Frozen Shoulder Timelines and Recovery

Frozen shoulder (adhesive capsulitis) causes progressive shoulder pain and loss of both active and passive range of motion due to thickening and stiffness of the shoulder joint capsule. It typically follows three stages (freezing, frozen, thawing) and can last 12 to 24 months.

Key points:

• Early on, pain and inflammation predominate; later, stiffness becomes the primary concern.
• Most people improve over time, but recovery is gradual and requires patience.
• Corticosteroid injections can reduce pain and speed early recovery when used in the first few months.
• Physiotherapy, including gentle range-of-motion exercises followed by strengthening, is central to treatment.
• Surgery is rarely needed.

Emerging research suggests peri-menopausal hormonal changes (especially declining estrogen) may increase the risk of frozen shoulder by affecting inflammation and connective tissue health, helping explain why it’s most common in women aged 45–60.
Bottom line: early diagnosis, stage-appropriate treatment, and consistent rehab lead to meaningful improvement for most people, even though full recovery can take time.

Frozen shoulder, known as adhesive capsulitis, is one of the most frustrating causes of shoulder pain. It presents with shoulder pain and progressive loss of range of motion in both active and passive shoulder movement. Patients with frozen shoulder often report a shoulder that “just won’t move,” particularly when attempting to lift their affected arm, reach across their chest, or place their hand behind their back.

Understanding the timeline and recovery process can significantly reduce fear and improve outcomes.

What Is Frozen Shoulder?

Frozen shoulder, also called adhesive capsulitis, is a condition where the shoulder joint capsule becomes inflamed, thickened, and stiff. The tissue known as the shoulder capsule surrounds the shoulder joint and helps contain synovial fluid, which allows smooth shoulder movement.

In frozen shoulder, the joint capsule and shoulder capsule thicken, lose elasticity, and develop adhesion. This reduces shoulder motion, particularly external rotation, flexion, and abduction. Unlike a rotator cuff tear, which primarily affects active shoulder strength, frozen shoulder limits both active and passive shoulder range of motion.

The hallmark clinical finding in the diagnosis of frozen shoulder is loss of passive shoulder range of motion, particularly external rotation, with a relatively normal shoulder X-ray. It is among the most common shoulder conditions in adults aged 40-65, particularly in women.

The Three Stages of Frozen Shoulder

Frozen shoulder typically progresses through three stages, although timelines vary.
1. Freezing Stage
Duration: typically 4 to 6 months
The freezing stage is marked by increasing shoulder pain, especially at night. The onset of frozen shoulder may seem gradual. Patients often experience shoulder pain with simple daily activities such as dressing or reaching overhead. Inflammation within the shoulder joint capsule causes pain and progressive stiffness.
During this phase, shoulder movement causes pain, and shoulder motion begins to decline. Shoulder flexion, abduction, and external rotation are often the first affected.

2. Frozen Stage
Duration: 4 to 12 months
In this phase, shoulder pain may reduce pain slightly, but stiffness becomes the dominant complaint. The shoulder becomes significantly restricted. Active and passive shoulder motion are both limited.
The capsule continues to thicken, and adhesion formation restricts shoulder mobility. Patients often cannot move their arm behind their back or lift their affected arm overhead. Activities such as reaching across your chest or lying on your back with the arm overhead are difficult.

3. Thawing Stage
Duration: 6 to 24 months
During the thawing stage, shoulder motion gradually improves. Frozen shoulder remains stiff but steadily improves. Most patients experience significant improvement in shoulder mobility and can return to normal activities.
Full return to the normal range of motion may take 12 to 24 months, although some mild residual stiffness may persist.

What Causes Frozen Shoulder?

The exact cause remains under investigation. Frozen shoulder may occur without a clear trigger, known as primary adhesive capsulitis, or develop after trauma, fracture, shoulder dislocation, or when the shoulder has been immobilized. This is called secondary frozen shoulder.

It is also associated with frozen shoulder risk factors such as diabetes, thyroid disorders, and various shoulder pathologies, including rotator cuff tears.

New Research: The Link to Peri Menopausal Hormonal Changes

Recent data suggests a growing link between peri menopausal hormonal changes and frozen shoulder. Estrogen plays an important role in regulating collagen, modulating inflammation, and supporting connective tissue health.

During peri menopause, declining estrogen levels may:

• Increase inflammation
• Alter collagen metabolism
• Reduce synovial fluid production
• Affect tissue remodelling

Emerging studies show that adhesive capsulitis is disproportionately common in peri menopausal women. Estrogen receptors have been identified in the shoulder joint capsule, and reduced estrogen may contribute to capsular thickening and fibrosis.

Some preliminary data suggest women receiving hormone replacement therapy may have a lower incidence of frozen shoulder, although more high quality trials are needed. While this does not yet change primary treatment, it provides insight into why this condition peaks between ages 45 and 60.

Diagnosis and Treatment

To diagnose frozen shoulder, clinicians assess active and passive shoulder range of motion. The defining feature is restriction in both active and passive shoulder movement, particularly external rotation.

Imaging is usually normal; however, ultrasound or MRI may reveal thickening of the shoulder joint capsule.

Treatment Options

Frozen shoulder treatment focuses on reducing pain and gradually restoring motion.
1. Pain Management in Early Stage
In the freezing stage, the primary treatment is pain control. A corticosteroid injection applied to the shoulder joint can reduce inflammation and pain. Evidence shows that corticosteroid injection can improve shoulder symptoms and accelerate early recovery when given within the first few months.

Injecting fluid into the shoulder joint, known as hydrodilatation, may also stretch the capsule and improve shoulder mobility.

2. Physiotherapy and Exercise
Physiotherapy is central to assessment and treatment. A structured home exercise program, including range-of-motion and frozen-shoulder exercises, is recommended.

Examples include:

• Passive shoulder range of motion using a stick
• Shoulder flexion and abduction in supine, lie on your back and assist the arm to lift your affected arm
• External rotation stretches
• Cross body stretch across your chest
• Gentle pendulum exercises

During early phases, aggressive stretching can worsen inflammation. As pain settles, progressive strengthening exercises for the shoulder muscles and rotator cuff are introduced to improve shoulder strength and shoulder and elbow coordination.

3. When Is Surgery Needed?

Surgery for frozen shoulder is uncommon but may be considered if progress plateaus after prolonged conservative care.

Options include:

• Manipulation under anesthesia
• Arthroscopic capsular release

Both aim to restore shoulder motion by releasing the thickened joint capsule. Most patients do not require surgery.

What Is the Prognosis?

Frozen shoulder can usually improve substantially over time. While traditional teaching suggested it was fully resolved, recent long-term studies indicate that some patients retain mild stiffness. However, most return to normal daily activities.

The key is a well-structured treatment plan tailored to the stage. With appropriate treatment options, gradual progression, and patience, most people experience meaningful recovery.

Final Thoughts

Frozen shoulder, known as adhesive capsulitis, causes significant shoulder pain and stiffness due to thickening of the shoulder joint capsule. It progresses through three stages and may last 12 to 24 months.

New evidence linking peri menopausal hormonal changes to adhesive capsulitis offers insight into why this condition commonly affects midlife women. While research continues, early diagnosis and treatment, including, when appropriate, corticosteroid injection and structured physiotherapy, remain the foundation of care.

If you experience shoulder pain and notice loss of both active and passive shoulder movement, early assessment can help you move your shoulder safely and improve shoulder mobility with less frustration.

Recovering from Frozen Shoulder: Take Action

If you are struggling with shoulder pain and limited movement, you don’t have to wait it out alone. The team at South Island Physiotherapy specializes in assessing and treating frozen shoulder through personalized physiotherapy programs designed to reduce pain, restore motion, and get you back to daily activities safely. Book an appointment today and start your path to a freer, stronger shoulder.