Frozen shoulder, or adhesive capsulitis, is inflammation, thickening and contraction of the capsule surrounding the shoulder joint. The shoulder becomes both painful and stiff. What distinguishes it is that the patient cannot lift the arm and neither can anyone else — the restriction is capsular, not muscular.
It is most common between 40 and 60, in women, and in people with diabetes.
Three stages, and the rule for each
1. Freezing (2–9 months) — pain dominates
Pain builds steadily, wakes you at night, and you cannot lie on that side. Loss of movement is just beginning.
What to do in this stage: control the pain. Aggressive stretching and forceful mobilisation now increase the inflammation and prolong the process. Movement within pain-free limits, pendulum exercises and sleep positioning are what matter.
2. Frozen (4–12 months) — stiffness dominates
Pain eases, restriction becomes the problem. Combing your hair, fastening a bra behind your back, reaching a back pocket all become difficult.
What to do in this stage: gain range. Manual therapy, joint mobilisation and a progressive stretching programme are the core treatment. Working consistently here shortens the overall course.
3. Thawing (6–24 months) — recovery
Movement returns gradually, both spontaneously and with treatment.
What to do in this stage: rebuild strength and shoulder girdle control so no lasting restriction remains.
Which movement is lost first
Loss follows a specific order in frozen shoulder: external rotation first (turning the arm away from the body), then elevation, and internal rotation last. Markedly restricted external rotation is the most useful finding separating frozen shoulder from shoulder impingement.
Risk factors
- Diabetes — the strongest association; more frequent and longer-lasting in people with diabetes
- Thyroid disease
- Prolonged immobility: a sling after fracture, not using the arm after surgery
- Previous shoulder injury
- Heart disease, Parkinson's
What physiotherapy involves
Hands-on work: Joint mobilisation directed at the restricted portions of the capsule, particularly into external rotation and elevation during the frozen stage.
Stretching programme: Long-duration, low-intensity stretching — more effective than short, forceful stretching. 30 seconds per direction, several times a day.
Strengthening: Rotator cuff and scapular muscles, introduced as pain settles.
Home programme: In frozen shoulder, what you do several times a day at home determines the outcome more than the clinic session does.
Four exercises you can do at home
1. Pendulum (Codman) Lean on a table with your good arm and let the affected arm hang free. Move your trunk gently so the arm swings forward and back and in circles. Let the trunk drive it, not the shoulder muscles. 30 seconds per direction.
2. External rotation with a stick Lie on your back, elbows bent to 90 degrees and tucked against your body. Hold a broom handle with your good hand and push the affected arm outward. Stop where pain begins, hold 20–30 seconds.
3. Finger walk up the wall Face a wall and walk your fingers up it, as far as you can go without hitching the shoulder. Ten repetitions.
4. Internal rotation with a towel Hold a towel diagonally behind your back. Pull upward with the top hand to draw the affected arm up your back. 20–30 seconds.
The target in stretching is mild tension. Sharp pain means you have gone past the limit.
How long does it take?
The whole process usually runs one to three years. Regular physiotherapy and a home programme shorten it and reduce the risk of permanent loss of movement. In people with diabetes the course is longer, and blood sugar control is part of the treatment.
Other options
- Corticosteroid injection: Reduces pain quickly, particularly in the painful freezing stage, making participation in physiotherapy possible. Combined with physiotherapy it outperforms injection alone.
- Hydrodilatation: Distending the capsule with fluid.
- Surgery (capsular release): Considered in long-standing, resistant cases; intensive rehabilitation follows.
Frequently asked questions
Will it resolve on its own? Most cases improve over time, but some of those left untreated keep a permanent restriction. Managing the process shortens it and improves the end result.
Why is it worse at night? Lying down increases intra-articular pressure and capsular tension. Sleeping on your back with a pillow under the arm, and avoiding the affected side, reduces night pain.
Can it happen in both shoulders? Simultaneous involvement is uncommon, but after one shoulder recovers the likelihood of the other being affected is higher than in the general population. This is more pronounced in people with diabetes.
It hurts too much to use my arm — should I rest it? Complete immobility accelerates capsular contraction. Everyday use within pain-free limits should continue.
This article is general information and does not replace an examination. If your shoulder is losing movement, book a staging assessment at our clinic in Muratpaşa, Antalya.