From the Guidelines
Treatment of frozen shoulder should prioritize intra-articular injections with corticosteroids, such as Triamcinolone, to significantly reduce pain and improve range of motion. This approach is supported by evidence from the study by 1, which found that intra-articular injections had significant effects on pain, with improvements in range of lateral rotation being a key factor in reducing shoulder pain.
When managing frozen shoulder, it's essential to consider the following interventions:
- Electrical stimulation, which may not change pain intensity but can improve pain-free lateral rotation, as found by Price and Pandyan 1
- Exercise, including gentle stretching exercises focusing on external rotation, internal rotation, and forward elevation
- Modalities such as ice, heat, soft tissue massage, and mobilization to improve comfort and reduce stiffness
- Shoulder positioning protocols and strapping the involved upper extremity may also be beneficial in certain cases
It's crucial to note that the treatment of frozen shoulder aims to reduce inflammation and gradually restore range of motion, with the goal of improving morbidity, mortality, and quality of life outcomes. As Bohannon et al noted in the study 1, range of lateral rotation is a significant factor in the onset and occurrence of shoulder pain, highlighting the importance of targeted interventions to improve this aspect of shoulder function.
In terms of specific treatment protocols, the use of corticosteroid injections, such as Triamcinolone, has been shown to be effective in reducing pain and improving range of motion, making it a recommended treatment option for frozen shoulder, as supported by the evidence from 1.
From the Research
Treatment Options for Frozen Shoulder
- Medication: Oral corticosteroids, such as prednisolone, can be used to treat frozen shoulder, especially in the early stages 2.
- Local steroid injection: Intra-articular glucocorticoid injections can be used to reduce pain and inflammation 3, 4.
- Physiotherapy: Therapeutic exercises, mobilization, and physical therapy interventions (PTI) are strongly recommended for reducing pain, improving range of motion (ROM), and function in patients with frozen shoulder 4, 5, 6.
- Hydrodistension: This treatment option is available, but its effectiveness is not well-studied in the provided evidence 3.
- Manipulation under anesthesia: This treatment option is available, but its effectiveness is not well-studied in the provided evidence 3.
- Arthroscopic capsular release: This surgical treatment option is available for patients who do not respond to conservative management 3.
- Open capsular release: This surgical treatment option is available for patients who do not respond to conservative management 3.
Comparison of Treatment Options
- A randomized controlled trial compared the efficacy of exercise and oral corticosteroids in patients with frozen shoulder, and found that both groups achieved significant improvements, but the exercise group was superior in terms of abduction and external rotation ROM 6.
- A study found that glucocorticoid therapy combined with pregabalin and a home exercise program is an effective treatment in the first stage of frozen shoulder 2.
- A systematic review found that therapeutic exercises and mobilization are strongly recommended for reducing pain, improving ROM, and function in patients with stages 2 and 3 of frozen shoulder 4.
Conservative Management
- Conservative management leads to improvement in most cases, and failure to obtain symptomatic improvement and continued functional disability after 3 to 6 months of conservative treatment are general indications for surgical management 3.
- Physical therapy exercises targeted at adhesive capsulitis can be used in combination with common analgesics 5.