How to recognise and treat adhesive capsulitis

Putting on a jacket becomes difficult. Reaching for something on a high shelf hurts. At night, finding a comfortable position seems impossible. Then, gradually, the shoulder appears to lock up. These difficulties may be caused by adhesive capsulitis, also known as frozen shoulder.

This condition can disrupt sleep, work and the simplest everyday tasks. The good news is that treatments can help relieve pain and support recovery. The first steps are to establish the right diagnosis and tailor care to a shoulder that may be very sensitive.

Shoulder pain is not always tendinitis

The medical term “omalgia” simply means shoulder pain. Pain that persists for more than three months is described as chronic. This describes its duration, rather than its cause: tendinopathy, osteoarthritis, pain referred from the neck and adhesive capsulitis require different approaches.

In adhesive capsulitis, the capsule — the sleeve of tissue surrounding the joint — becomes inflamed, thickened and contracted. It loses flexibility and restricts movement. Think of it as a jacket that has become too tight around the joint. [1]

The key sign that suggests frozen shoulder

Pain, often worse at night, together with increasing stiffness is a typical pattern. Combing your hair, reaching behind your back, fastening a bra or putting on a coat becomes difficult.

During the examination, the doctor looks particularly for restricted active and passive movement: your arm moves less when you lift it yourself, but also when the clinician gently moves it for you. Outward rotation, with the elbow close to the body, is especially informative.

This loss of passive movement helps distinguish frozen shoulder from a tendon problem, where assisted movement may be better preserved. However, more than one problem can be present, so a thorough examination remains essential. [1]

Why it develops

Frozen shoulder occurs most often between the ages of 40 and 60, sometimes without an obvious trigger. It can also develop after an injury, surgery or a period of immobilisation. Diabetes and certain thyroid disorders are associated with a higher risk.

These associations do not mean that everyone needs extensive blood tests. The doctor decides which investigations are useful based on the medical history and symptoms. [1,2]

When an MRI is needed

An MRI is not routinely necessary. Diagnosis relies mainly on the history of the symptoms and examination of the shoulder.

An X-ray helps identify other causes of stiffness, particularly osteoarthritis or a bone abnormality. It may look normal even when frozen shoulder is very painful. Ultrasound helps assess the tendons and bursae, the small fluid-filled sacs around the joint. MRI is most useful when the presentation is unusual or another injury is suspected.

Reassuring imaging therefore does not mean that the pain is imaginary. [1,2]

How long it can last

The condition is traditionally described as a period dominated by pain, followed by a period of stiffness and then gradual recovery. These phases overlap and do not follow the same timetable for everyone.

Recovery usually takes months and may extend over two to three years, sometimes longer. Some people are left with discomfort or restricted movement. It would therefore be misleading to guarantee full recovery by a particular date.

This does not mean waiting without treatment: better sleep, easier dressing and gradually regaining useful movements are meaningful goals in their own right. [1]

Relieving pain to help restore movement

1. Tailored rehabilitation without forcing the stiffness

Depending on the situation, physiotherapy combines mobilisation, supervised exercises and a home programme. Early on, when the shoulder is very painful, movements should be gentle and gradual. Forceful stretching can make symptoms worse.

As pain eases, mobility work and strengthening can increase. Consistency matters more than trying to achieve the greatest possible range at every session. If an exercise causes lasting worsening, its intensity should be adjusted with the physiotherapist. [1]

2. Medication chosen for your circumstances

A painkiller or an anti-inflammatory medicine may be offered for symptom relief, taking into account digestive, kidney and cardiovascular risks, among others. These medicines alone cannot restore the capsule’s flexibility. Oral corticosteroids are not a routine treatment: their benefits are mainly temporary, and potential adverse effects must be considered. [1]

3. Corticosteroid injection

An injection into the joint may reduce pain and improve function in the short term, particularly while inflammation is still a prominent feature. A large review of clinical trials supports its use, alongside suitable exercises to support recovery. [3]

Ultrasound guidance allows the clinician to see the target, although it does not, by itself, guarantee a better clinical outcome in every case. Expected benefits and risks are discussed before treatment: a temporary increase in pain, rare infection and, in people with diabetes, a possible temporary rise in blood glucose. [1,2]

4. Hydrodilatation to stretch the capsule

This procedure involves injecting fluid into the joint to stretch the capsule, often together with a local anaesthetic and a corticosteroid.

A trial published in September 2026 suggests improvements in movement and function lasting up to six months with capsule-preserving hydrodilatation, compared with corticosteroid injection alone. However, only 50 of the 62 randomised patients were included in the final analysis. This encouraging result does not establish that the procedure is better for everyone. Its value depends on the patient’s circumstances and the protocol used. [4]

5. Suprascapular nerve block

This procedure targets a nerve carrying a substantial part of the shoulder’s sensory signals. It may be considered when pain severely interferes with sleep or movement.

Recent studies suggest that expectations should remain measured. A trial published in August 2026 reported better results on some measures than an injection into the joint. Another trial, appearing in its journal issue in 2026, found no meaningful lasting clinical benefit from routinely adding this block to a joint injection.

These studies assessed different strategies. A nerve block remains an individual treatment option and does not guarantee a shorter course of the disease. [5,6]

PRP and the evidence published in 2026

Platelet-rich plasma, prepared from the patient’s own blood, has attracted considerable interest. However, findings remain conflicting.

A meta-analysis published in January 2026 suggests benefits at three and six months, with low to moderate certainty of evidence. In contrast, a randomised trial involving 90 patients published in 2026 found better outcomes with corticosteroids, particularly during the painful freezing stage.

Differences in preparation, injection techniques and disease stage make comparisons difficult. At present, it would be premature to present PRP as a superior option or a cure for frozen shoulder. [7,8]

When surgery may be considered

Manipulation under anaesthesia or arthroscopic capsular release may be discussed when substantial limitations persist despite an appropriate course of non-surgical treatment.

The UK FROST trial, which included 503 patients, found no clinically important difference at one year between the three strategies studied: structured physiotherapy combined with an injection, manipulation under anaesthesia and arthroscopic capsular release. The last of these involved more serious adverse events.

Surgery is therefore an individual decision made after reassessing the diagnosis, functional limitations and expectations. [9]

Making everyday life easier

A few adjustments may help during this period:

• Keep using your arm within tolerable limits, avoiding prolonged immobilisation unless prescribed.
• Spread out demanding tasks and keep frequently used objects within easy reach to reduce repeated overhead movements.
• Try supporting your forearm on a pillow to find a more comfortable sleeping position.
• Follow the exercises agreed with your physiotherapist rather than adding multiple stretches found online.
• Explain how the condition affects your sleep, mood or work: these difficulties are part of your care. [1]

When to seek prompt medical attention

Persistent pain with increasing stiffness warrants a medical assessment. Seek prompt advice for fever, a red or hot shoulder, pain after a significant injury, sudden weakness or unusual symptoms. Shoulder pain accompanied by chest pain, shortness of breath or feeling faint requires a call to 15 or 112 in France, Spain, or the local emergency number elsewhere. [1]

Regaining the movements that matter

Frozen shoulder care focuses on realistic goals that are reviewed over time: sleeping more comfortably, dressing more easily and returning to activities. Treatment combines pain relief with gradual movement, with additional procedures when useful.

Your shoulder recovers at its own pace. Slow progress deserves support and, when needed, reassessment of the diagnosis and treatment.

This article provides general information and does not replace an individual medical assessment.

References

1. Hudnall S. Frozen shoulder (adhesive capsulitis). In: UpToDate. Fields KB, section editor; Grayzel JS, deputy editor. Topic last updated: 1 September 2026. Literature review current through September 2026. https://www.uptodate.com/contents/frozen-shoulder-adhesive-capsulitis
2. Lee BC, Kim BS, Lee BJ, et al. Clinical Practice Guidelines for Diagnosis and Non-Surgical Treatment of Primary Frozen Shoulder. Ann Rehabil Med. 2025;49(3):113-138. doi:10.5535/arm.250057. https://pmc.ncbi.nlm.nih.gov/articles/PMC12231400/
3. Challoumas D, Biddle M, McLean M, Millar NL. Comparison of Treatments for Frozen Shoulder: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020;3(12):e2029581. doi:10.1001/jamanetworkopen.2020.29581. https://pubmed.ncbi.nlm.nih.gov/33326025/
4. Kim YT, Hwang JT, Han SH, et al. Simplified, single-shot, capsule-preserving hydrodilatation combined with corticosteroids versus isolated corticosteroid injection for adhesive capsulitis: a randomized controlled trial. J Orthop Surg Res. 2026;21:613. doi:10.1186/s13018-026-07215-2. https://doi.org/10.1186/s13018-026-07215-2
5. Yalvaç M, Başaran PÖ, Doğan AG, et al. Comparison of the effects of ultrasound-guided suprascapular nerve block and intra-articular shoulder injection on pain, functional status and range of motion in patients with adhesive capsulitis: Randomized, controlled trial. J Back Musculoskelet Rehabil. Published online 18 August 2026. doi:10.1177/10538127261476808. https://pubmed.ncbi.nlm.nih.gov/42610979/
6. Elango Y, Adinarayanan S, Swaminathan S, et al. Comparison of the analgesic efficacy of intra-articular steroid injections and its combination with suprascapular nerve block for adhesive capsulitis of the shoulder joint: a randomized clinical trial. Reg Anesth Pain Med. 2026;51(4):404-410. doi:10.1136/rapm-2024-105902. https://pubmed.ncbi.nlm.nih.gov/39709187/
7. Peng R, Chen H, Li P. Platelet-Rich plasma vs corticosteroid for primary frozen shoulder: Meta-analysis of randomized trials. J Back Musculoskelet Rehabil. 2026;39(3). doi:10.1177/10538127251412669. https://doi.org/10.1177/10538127251412669
8. Hsieh LF, Fu YS, Chen TA, et al. Platelet-Rich Plasma Versus Corticosteroid Injection in Patients With Primary Frozen Shoulder: A Single-Blinded Randomized Controlled Trial. Arch Phys Med Rehabil. 2026;107(6):1221-1230. doi:10.1016/j.apmr.2026.01.031. https://pubmed.ncbi.nlm.nih.gov/41763349/
9. Rangan A, Brealey SD, Keding A, et al. Management of adults with primary frozen shoulder in secondary care (UK FROST): a multicentre, pragmatic, three-arm, superiority randomised clinical trial. Lancet. 2020;396(10256):977-989. doi:10.1016/S0140-6736(20)31965-6. https://pubmed.ncbi.nlm.nih.gov/33010843/