What is frozen shoulder?
Frozen shoulder, or adhesive capsulitis, happens when the capsule surrounding the shoulder joint becomes inflamed, thickened and tight. It classically moves through phases: a painful phase, a stiff or 'frozen' phase where movement is severely restricted, and a gradual thawing. The whole course can run from months to a couple of years. It most often affects people between 40 and 60, is more common in women, and is notably more frequent in people with diabetes or thyroid conditions. It can also follow shoulder injury, surgery or a period of immobility.
Diagnosis is usually clinical: the hallmark is loss of external rotation both when you move the arm and when the examiner does. X-rays help rule out arthritis, and further imaging is only needed if the picture is unclear.
Common symptoms
- Constant aching pain in the shoulder and upper arm
- Sharp pain with sudden movements or knocks
- Progressive stiffness in all directions
- Marked difficulty reaching behind the back or overhead
- Night pain that disturbs sleep
- Difficulty with dressing, washing and driving
How long will you wait?
Routine NHS referral for frozen shoulder typically involves a wait of a few months for clinic review and any injection or procedure, against a national median wait of 12.4 weeks with around 34% waiting over 18 weeks.
Privately, you can typically see a shoulder specialist within 3–7 days, with an injection or hydrodilatation often performed within 1–2 weeks and surgery, if needed, within 2–6 weeks.
NHS England median referral-to-treatment wait: 12.4 weeks, with 2.5 million people waiting over 18 weeks (May 2026). Individual waits vary by trust and urgency.
Treatment options
- Physiotherapy. Gentle, phased exercises maintain movement and guide recovery through the stiff and thawing phases.
- Steroid injection. An injection into the joint, ideally early in the painful phase, can substantially reduce pain and shorten symptoms.
- Hydrodilatation. An image-guided injection of saline and steroid stretches the tight capsule from within and can restore movement without surgery.
- Arthroscopic capsular release. Keyhole surgery divides the thickened capsule, reserved for shoulders that remain very stiff despite other treatment.
What does private treatment cost?
As a guide, self-pay hydrodilatation typically costs around £1,500–£2,500, while arthroscopic capsular release typically costs around £5,000–£7,000.
Does health insurance cover frozen shoulder?
Private medical insurance usually covers frozen shoulder as an acute condition, including consultations, injections, hydrodilatation and capsular release where needed. If your shoulder symptoms began before the policy started, treatment will normally be excluded as pre-existing. People with diabetes should note that the diabetes itself is typically excluded as chronic, but a new frozen shoulder is generally still covered as a distinct acute problem.
Frequently asked questions
Does frozen shoulder get better on its own?
Usually, yes, but slowly; the natural course often runs eighteen months to two years, and some people are left with mild lasting stiffness. Because the painful early phase responds well to steroid injection or hydrodilatation, seeking treatment early can shorten the illness considerably rather than simply waiting it out.
Why is frozen shoulder linked to diabetes?
People with diabetes are several times more likely to develop frozen shoulder, and it can be more stubborn to treat. The exact mechanism is not fully understood, but higher glucose levels are thought to affect the collagen in the joint capsule, making it more prone to thickening and stiffness. Both shoulders can be affected over time.
What is hydrodilatation and does it hurt?
Hydrodilatation is an outpatient procedure in which a radiologist injects a mixture of saline, local anaesthetic and steroid into the shoulder joint under X-ray or ultrasound guidance, stretching the tight capsule. There is a feeling of pressure and brief discomfort, but it is over in minutes, and many people notice improved movement within days to weeks.
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