From the Guidelines
The recommended treatment for frozen shoulder, also known as adhesive capsulitis, typically involves a combination of pain management and physical therapy, with steroid injections being a significant treatment option. According to the study by 1, intra-articular injections, such as Triamcinolone, have been found to have significant effects on pain, and range of motion (ROM) improved with the injections. The treatment of shoulder pain, including frozen shoulder, includes interventions such as electrical stimulation, treatment with steroid injections/medication, exercise, shoulder positioning protocols, strapping the involved upper extremity, and modalities including ice, heat, soft tissue massage, and mobilization 1.
Key aspects of treatment include:
- Pain management
- Physical therapy to maintain and improve range of motion
- Steroid injections for temporary relief in more severe cases
- Consideration of other interventions like electrical stimulation, exercise, and modalities such as ice, heat, and massage
It's crucial to note that the study by 1 found a significant treatment effect in favor of pain-free lateral rotation with electrical stimulation, although pain intensity did not change. Additionally, the range of lateral rotation is considered a significant factor related to the onset or occurrence of shoulder pain 1.
In terms of specific treatment protocols, a combination of gentle stretching exercises, such as pendulum exercises, wall climbing with fingers, and external and internal rotation stretches, held for 20-30 seconds and repeated 5-10 times, twice daily, can help maintain and improve range of motion. For more severe cases, corticosteroid injections, like triamcinolone 40mg, can provide temporary relief. If conservative treatments fail, more invasive options may be considered. Recovery from frozen shoulder can be prolonged, taking 1-3 years, with most patients eventually regaining significant function.
From the Research
Recommended Treatment for Frozen Shoulder
The recommended treatment for frozen shoulder includes a combination of conservative treatments, such as:
- Physiotherapeutic interventions, including therapeutic exercises and mobilization, which are strongly recommended for reducing pain, improving range of motion (ROM), and function in patients with stages 2 and 3 of frozen shoulder 2
- Corticosteroid injections, which can be used for stage 1 frozen shoulder 2
- Acupuncture with therapeutic exercises, which is moderately recommended for pain relief, improving ROM, and function 2
- Low-level laser therapy, which is strongly suggested for pain relief and moderately suggested for improving function, but not recommended for improving ROM 2
Combination of Treatments
Combining different conservative treatments may provide additive benefits for improving patient outcomes, such as:
- Combining suprascapular nerve block (SSNB) with physical therapy and/or intra-articular corticosteroid (IACS) injection 3
- Combining IACS injection with physical therapy 3
- Combining hydrodilatation with physical therapy, which may offer some additive benefits for improving shoulder ROM 3
Physical Therapy
Physical therapy is a common conservative treatment for frozen shoulder, and may include exercises targeted at adhesive capsulitis, which can be used in combination with common analgesics 4
Other Treatments
Other treatments, such as oral medication, injection therapy, arthrographic distension, and surgical interventions, may also be effective in treating frozen shoulder, but the evidence for their effectiveness is limited or unclear 5, 6