Frozen Shoulder Treatment
Frozen shoulder — clinically known as adhesive capsulitis — is a condition in which the capsule of connective tissue surrounding the shoulder joint becomes inflamed, thickened, and contracted, progressively restricting the joint’s range of motion until even basic movements like reaching overhead, behind the back, or out to the side become painful or impossible. The condition develops gradually and follows a predictable pattern of worsening stiffness followed by a slow recovery — a cycle that can take one to three years to complete without treatment. Frozen shoulder most commonly affects adults between the ages of 40 and 60, occurs more frequently in women than men, and is significantly more common in patients with diabetes, thyroid disorders, and those who have experienced a prolonged period of shoulder immobilization following surgery, injury, or illness.
Dr. Jonathan Glashow is a board-certified orthopedic surgeon and Clinical Associate Professor of Orthopedic Surgery at NYU Grossman School of Medicine, with specialized shoulder training that includes a traveling fellowship under Dr. Charles Rockwood and Dr. Richard Hawkins and fellowship training at the Southern California Orthopedic Institute/UCLA. Frozen shoulder requires a treatment approach that is carefully calibrated to the stage of the disease — and the clinical experience to distinguish adhesive capsulitis from other conditions that mimic its symptoms, including rotator cuff tears, shoulder impingement, and glenohumeral arthritis, is essential for selecting the right treatment at the right time. With over 30 years of experience, more than 15,000 procedures performed, and recognition as a Castle Connolly Top Doctor every year since 2000, Dr. Glashow evaluates and treats frozen shoulder at his Upper East Side practice in New York City.
The Three Stages of Frozen Shoulder
Frozen shoulder progresses through three distinct stages, each with different symptoms and treatment considerations.
Freezing Stage (6 weeks to 9 months): Pain develops gradually and worsens over time. Range of motion begins to decrease as the shoulder capsule becomes inflamed. Pain is often worst at night and may disrupt sleep. This is typically the most painful stage.
Frozen Stage (4 to 12 months): Pain may begin to diminish, but stiffness becomes the dominant problem. The shoulder’s range of motion is significantly restricted in all directions — particularly external rotation, overhead reach, and reaching behind the back. Daily activities such as dressing, grooming, and driving become difficult.
Thawing Stage (6 months to 2 years): Range of motion gradually improves as the capsular contracture begins to release. Strength and function return progressively, though some patients may not regain their full pre-condition range of motion without intervention.
Causes and Risk Factors
The exact cause of frozen shoulder is not fully understood, but several factors significantly increase the risk. Diabetes is the strongest risk factor — patients with diabetes develop frozen shoulder at two to four times the rate of the general population and often experience a more severe and prolonged course. Other risk factors include thyroid disease (both hypothyroidism and hyperthyroidism), prolonged immobilization of the shoulder after surgery or injury, cardiac disease, Parkinson’s disease, and a history of frozen shoulder in the opposite shoulder. Women are affected more frequently than men.
Symptoms of Frozen Shoulder
- Progressive shoulder pain that worsens over weeks to months
- Stiffness and loss of range of motion in all directions
- Difficulty reaching overhead, behind the back, or out to the side
- Night pain that disrupts sleep
- Inability to perform daily tasks such as dressing, grooming, or fastening a seatbelt
- Pain and stiffness that affect both active movement (what you can do yourself) and passive movement (what the examiner can move for you)
Treatment Options for Frozen Shoulder
The majority of frozen shoulder cases respond to non-surgical treatment, though the timeline for recovery can be prolonged. Dr. Glashow tailors the treatment approach to each patient’s stage of disease and symptom severity.
Conservative treatment options include anti-inflammatory medications and corticosteroid injections to reduce capsular inflammation and pain — particularly during the freezing stage — along with a structured physical therapy program focused on gentle range-of-motion exercises that progressively stretch the contracted capsule without aggravating the inflammation. Hydrodilatation — an injection of saline and corticosteroid under pressure to stretch the capsule — may also be recommended for patients who plateau with standard therapy.
When frozen shoulder does not respond adequately to conservative treatment after several months, or when the functional limitation is severe and the patient cannot wait for natural resolution, Dr. Glashow offers two procedural options. Manipulation under anesthesia involves carefully moving the shoulder through its full range of motion while the patient is under anesthesia, breaking up the adhesions and scar tissue within the capsule. Arthroscopic capsular release involves using small instruments inserted through keyhole incisions to surgically cut the thickened, contracted portions of the capsule — providing a more controlled and precise release than manipulation alone. Both procedures are followed by immediate physical therapy to maintain the motion gained.
Frozen Shoulder Treatment in New York City
If you are experiencing progressive shoulder stiffness, pain that disrupts sleep, or difficulty performing daily activities because of limited shoulder motion, frozen shoulder may be the cause — and early evaluation can help determine the right treatment strategy for your stage of the condition. Dr. Glashow offers comprehensive shoulder evaluation with same-day imaging at his Upper East Side practice. Contact our office to schedule your consultation.
Frequently Asked Questions About Frozen Shoulder
What causes frozen shoulder?
The exact cause is not fully understood. Frozen shoulder occurs when the shoulder capsule — the envelope of connective tissue that surrounds the joint — becomes inflamed and progressively thickens and contracts, forming adhesions that restrict movement. Why this process begins in some patients and not others is unclear, but it is strongly associated with diabetes, thyroid disorders, prolonged shoulder immobilization, and certain systemic conditions. In many cases, no specific trigger is identified.
How is frozen shoulder diagnosed?
Dr. Glashow diagnoses frozen shoulder through a clinical examination that assesses both active range of motion (what you can move yourself) and passive range of motion (what the examiner can move for you). The hallmark finding is a global loss of motion in all directions — particularly external rotation — that affects both active and passive movement equally. This distinguishes frozen shoulder from conditions like rotator cuff tears, where passive motion is often preserved. X-rays are taken to rule out arthritis or other bony abnormalities, and an MRI may be ordered to exclude rotator cuff pathology or other structural causes of stiffness.
How long does frozen shoulder last?
Without treatment, the natural history of frozen shoulder is one to three years — progressing through the freezing, frozen, and thawing stages at varying rates. With appropriate treatment — including physical therapy, anti-inflammatory medications, corticosteroid injections, and when necessary, manipulation or arthroscopic release — the timeline can often be shortened significantly and the severity of symptoms reduced. Some patients, particularly those with diabetes, experience a more prolonged course and may benefit from earlier intervention.
Can frozen shoulder be treated without surgery?
Yes — the majority of frozen shoulder cases resolve with non-surgical treatment. A combination of anti-inflammatory medications, corticosteroid injections to reduce capsular inflammation, and a structured physical therapy program focused on gentle progressive stretching is effective for most patients. The key is consistency with the physical therapy program and patience with the recovery timeline. Surgery is reserved for patients who have not improved adequately after several months of conservative care or whose functional limitation is too severe to manage non-operatively.
What is the difference between manipulation under anesthesia and arthroscopic capsular release?
Manipulation under anesthesia involves placing the patient under general anesthesia and carefully forcing the shoulder through its full range of motion to break up the adhesions within the contracted capsule. It is effective but less controlled — the surgeon cannot see exactly which structures are releasing. Arthroscopic capsular release involves inserting a small camera and instruments into the shoulder through keyhole incisions and surgically cutting the thickened capsule in a precise, controlled manner under direct visualization. Dr. Glashow selects the approach based on each patient’s severity, response to prior treatment, and whether any associated shoulder pathology needs to be addressed simultaneously.
Is frozen shoulder likely to come back after treatment?
Frozen shoulder can recur, though it is uncommon in the same shoulder. However, patients who have experienced frozen shoulder in one shoulder have a higher risk of developing it in the opposite shoulder — studies suggest this occurs in approximately 20 to 30 percent of patients. Patients with diabetes or thyroid disease are at the highest risk for bilateral or recurrent disease. Maintaining shoulder mobility with regular stretching and range-of-motion exercises — particularly after any period of immobilization — can help reduce the risk of recurrence.
