shoulder motion, and function in people with frozen shoulder.

We often combine treatments to help people feel better and move better faster!

Living with Frozen Shoulder

• Keep moving the shoulder within a comfortable range. Total rest can make stiffness worse.
• Use heat before stretching and stay consistent with your exercise program.
• If you have diabetes or a thyroid condition, keeping it well controlled may help.
• Be patient. Recovery is often slow, but the outlook is generally good.

References

Challoumas, D., Biddle, M., McLean, M., & Millar, N. L. (2020). Comparison of treatments for frozen shoulder: A systematic review and meta-analysis. JAMA Network Open, 3(12), Article e2029581. https://doi.org/10.1001/jamanetworkopen.2020.29581

Hussien, N., Mogahed, H., Abdelmoneim, M., & Saafan, K. I. (2023). Dry needling versus muscle energy technique on shoulder adhesive capsulitis post mastectomy. Fizjoterapia Polska, 23(3), 22–28.

Ji, R., Huang, W., Weng, M., & Zhang, M. (2025). Comparative effectiveness of acupuncture-related therapies for frozen shoulder: A systematic review and network meta-analysis. Frontiers in Medicine, 12, Article 1500123. https://doi.org/10.3389/fmed.2025.1500123

Kalia, V., & Mani, S. (2020). Dry needling with and without paraspinal needling in patients with adhesive capsulitis: A randomized clinical trial. International Journal of Physiotherapy, 7(3), 98–104.

Kalia, V., Mani, S., & Kumar, S. (2020). Short-term effect of myofascial trigger point dry-needling in patients with adhesive capsulitis. Journal of Bodywork and Movement Therapies, 25, 146–150. https://doi.org/10.1016/j.jbmt.2020.11.003

Mülkoğlu, C., Tiftik, T., Deniz, A. B., Kandaşoğlu, H., & Genç, H. (2024). Additive effect of glenohumeral joint hydrodilatation applied in addition to suprascapular nerve blockage in patients with adhesive capsulitis. BMC Musculoskeletal Disorders, 25(1), Article 945. https://doi.org/10.1186/s12891-024-08068-1

Mullen, J. P., Hauer, T. M., Lau, E. N., & Lin, A. (2025). Adhesive capsulitis of the shoulder. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 41(7), 2176–2178. https://doi.org/10.1016/j.arthro.2025.02.011

Navarro-Ledesma, S. (2025). Frozen shoulder as a systemic immunometabolic disorder: The roles of estrogen, thyroid dysfunction, endothelial health, lifestyle, and clinical implications. Journal of Clinical Medicine, 14(20), Article 7315. https://doi.org/10.3390/jcm14207315

Rangan, A., Brealey, S. D., Keding, A., Corbacho, B., Northgraves, M., Kottam, L., Goodchild, L., Cooper, C., Sharples, G. J., Torgerson, D. J., & UK FROST Study Group. (2020). Management of adults with primary frozen shoulder in secondary care (UK FROST): A multicentre, pragmatic, three-arm, superiority randomised clinical trial. The Lancet, 396(10256), 977–989. https://doi.org/10.1016/S0140-6736(20)31961-0

Takele, M. D., Kibret, A. K., Belay, G. J., & Workie, B. S. (2025). The effectiveness of Spencer muscle energy technique on pain, function and range of motion in patients with frozen shoulder: Systematic reviews and meta-analyses. BMC Musculoskeletal Disorders, 26(1), Article 793. https://doi.org/10.1186/s12891-025-08912-2

Wang, Z., Li, X., Liu, X., Zhang, Y., & Chen, J. (2025). Mechanistic insights into the anti-fibrotic effects of estrogen via the PI3K-Akt pathway in frozen shoulder. The Journal of Steroid Biochemistry and Molecular Biology, 249, Article 106701. https://doi.org/10.1016/j.jsbmb.2025.106701