Frozen Shoulder Treatment: What Works and When Surgery Makes Sense

How do you treat a frozen shoulder? Most frozen shoulders get better without surgery, although the American Academy of Orthopaedic Surgeons notes that recovery may take up to 3 years. The treatment with the best evidence is a steroid injection into the shoulder joint early in the condition, combined with a home stretching program or physical therapy. Surgery is kept for stiffness that does not respond, and stem cells are not a proven treatment for this condition.

Frozen shoulder (adhesive capsulitis) happens when the capsule around the shoulder joint becomes thick, stiff and inflamed. It limits movement both when you lift the arm yourself and when someone else moves it, a key clue that separates it from a rotator cuff tear.

How long frozen shoulder lasts: the three stages

Frozen shoulder usually follows a predictable course. Knowing which stage you are in matters, because treatment that helps in one stage can be useless in another.

Stage	What you notice	Typical duration (AAOS)
1. Freezing	Pain that slowly gets worse, with loss of motion	6 weeks to 9 months
2. Frozen	Pain may ease, but stiffness stays; daily tasks are hard	4 to 6 months
3. Thawing	Motion slowly returns	6 months to 2 years to return to normal or near normal

The cause is not fully understood. Frozen shoulder is much more common in people with diabetes, who also tend to stay stiff longer before the shoulder thaws. Thyroid disease, Parkinson’s disease, heart disease and a period of immobilization after an injury or surgery are other known associations. X-rays, ultrasound or MRI are not required to diagnose it, but they help rule out arthritis or a rotator cuff tear, which are treated differently (AAOS; StatPearls).

What to do for frozen shoulder: treatments compared

A 2020 meta-analysis in JAMA Network Open pooled 65 randomized studies with 4,097 participants. Only a steroid injection into the joint was clinically superior to other options for short-term pain and function, and adding a home exercise program and physiotherapy brought extra benefit in the medium term. The authors recommend early injection in shoulders that have been frozen for less than a year, always with exercise (Challoumas et al.).

Treatment	What the evidence shows	Best suited to
Steroid injection into the joint	Best short-term pain and function in the 2020 meta-analysis	Painful early stage, ideally under 1 year
Home stretching and physical therapy	Adds benefit when combined with injection	Every stage; the backbone of treatment
Anti-inflammatory medication	Controls pain; does not change stiffness	Symptom relief
Hydrodilatation (stretching the capsule with fluid)	No meaningful gain over steroid injection alone in a 2026 review of 103 studies	Selected cases that do not respond
Platelet-rich plasma (PRP)	Similar to steroid at 1 to 3 months; better scores at 6 months in a 2026 meta-analysis of 13 trials	An option to discuss, with modest evidence
Collagen supplements	We found no clinical trials testing them for frozen shoulder	Not a treatment

If you have diabetes, better blood sugar control is part of the treatment; AAOS says it can help the shoulder recover faster.

Hydrodilatation is a reasonable step when injection and therapy are not enough, but expectations should be modest: the 2026 British Journal of Sports Medicine review concluded the evidence does not support meaningful improvement over steroid injection alone, while infections were rare, at two cases among 8,754 patients (Rhim et al.). For PRP, the pooled trials were heterogeneous, so the 6-month advantage is a signal, not a settled answer (Xu et al.). Our comparison of stem cells and PRP explains how the two differ.

When surgery is the better choice

Surgery is considered when months of injection and structured therapy have not restored useful motion. It is usually offered during the frozen stage, and the goal is to release the tight capsule, either by manipulation under anesthesia or by arthroscopic capsular release (AAOS).

The UK FROST trial randomized 503 adults with frozen shoulder to manipulation under anesthesia, arthroscopic capsular release, or early structured physiotherapy with a steroid injection. At 12 months none of the three was clinically superior. Capsular release had more serious adverse events (eight, against two with manipulation), and manipulation was the most cost-effective (Rangan et al., Lancet 2020).

• Stiffness that still blocks daily activities after a full course of injection and therapy is a reason to see a shoulder surgeon.
• If imaging shows a full-thickness rotator cuff tear, arthritis or a fracture, that problem needs its own plan. See whether a rotator cuff tear can heal without surgery.
• Sudden weakness, numbness down the arm, fever or a red, hot shoulder need prompt medical evaluation, not stretching.

Where stem cell therapy fits

Here the honest answer is: it mostly does not. The research we found on stem cells or their derivatives for frozen shoulder is in animal models, and we found no randomized trials in people. Frozen shoulder is a problem of a thickened, contracted capsule, and the treatments that work either calm the early inflammation or stretch the capsule. Stem cell therapy for this use is not FDA approved; read what FDA approval means for US patients.

Where regenerative treatment can make sense is when shoulder pain comes from something else, or from something in addition to the stiffness: chronic rotator cuff tendinopathy, a partial tear or early arthritis. Dr. Henao reviews your history and imaging to sort out which problem is driving your pain. Our shoulder pain therapy in Medellín page and the guide to shoulder pain treatment options explain those cases. If you have a classic frozen shoulder in the freezing stage, you are not a candidate yet: start with injection and exercise.

Next step

If you are unsure whether your stiff shoulder is a frozen shoulder or another problem, send your records for a free case review. Dr. Catalina Henao reviews your history and X-rays or MRI and tells you plainly whether regenerative treatment makes sense, and if it does, you receive a written quote before you buy flights. Request your free case review.

Frequently asked questions

How long does a frozen shoulder last?

It moves through freezing, frozen and thawing stages. AAOS describes the freezing stage as 6 weeks to 9 months, the frozen stage as 4 to 6 months, and the return of near-normal motion as taking 6 months to 2 years. Overall it may take up to 3 years, and it often lasts longer in people with diabetes.

Can a frozen shoulder heal on its own?

Most frozen shoulders improve over time without surgery. Treatment does not have to wait, though: a steroid injection plus home stretching early on gives better short-term pain and function than waiting it out.

Do collagen supplements help a frozen shoulder?

We found no clinical trials that tested collagen supplements for frozen shoulder. They are not a substitute for the treatments with evidence, which are joint injection and a stretching program.

Is PRP or a steroid injection better for frozen shoulder?

A 2026 meta-analysis of 13 trials found them similar at 1 to 3 months, with better scores for PRP at 6 months. The trials varied a lot, so steroid injection with exercise remains the best-established first step.

Can stem cells treat frozen shoulder?

There is no good human evidence for it. Published work on stem cells in frozen shoulder is in animals. Stem cells may be considered when the pain comes from a tendon problem or early arthritis rather than the stiff capsule.

Should I keep moving a frozen shoulder?

Yes, within tolerable pain. Gentle daily stretches help restore motion, while keeping the arm still tends to make the stiffness worse. Ask your physical therapist how many repetitions suit your stage.

Sources

• AAOS OrthoInfo: Frozen Shoulder (Adhesive Capsulitis)
• StatPearls: Adhesive Capsulitis (Frozen Shoulder), NCBI Bookshelf
• Challoumas D, et al. Comparison of treatments for frozen shoulder: a systematic review and meta-analysis. JAMA Netw Open. 2020
• Rangan A, et al. UK FROST: manipulation under anaesthesia vs capsular release vs early structured physiotherapy. Lancet. 2020
• Rhim HC, et al. Hydrodilatation for adhesive capsulitis: a systematic review. Br J Sports Med. 2026
• Xu C, et al. Platelet-rich plasma vs corticosteroid for adhesive capsulitis: meta-analysis of RCTs. Front Med. 2026