Frozen Shoulder Treatment

The exact cause isn't fully understood, but frozen shoulder involves inflammation and thickening of the connective tissue capsule that surrounds the shoulder joint. The capsule contracts, restricting motion and causing pain. Risk factors include diabetes (significantly higher risk), thyroid disease, a period of shoulder immobilization (after surgery, sling, fracture or stroke), and being female between 40 and 60. Sometimes it appears with no obvious trigger at all (idiopathic or 'primary' frozen shoulder).

Frozen shoulder usually resolves on its own — but the full cycle of freezing, frozen and thawing phases takes 1 to 3 years. Many patients live with significant disability through that period. Treatment doesn't always shorten the total disease course dramatically, but it can meaningfully reduce pain, accelerate return of range of motion, and limit how much the condition disrupts your work, sleep and daily life.

The strongest evidence supports intra-articular cortisone injection combined with structured physiotherapy as first-line treatment, particularly during the painful freezing phase. For patients who don't respond adequately, ultrasound-guided hydrodilatation (joint distension with saline and steroid) is a well-supported next step. PRP is an emerging option with growing but still limited evidence — it can be a reasonable choice for patients who want to avoid repeat cortisone or who haven't fully responded to standard care. Across all of these, structured physiotherapy is essential.

PRP for frozen shoulder is an emerging area. Some randomized controlled trials suggest intra-articular PRP can improve pain and shoulder range of motion in adhesive capsulitis, but the evidence base is smaller than for cortisone or hydrodilatation. We don't recommend PRP as a first-line treatment for most frozen shoulder patients, but it is a reasonable option to consider when cortisone has plateaued, when you've already had multiple cortisone injections and want to avoid more, or when your physician judges your specific clinical picture supports it.

Hydrodilatation is an ultrasound-guided injection that distends the shoulder joint capsule with a mixture of saline, local anesthetic and a steroid. The volume of fluid physically stretches the tight, inflamed capsule, which can dramatically reduce pain and improve range of motion. It's typically used for frozen shoulder patients who haven't responded sufficiently to a first cortisone injection plus physiotherapy.

Yes — and this is the most important point. No injection (cortisone, hydrodilatation or PRP) replaces the structured physiotherapy that's essential for restoring shoulder motion. Injections control pain and reduce capsule inflammation; physiotherapy actually restores the range of motion. We coordinate closely with your physiotherapist for the best results.

Cortisone injections performed by a licensed Ontario physician are covered by OHIP with a valid health card. Hydrodilatation is sometimes OHIP-covered depending on the procedure code; sometimes private. PRP is a private-pay procedure. We confirm your specific costs at consultation and provide receipts for extended-health insurance submission for any private-pay portion.

Diabetes is a major risk factor for frozen shoulder, and frozen shoulder in diabetics tends to be more severe and slower to resolve. Diabetic patients also tend to respond less robustly to cortisone, which can affect blood sugar — we monitor and discuss alternatives. Tight blood sugar control is part of the treatment plan: better glycemic control improves shoulder outcomes.

Surgery (manipulation under anesthesia or arthroscopic capsular release) is generally a last resort, considered only after 6–12 months of structured non-surgical treatment has not produced adequate improvement, particularly in the frozen phase. Most patients never need surgery — non-surgical treatment is effective for the majority. We'd refer you to an orthopaedic surgeon if surgical evaluation became appropriate.

No. Oakville Pain Clinic accepts self-referrals — book directly through our online self-referral form or call 647-910-5359 and our team will contact you within 24 hours to schedule your consultation. We also accept referrals from family doctors, physiotherapists and orthopaedic surgeons.