Treatment For Frozen Shoulder And Mobility Support

Frozen shoulder is a condition that leads to pain, stiffness, and limited movement in the shoulder joint. This may affect daily activities, such as reaching overhead or getting dressed. The condition often develops gradually, causing symptoms that interfere with daily life and last for months.

Several treatment options are available. These range from conservative care and physical therapy to targeted injection-based therapies and minimally invasive procedures. Understanding these options can help patients make informed decisions about potential treatment plans to support shoulder movement and improve function.

Frozen Shoulder And Its Impact On Movement

Frozen shoulder, also known as adhesive capsulitis, is a condition that occurs when the connective tissue surrounding the shoulder joint becomes inflamed and stiff. This restricts the shoulder’s range of motion, impacting daily activities and making movements painful. 

The condition typically develops gradually and progresses through different stages:

• Freezing Stage: This is the initial stage, marked by a gradual onset of pain that worsens over time and with movement. It can last up to 9 months. 
• Frozen Stage: Pain may ease during this stage, but the stiffness and restricted range of motion intensify, making it difficult to use the shoulder for daily activities. It can last up to 12 months.
• Thawing Stage: The shoulder’s range of motion slowly begins to improve. It can last between 5 and 24 months.

It can take up to three years for the condition to reach the end of the thawing stage.^[1] This loss of flexibility may significantly affect daily life, work, hobbies, and routine activities such as getting dressed. 

Impact On Movement

Frozen shoulder often limits the ability to raise the arm, rotate it outward, or perform movements behind the back. 

Signs And Symptoms 

Common symptoms include a gradual onset of shoulder pain, increasing stiffness, and reduced mobility. Pain is often worse at night and can disrupt sleep. Over time, pain may ease, but stiffness can persist, affecting function.

Causes And Risk Factors

The exact cause of frozen shoulder is not always clear. It sometimes follows an injury or surgery that limits shoulder movement for an extended period. This can cause stiff tissues, weaker muscles, and inflammation. A study on rats conducted in 2016 showed that inflammatory cells were found in the joint’s synovial fluid two weeks after immobilization,^[2]  while 2017 research indicates that frozen shoulder is a severe post-surgical complication, occurring in an estimated 11% of patients following shoulder surgery, irrespective of the specific procedure performed.^[3] 

Risk factors may include diabetes, thyroid disorders, prolonged immobility, or age (most common between ages 40 and 60).^[4]

Conservative Care Options That Can Help

Conservative care options are often the first step in managing frozen shoulder. These approaches aim to help reduce pain, may improve mobility, and promote healing.

• Physical therapy / Exercises: Physician-guided stretching and strengthening exercises may help restore shoulder movement and flexibility. Physical therapists design customized routines to support an improvement in range of motion over time.
• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) and other pain relievers may help reduce pain and inflammation, making it easier to participate in therapy and daily activities. However, long-term use may lead to side effects such as stomach ulcers, an increased risk of heart attack and stroke, and kidney dysfunction.^[5] 
• Heat and ice therapy: Applying heat can relax tight muscles and increase blood flow, while cold packs may help decrease pain and swelling. 
• Activity modification: Avoiding strain on the shoulder and painful movements may help prevent further inflammation of the shoulder joint.

Targeted Injection-Based Treatments

Targeted injection-based treatments may be considered when symptoms of frozen shoulder do not improve with conservative care. 

• Corticosteroid injections: Corticosteroid injections can help reduce inflammation and pain in the shoulder joint, making it easier to participate in other treatments like physical therapy. They are sometimes used in the early stages, but long-term use can disrupt the natural production of the cortisol hormone in the body.^[6] 
• Hyaluronic acid injections: Hyaluronic acid is used to help lubricate the joint, potentially improving comfort and movement. 
• PRP (Platelet-Rich Plasma) injections: PRP injections use platelets derived from the patient’s own blood to promote natural healing within the joint. This option may support tissue repair and may help reduce inflammation.

Minimally Invasive Treatment Approaches

Minimally invasive treatments may be considered when shoulder movement remains limited despite other therapies. These approaches aim to restore mobility with less recovery time compared to typical surgery.

• Hydrodilatation: Hydrodilatation involves injecting fluid into the shoulder joint to gently stretch the joint capsule to reduce stiffness and improve range of motion.
• Manipulation Under Anesthesia (MUA): During this procedure, the patient is given anesthesia, and the physician carefully moves the shoulder to release tight tissue. MUA may help quickly increase mobility and has a high satisfaction rate of 85%. However, repeated interventions may become necessary.^[7] 
• Arthroscopic Capsular Release (ACR): This procedure uses instruments and a camera inserted through a small incision to identify and release tight areas within the shoulder joint.^[8]

Surgical Method That May Aid Shoulder Mobility

Surgical intervention for frozen shoulder is usually considered when conservative measures and minimally invasive treatments do not provide sufficient support for mobility or pain reduction. Surgery may be recommended in cases where the shoulder remains severely stiff and functionally limited for months or even years.

• Arthroscopic Debridement: This procedure removes inflamed or damaged tissue from the shoulder joint to help reduce pain and may improve mobility.
• Surgery for Underlying Structural Issues: If frozen shoulder is related to other structural problems, such as a rotator cuff tear or bone spur, additional surgical procedures may be necessary to address these issues and help regain function.

The Regenexx Approach To Supporting Shoulder Recovery

Physicians in the licensed Regenexx network perform non-surgical procedures designed to help promote healing and function. 

These approaches use a patient’s own cells and healing agents to encourage the body’s natural healing processes. Procedures using Regenexx injectates are performed by physicians in the licensed Regenexx network trained in injection techniques, using thorough imaging guidance for accuracy.

Regenexx SD Injectate

Regenexx SD injectate is used in a bone marrow concentrate procedure. It uses the patient’s own bone marrow cells, collected from an area at the back of the hip, where these important repair cells are found. 

After they are concentrated in specialized laboratory environments, the cells are injected into the affected shoulder area under imaging guidance for precision. Regenexx SD injectate aims to help reduce pain and may help regain function by supporting the body’s natural repair mechanisms.

Regenexx SCP Injectate

Regenexx SCP injectate stands for “Super Concentrated Platelets.” This procedure uses a customized and more concentrated version of platelet-rich plasma (PRP), which is derived from the patient’s own blood. 

High concentrations of platelets are injected into the shoulder joint or surrounding tissues to stimulate healing. The concentrated PRP may help promote tissue repair and may provide relief from discomfort.

Regenexx PL Injectate

Regenexx PL injectate, or Platelet Lysate, is an advanced platelet-based procedure. Platelet lysate is produced by breaking down platelets contained in a sample of the patient’s blood to release growth factors important for tissue repair. 

The injectate is precisely placed into targeted areas using imaging guidance, potentially aiding in healing soft tissue or mild arthritis in the shoulder.

Why Proper Evaluation Matters For Treatment Choices

Before starting any treatment for frozen shoulder, an accurate diagnosis is essential. 

Knowing the severity and underlying cause of the condition is essential for choosing the most appropriate care plan. Consulting an experienced healthcare provider is key to getting a thorough assessment that takes into account the patient’s specific needs and overall health. 

With expert guidance, patients may better understand their options and make informed choices about their recovery. Physicians in the licensed Regenexx network are prepared to provide thorough evaluations and discuss suitable non-surgical and minimally invasive approaches.

Support Shoulder Recovery With The Right Care

By working with a knowledgeable physician, patients can review a range of care options for frozen shoulder, from conservative measures to regenerative therapies. Taking steps toward timely and accurate diagnosis, along with the right therapies, may help regain function and may provide pain reduction.

Still exploring treatment options for your shoulder? Learn about procedures using Regenexx injectates that may help support shoulder function and mobility.

Sources

1. Mezian K, Coffey R, Chang KV. Frozen Shoulder(Archived) [Updated 2023 Aug 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482162/
2. Kim DH, Lee KH, Lho YM, Ha E, Hwang I, Song KS, Cho CH. Characterization of a frozen shoulder model using immobilization in rats. J Orthop Surg Res. 2016 Dec 8;11(1):160. doi: 10.1186/s13018-016-0493-8. PMID: 27931231; PMCID: PMC5146898.
3. Koorevaar, R.C.T., van‘t Riet, E., Ipskamp, M. et al. Incidence and prognostic factors for postoperative frozen shoulder after shoulder surgery: a prospective cohort study. Arch Orthop Trauma Surg 137, 293–301 (2017). https://doi.org/10.1007/s00402-016-2589-3
4. Dyer BP, Burton C, Rathod-Mistry T, Blagojevic-Bucknall M, van der Windt DA. Diabetes as a Prognostic Factor in Frozen Shoulder: A Systematic Review. Arch Rehabil Res Clin Transl. 2021 Jul 14;3(3):100141. doi: 10.1016/j.arrct.2021.100141. PMID: 34589691; PMCID: PMC8463473.
5. Marcum ZA, Hanlon JT. Recognizing the Risks of Chronic Nonsteroidal Anti-Inflammatory Drug Use in Older Adults. Ann Longterm Care. 2010;18(9):24-27. PMID: 21857795; PMCID: PMC3158445.
6. Leonie H. A. Broersen, Alberto M. Pereira, Jens Otto L. Jørgensen, Olaf M. Dekkers, Adrenal Insufficiency in Corticosteroids Use: Systematic Review and Meta-Analysis, The Journal of Clinical Endocrinology & Metabolism, Volume 100, Issue 6, 1 June 2015, Pages 2171–2180, https://doi.org/10.1210/jc.2015-1218
7. Kraal T, Beimers L, The B, Sierevelt I, van den Bekerom M, Eygendaal D. Manipulation under anaesthesia for frozen shoulders: outdated technique or well-established quick fix? EFORT Open Rev. 2019 Mar 19;4(3):98-109. doi: 10.1302/2058-5241.4.180044. PMID: 30993011; PMCID: PMC6440298.
8. Galasso O, Mercurio M, Luciano F, Mancuso C, Gasparini G, De Benedetto M, Orlando N, Castricini R. Arthroscopic capsular release for frozen shoulder: when etiology matters. Knee Surg Sports Traumatol Arthrosc. 2023 Nov;31(11):5248-5254. doi: 10.1007/s00167-023-07561-2. Epub 2023 Sep 13. PMID: 37702747; PMCID: PMC10598184.