What is frozen shoulder?
Frozen shoulder, medically called adhesive capsulitis, is a condition in which the capsule of connective tissue around the shoulder joint becomes inflamed, thickened and tight. This causes pain and a marked loss of movement in all directions, especially turning the arm outwards.
It usually develops in three overlapping stages:
- Freezing (painful) stage: increasing pain, often worse at night, with gradual loss of movement; lasts weeks to months
- Frozen (stiff) stage: pain may ease, but stiffness is severe; lasts several months
- Thawing (recovery) stage: movement slowly returns over months to a year or more
The NHS frozen shoulder page and the Mayo Clinic frozen shoulder guide provide useful overviews.
Causes and risk factors
The exact cause is not fully understood. Risk factors include:
- Age between 40 and 60, and female sex
- Diabetes, which substantially increases the risk and the severity
- Thyroid disease
- A period of shoulder immobility after injury, surgery or stroke
- Heart disease and Dupuytren’s contracture
Many people develop frozen shoulder with no obvious trigger.
Diagnosis: ruling out other causes
Frozen shoulder is diagnosed mainly by examination: both active and passive movements are restricted, particularly external rotation. X-rays are used to rule out arthritis or calcific tendinitis, which can look similar. Ultrasound or MRI helps exclude a rotator cuff tear and may show thickening of the capsule and ligaments. Blood tests for diabetes and thyroid function are often worthwhile.
Shoulder pain can also come from the neck, so a doctor may examine the cervical spine too (see neck pain). If you have shoulder imaging, you can send your MRI or X-ray for a doctor review.
Conventional frozen shoulder treatment
- Pain relief. Paracetamol and anti-inflammatories, plus heat or ice.
- Physiotherapy. Physical therapy for frozen shoulder focuses on gentle, pain-free movement during the painful stage, and more active stretching as pain eases. Aggressive stretching early on can worsen pain.
- Steroid injection. An injection into the shoulder joint in the early painful stage can reduce pain and improve movement faster, especially combined with physiotherapy.
- Hydrodilatation. Injecting a larger volume of fluid, often with steroid, to stretch the capsule. Evidence suggests short-term benefits.
- Manipulation under anaesthesia and arthroscopic capsular release. Considered for persistent, severe stiffness. The UK FROST trial (The Lancet, 2020) compared both with early structured physiotherapy plus steroid injection and found no clinically important difference between the three approaches, so less invasive care is usually tried first.
Regenerative options: what the evidence says
- PRP therapy: small randomised trials have compared PRP injection with steroid or physiotherapy alone for adhesive capsulitis. Some report improvements in pain and movement, but trials are small and short-term. See PubMed research on PRP for frozen shoulder.
- Stem cell therapy: evidence is very limited, mainly early studies and case reports. See PubMed research on stem cells for adhesive capsulitis.
- Exosome therapy: no meaningful human evidence for frozen shoulder.
Because frozen shoulder usually improves with time and conventional care, regenerative injections are not a first-line option. Stem cell products for this use are not approved in the US, UK or Australia; the US FDA warns about unapproved stem cell therapies.
Comparing frozen shoulder treatment options
| Option | Best stage | Evidence | Main benefit | Main downside |
|---|---|---|---|---|
| Pain relief and heat | All stages | Moderate | Symptom control | Does not restore movement |
| Physiotherapy | All stages, adapted | Moderate | Movement and function | Slow; can flare if too aggressive |
| Steroid injection | Painful stage | Good, short to medium term | Faster pain relief | Temporary; raises blood sugar |
| Hydrodilatation | Painful or stiff stage | Moderate, short term | Stretches capsule | Discomfort; benefit may fade |
| Manipulation or capsular release | Persistent stiffness | Good in selected cases | Restores movement | Anaesthetic and surgical risks |
| PRP injection | Painful or stiff stage | Early, small trials | Possible pain relief | Not standard |
| Stem cell injection | Experimental | Very limited | Uncertain | Unproven |
Self-help for frozen shoulder
- Keep the shoulder moving gently within comfort; avoid holding it still
- Use heat before exercises and ice afterwards if it helps
- Sleep with a pillow supporting the arm
- Keep blood sugar well controlled if you have diabetes
- Be patient: most people recover substantial movement with time
Frozen shoulder and diabetes
Frozen shoulder is several times more common in people with type 1 or type 2 diabetes, and it can affect both shoulders, last longer and respond less well to treatment. Treatment of frozen shoulder in diabetes follows the same principles, with some extra points:
- Blood sugar control matters for tissue health and recovery, so it is worth reviewing with your diabetes team.
- Steroid injections can raise blood sugar for several days; monitor more closely and agree a plan with your doctor beforehand.
- Physiotherapy may need to continue for longer, and progress can be slower.
- Screening: anyone with unexplained frozen shoulder may be offered a diabetes test, since it is sometimes the first sign.
Who may be a candidate for regenerative treatment?
- Persistent frozen shoulder symptoms despite pain relief, physiotherapy and at least one steroid injection
- People who cannot have, or wish to avoid, further steroid injections, for example due to blood sugar concerns
- Imaging that excludes a significant rotator cuff tear or arthritis
- Acceptance that evidence is early
Who should not have regenerative treatment
- Shoulder pain from another cause, such as arthritis, fracture or a large tendon tear
- Active joint or skin infection
- Bleeding disorders, active cancer or pregnancy
- Very poorly controlled diabetes
Risks and side effects
Shoulder injections can cause temporary pain, stiffness and bruising. Rare risks include joint infection, bleeding and allergic reactions. Steroid injections can temporarily raise blood sugar in people with diabetes. Cell-based treatments using your own fat or marrow add harvest-site soreness. Cells used in our programmes are prepared in ISO 9001:2015-certified partner laboratories.
What a frozen shoulder treatment trip to Bangkok looks like
- Before travel: send your shoulder X-ray, ultrasound or MRI and reports on WhatsApp. A doctor reviews the stage and likely options.
- Day 1: consultation, shoulder and neck examination and imaging review.
- Day 2: image-guided injection according to the protocol.
- Following days: physiotherapy sessions and a home exercise program.
Most programmes need around 3 to 7 days in Bangkok. Patients travel from Australia, the UK, the US and Canada. See how it works. No outcome can be guaranteed.
Recovery and aftercare at home
- Continue daily gentle mobility exercises; consistency matters more than intensity
- Avoid heavy lifting and sudden overhead movements for the period advised
- Avoid anti-inflammatory medicines after PRP for the period your doctor recommends
- Monitor blood sugar closely if you have diabetes
- Share progress with the medical team on WhatsApp and continue physiotherapy locally
Fever, a hot swollen shoulder or rapidly worsening pain after an injection needs urgent medical care.
Frequently asked questions
How long does frozen shoulder last?
Frozen shoulder typically lasts one to three years, passing through painful, stiff and recovery (thawing) stages. Most people regain much of their movement, although some have mild long-term stiffness. Treatment can shorten the painful phase.
What is the best treatment for frozen shoulder?
For the painful early stage, a steroid injection into the shoulder joint combined with gentle physiotherapy has good evidence for faster pain relief. Later, stretching and mobility work help. Hydrodilatation or surgery is considered when stiffness persists despite these.
Can stem cell therapy help frozen shoulder?
There is very little evidence. A small number of studies have explored cell-based injections for adhesive capsulitis, but there are no robust trials. Stem cell therapy for frozen shoulder should be regarded as experimental.
Why is frozen shoulder more common in people with diabetes?
People with diabetes have a several-fold higher risk of frozen shoulder, possibly because high blood sugar changes collagen in the joint capsule. Symptoms can be more severe and last longer, so good blood sugar control is part of treatment.
Which scans does a doctor need to assess frozen shoulder?
Frozen shoulder is mainly a clinical diagnosis. An X-ray helps rule out arthritis, and an ultrasound or MRI helps exclude a rotator cuff tear or other problems. MRI may show a thickened joint capsule.
How much does frozen shoulder treatment in Bangkok cost?
It depends on your stage of frozen shoulder, your imaging and the program a doctor recommends. Send your shoulder X-ray, ultrasound or MRI on WhatsApp for a free doctor review and a personalised program.
This page is general information, not medical advice, and does not replace a consultation with your own doctor. Results vary and no treatment outcome can be guaranteed. We are a patient coordination service and may receive a referral fee from partner medical providers. See our medical disclaimer and referral disclosure.