Frozen Shoulder: How Long It Really Lasts

The shoulder joint sits inside a soft, stretchy envelope called the capsule. In frozen shoulder — the medical name is adhesive capsulitis — that capsule becomes inflamed, then thickens and tightens. The joint itself, the cartilage and the bone are usually perfectly healthy. The problem is that the envelope around them has shrunk.

That explains the two things patients notice. First, a deep, aching pain that is often worst at night and when the arm is jolted. Second, a stiffness that is different from ordinary soreness: the arm simply will not go further, no matter who pushes it. Reaching behind your back to tuck in a shirt or fasten a blouse, combing your hair, holding the overhead handle in a local train, putting on a seat belt — these are usually the first things to go.

It most often affects people between forty and sixty, women somewhat more than men. It is noticeably more common, more stubborn and more often on both sides in people with diabetes, and it is also linked to thyroid problems. Sometimes it follows a minor injury or a period of keeping the arm still. Very often there is no clear trigger at all, which patients find frustrating but is entirely normal.

Frozen shoulder runs through three stages. They overlap, and their length varies a great deal between people, but knowing which one you are in tells you what to expect and what to do.

• Freezing — the painful stage. Pain builds up over weeks to months and movement steadily reduces. Sleep is the main casualty; lying on that side often becomes impossible. This stage commonly lasts two to nine months.
• Frozen — the stiff stage. The pain eases, often quite a lot, but the stiffness stays. People sleep better and feel more themselves, yet still cannot reach the top shelf or behind their back. This usually lasts several months to a year.
• Thawing — the recovery stage. Movement slowly returns. It is gradual enough that many people only notice when they realise they have just done something they could not do a few months ago.

Put together, one to two years is a realistic expectation, and in people with diabetes it can be longer. Most recover all or nearly all of their movement. Some are left with a little stiffness at the extremes, which in day-to-day life most of them never notice.

I tell patients this timeline at the first visit on purpose. A frozen shoulder that is still stiff at four months is not failing to respond — it is behaving exactly as frozen shoulders do. Knowing that saves a great deal of worry, and a great deal of money spent chasing quick fixes.

The single most common mistake I see is the right treatment at the wrong time.

In the painful freezing stage, the goal is controlling pain, not forcing movement. A steroid injection into the shoulder joint, given early, is one of the most useful things we have here. It does not shorten the whole condition dramatically, but it calms the inflammation and often makes the worst months far more bearable — especially the nights. Simple painkillers, a pillow under the arm at night, and gentle movement within comfort all help.

What does not help in this stage is aggressive stretching. Being pushed hard by a therapist, or a relative trying to “open up” the shoulder, inflames an already angry capsule and frequently makes the pain worse. Pain-led, gentle exercises are the right approach early on.

In the stiff and thawing stages, exercises become the main treatment. Now regular, progressive stretching — a few minutes, several times a day, at home — genuinely speeds up the return of movement. A physiotherapist is useful for teaching the right exercises and checking progress, but the daily home work is what makes the difference.

Hydrodilatation, where the capsule is gently stretched by injecting fluid into the joint, is another option some patients benefit from, usually combined with a steroid. And if you are offered PRP or stem cell injections for a frozen shoulder, ask what evidence supports them. The same problem I described in my article on knee injections applies here: they are sold with far more confidence than the evidence currently justifies.

The great majority of frozen shoulders never need an operation. I consider one only when a shoulder remains significantly stiff and limiting after many months of proper treatment — and when the stiffness is genuinely interfering with work or daily life, not simply present.

The two procedures used are:

• Arthroscopic capsular release — keyhole surgery in which the tight capsule is released from the inside with fine instruments. It allows a controlled release and is usually my preference when surgery is needed.
• Manipulation under anaesthesia — the shoulder is moved firmly while you are asleep to stretch the capsule. It avoids incisions but carries a risk of fracture, particularly in older patients with thinner bones, so I am selective about who it suits.

Both are followed by early, intensive physiotherapy; the surgery restores the movement, and the exercises keep it. Neither is a shortcut in the early painful stage. Operating on a shoulder that is still in its acute inflammatory phase rarely ends well.

Not every painful, stiff shoulder is a frozen shoulder, and the difference matters because the treatment is completely different.

• Rotator cuff tear. The tendons over the top of the shoulder are torn, often after a fall or in older age. The arm is weak, but when someone else lifts it, it usually moves freely. In a frozen shoulder it will not move even when someone else tries.
• Shoulder arthritis. Less common than in the knee, but it causes stiffness too. This is where the X-ray earns its place.
• Neck problems. A trapped nerve in the neck can cause pain over the shoulder and down the arm, often with tingling in the hand, while the shoulder itself moves normally.

Come in promptly, rather than waiting it out, if:

• The shoulder became painful and weak after a fall or injury, and you cannot lift the arm.
• There is fever, redness or heat over the joint — infection must be ruled out.
• Left shoulder or arm pain comes on with exertion or with breathlessness, sweating or chest discomfort. That can be the heart, and it needs an emergency department, not an orthopaedic clinic.
• You have diabetes and the shoulder pain is severe and unrelenting despite painkillers.

If your shoulder has been stiff for some weeks and you are not sure which of these it is, an examination at the Mira Road clinic usually answers the question in a single visit. You can read other plain-language guides in the articles section.