Frozen Shoulder

The capsule around the shoulder joint becomes inflamed, then thick and tight, so the shoulder hurts and then stiffens in every direction. It’s slow and frustrating, but it gets better on its own for most people over 1 to 3 years.

Symptoms. A deep ache in the shoulder and upper arm, often worse at night and when lying on it, then growing stiffness. Turning the arm out and reaching behind your back or up to a shelf get hard, even when someone else tries to move the arm for you.

The three stages. Freezing (painful, about 2–9 months), frozen (stiff but less painful, about 4–12 months) and thawing (movement slowly returns, about 5–24 months). The stages overlap and timing varies a lot.

Who gets it. Mostly people aged 40 to 60, women a little more often than men. It’s more common with diabetes (about 5 times more likely), thyroid disease, and after a shoulder injury, surgery or a spell of keeping the arm still. Often there’s no clear cause.

How it’s diagnosed. From how your shoulder moves when your GP or physio examines it. An X-ray may be used to rule out arthritis, which can look similar. With diabetes or no clear cause, your GP may check your blood sugar.

The frozen shoulder ladder

Frozen shoulder gets better on its own; treatment eases the pain and helps you keep and regain movement while it does.

1. Step 1 · Self-careKeep it moving, gentlyUse the arm for light daily tasks and do gentle range-of-motion exercises within comfort, little and often. Heat before stretching can help.

   Works

   Doesn’t change the overall course, but gentle beats forceful: in a Dutch study (not randomised), 89% of people exercising within their pain limits had a normal or near-normal shoulder at 2 years vs 63% with intensive stretching

   Cost

   Free

   How long

   Daily, for months

   Watch for

   Don’t rest it in a sling or force painful stretches in the early stage.

   Little and often. The shoulder doesn’t respond to bullying.

2. Step 2 · PharmacyPain relief (paracetamol, ibuprofen or anti-inflammatory gel)To make sleep and gentle movement possible.

   Works

   Short-term pain relief; doesn’t shorten the condition

   Cost

   About $5–15 a pack

   How long

   Days to weeks at a time

   Watch for

   Anti-inflammatory tablets: stomach, kidney and blood pressure risks. Check with a pharmacist if you have other conditions.

   Painkillers buy you sleep and a window to move.

3. Step 3 · Allied healthPhysio and a home exercise programStage-matched stretches, hands-on mobilisation and advice on how hard to push.

   Works

   In a 2020 review of 65 trials, adding home exercises to a steroid injection may have given extra benefit over the following months

   Cost

   Free at home with our handout; physio about $80–120 a session (Medicare rebates with a GP care plan)

   How long

   Months

   Watch for

   Stretching should leave only mild discomfort that settles within about 30 minutes.

   The program that suits your stage beats the hardest one.

4. Step 4 · ProcedureSteroid injection into the joint (sometimes with hydrodilatation)An injection into the shoulder joint, often guided by ultrasound. Hydrodilatation adds a larger volume of fluid to stretch the tight capsule.

   Works

   Injection: the best-supported treatment for pain in the first 12 weeks, about 1 point lower on a 10-point pain scale than no treatment, best given in the first year. Hydrodilatation: short-term benefit for pain and movement in a Cochrane review; unclear if it beats an injection alone

   Cost

   Medicare rebates; out-of-pocket fees vary, especially with imaging

   How long

   One injection, sometimes repeated

   Watch for

   Short-lived flare, skin thinning at the site, and raised blood sugar for a few days with diabetes.

   A window of relief to get moving, not a cure.

5. Step 5 · SpecialistManipulation under anaesthetic or keyhole capsular releaseFor severe, stubborn stiffness despite the steps above, usually after months of trying.

   Works

   In the UK FROST trial (503 people), physio plus injection, manipulation and keyhole release scored within about 3 points of each other on a 48-point shoulder score at 1 year, smaller than a difference that matters. Keyhole release had the most serious complications (8 vs 2 with manipulation)

   Cost

   Public waiting lists; private fees vary

   How long

   Recovery over weeks, with physio afterwards

   Watch for

   Anaesthetic risks; rarely fracture or nerve injury with manipulation.

   Bigger isn’t automatically better. Ask what each option adds.

Costs are rough Australian prices in November 2026 and vary by pharmacy and provider. PBS co-payment: $25, or $7.70 with a concession card. Results are typical figures from trials, not promises.

Save your money

Popular, heavily marketed or often asked about, but the evidence is weak or says no.

• Forceful stretching in the painful stagePushing hard into pain early on did worse than gentle exercise within pain limits in a 2-year study. Save firmer stretches for the stiff stage.
• Rushing to surgeryIn the FROST trial, surgery did no better than physio plus an injection at a year, with more complications and cost. It’s for the stubborn minority.
• Resting it in a slingKeeping the arm still is a known trigger for stiffness. Keep using it for light tasks.

What you can do

• Follow our frozen shoulder exercise handout: six gentle stretches, with what to do at each stage.
• Keep using the arm for light tasks below shoulder height.
• Sleep on your back or good side with a pillow hugging the sore arm.
• With diabetes, keep sugars well controlled, and ask your GP about a blood sugar check if you haven’t had one.
• Ask about an injection early if pain is stopping you sleeping or moving.

See your GP if

• Shoulder pain and stiffness aren’t easing after a few weeks
• Pain is waking you most nights
• Weakness lifting the arm, especially after a fall (this may be a tendon tear)
• Pain in both shoulders and hips with morning stiffness, especially if you’re over 50

Get urgent help for shoulder or arm pain with chest pain, breathlessness, sweating or nausea, which can be a heart attack: call 000 (Australia) or your local emergency number. See a doctor the same day for a hot, swollen shoulder with fever, or a shoulder that looks out of place after a fall.

Helpful resources

• Frozen shoulder exercise handoutPrintable, one page, with diagrams and stage-by-stage advice. Free, from us.
• Self-help for frozen shoulderPrintable leaflet with gentle stretches and advice on pain. Free, from an NHS orthopaedic hospital (UK).

Evidence and more information

• Challoumas et al, JAMA Netw Open 2020: Comparison of treatments for frozen shoulder
• Rangan et al, Lancet 2020: UK FROST trial
• Buchbinder et al, Cochrane 2008: Arthrographic distension (hydrodilatation) for frozen shoulder
• Zreik et al 2016: Frozen shoulder and diabetes, meta-analysis of prevalence
• Hand et al 2008: Long-term outcome of frozen shoulder
• Diercks and Stevens 2004: Gentle thawing of the frozen shoulder
• Mayo Clinic: Frozen shoulder

Reviewed 8 November 2026. General education, not personal medical advice. Treatment depends on your situation, so talk to your GP or pharmacist.

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