The short answer
Frozen shoulder (adhesive capsulitis) is pain and restricted movement caused by thickening of the shoulder joint capsule. It progresses through three stages — freezing (severe pain), frozen (stiffness), and thawing (gradual recovery). Treatment includes physical therapy and ultrasound-guided hydrodilatation, an injection that expands the capsule for rapid relief.
Medically reviewed by Marc Gruner, DO, MBA, RMSK
Sports medicine physician, Mayo Clinic fellowship. Last reviewed June 2026
Overview
Frozen shoulder, or adhesive capsulitis, causes shoulder pain and progressive loss of movement as the joint capsule thickens and tightens. It moves through three predictable stages: a painful freezing stage (often worse at night), a stiff frozen stage with marked loss of motion — particularly external rotation — and a thawing stage of gradual improvement. Its exact cause is not fully understood but involves genetic and environmental factors.
Dr. Gruner treats frozen shoulder with a combination of physical therapy and ultrasound-guided hydrodilatation — an injection of saline, lidocaine, and steroid that expands the joint capsule and provides immediate relief, especially when paired with therapy.
Common symptoms
- Constant, severe pain (especially at night) in the freezing stage
- Marked stiffness and loss of motion in the frozen stage
- Loss of external rotation
- Gradual return of motion in the thawing stage
Videos from Dr. Gruner
Is It Frozen Shoulder? Diagnosis and Treatment — Dr. Marc Gruner
Treating Frozen Shoulder with Capsular Distension — Dr. Marc Gruner
Shoulder Pain From Frozen Shoulder? How the Diagnosis Is Made
Capsular Distension for Treating Frozen Shoulder Pain
What to expect at your visit
- 1.
A focused conversation
Dr. Gruner reviews your history, prior imaging, and goals — what you want to get back to doing.
- 2.
Point-of-care ultrasound
When useful, a diagnostic musculoskeletal ultrasound evaluates the injury in real time, with no radiation.
- 3.
A clear, individualized plan
You leave understanding the diagnosis, the non-surgical options, and the expected timeline — in plain language.
Rehabilitation protocol
What to expect week by week after your procedure. Your plan is individualized; follow these alongside your physical therapist.
Shoulder — Ultrasound-Guided Lipogems / PRP Protocol
Week 1
Protect, reduce pain and swelling
- Sling for 7 days; begin weaning after day 3
- No lifting > 5 lbs; avoid overhead activity 2 weeks
- Don't sleep on the procedure side
- Begin gentle active ROM (pendulums) 4×/day
Week 2
Begin active range of motion
- No lifting > 10 lbs; avoid overhead activity
- Continue AROM and PROM
- Begin isometrics and thoracic mobility
- Stop any exercise if pain > 4/10
Weeks 3–6
Shoulder strengthening
- May lift 10–20 lbs; avoid eccentrics
- Continue active ROM
- Progressive strengthening
Weeks 6–12
Return to sport
- Activities as tolerated
- Begin eccentric training/loading
- Sport-specific exercises
Do not use NSAIDs (ibuprofen, Aleve, aspirin) for 4 weeks, and avoid ice for the first week — both blunt the healing response. Acetaminophen (Tylenol) is fine for discomfort. Care is tailored to you; use these guidelines with your physical therapist.
Frequently asked questions
- What is hydrodilatation for frozen shoulder?
- Hydrodilatation is an ultrasound-guided injection of saline, lidocaine, and steroid that expands (dilates) the tight joint capsule. It can provide immediate relief and works best combined with physical therapy.