Frozen shoulder (adhesive capsulitis) stiffens the joint capsule and limits everyday movement. Pain often peaks at night, then eases as stiffness takes centre stage before mobility gradually returns. Treatment should manage pain, protect sleep, and restore range in a steady, measurable way.

What Is Frozen Shoulder?

Frozen shoulder (adhesive capsulitis) happens when the shoulder joint capsule becomes inflamed, thickens and tightens. Pain builds first, then stiffness limits reach and rotation before movement gradually returns.

Causes and Links

Primary (no clear trigger): more common between 40–60 years, and associated with diabetes and thyroid disorders.

Secondary: follows shoulder injury or surgery, or after prolonged immobilisation in a sling or cast.

Contributors: persistent shoulder pain that leads to guarding, poor sleep, and reduced daily use can maintain stiffness.

Treatment

First-Line Measures

• Start with simple steps that reduce pain without provoking flare-ups.
• Short courses of paracetamol can help; non-steroidal anti-inflammatory drugs may be suitable if tolerated.
• Use heat before exercise to loosen soft tissue, then a brief ice pack after stretching.
• Prioritise sleep: side-lie on the unaffected shoulder with a supported forearm, or rest slightly elevated.
• Keep the joint moving daily within a comfortable range rather than forcing end positions.

Physiotherapy That Builds Momentum

A structured program offered by an orthopaedic Cyprus doctor is the backbone of recovery. Early work focuses on gentle mobility: pendulums, table slides, assisted external rotation with a stick, and wall-assisted flexion. As pain settles, lengthen holds at end range and add scapular control. Strength follows in stages: isometrics first, then light resistance two to three times a week. Short, frequent sessions beat occasional long efforts, and pacing reduces rebound soreness.

Injections and Imaging-Guided Options

Targeted procedures can open a window for progress. An image-guided intra-articular corticosteroid injection often helps during the painful “freezing” phase by calming inflammation and improving sleep. Hydrodilatation uses sterile fluid to gently stretch the capsule under ultrasound or fluoroscopy; many patients gain easier movement for several months when it is paired with active rehab. A suprascapular nerve block may reduce pain in selected cases. These interventions are typically delivered by an orthopaedic surgeon working alongside a specialist physiotherapy team.

When to Consider Surgery

Surgery is considered when a thorough period of non-operative care has failed and pain or stiffness still limits work or self-care. Two procedures are used: manipulation under anaesthetic to free adhesions through controlled movement, and arthroscopic capsular release to divide tight sections directly. Both demand immediate, disciplined physiotherapy to maintain any gains in range. Risks exist with any procedure, so agree clear goals and a rehabilitation plan in advance.

Tips to Manage the Symptoms and Ease the Pain

• Calm the Pain: analgesia as needed, heat before movement, ice after stretching.
• Move Daily: gentle mobility drills within tolerance; build minutes, not inches.
• Stretch with Intent: longer end-range holds as symptoms settle.
• Strengthen on Schedule: isometrics, then light resistance two to three times weekly.
• Add Targeted Procedures When Required: corticosteroid injection, hydrodilatation, or nerve block to support rehabilitation.
• Escalate Thoughtfully: consider surgical options only if progress stalls despite a comprehensive plan.

Recovery varies with diabetes status, recent shoulder surgery, and baseline sleep quality. Many people benefit from a combined approach, such as a single injection followed by six to eight weeks of focused physiotherapy. If symptoms stall or daily life remains on hold, check with the orthopaedic surgeon near me at the earliest.

The author is a highly respected orthopaedic surgeon based in Limassol. Driven by values of integrity, respect, responsibility, and empathy, he delivers personalised, cutting-edge, evidence-based treatment plans tailored to each patient’s unique needs. Visit https://cyprusorthopaedics.cy/ for more details.