From the Guidelines
Frozen shoulder treatment should prioritize a combination of pain management, physical therapy, and sometimes more invasive procedures, with a focus on gentle stretching exercises and corticosteroid injections for temporary relief. The treatment approach for frozen shoulder aims to reduce inflammation, improve range of motion, and alleviate pain. Key components of treatment include:
- Pain relief with over-the-counter medications like ibuprofen (400-800mg three times daily) or naproxen (250-500mg twice daily) for 2-3 weeks 1
- Application of heat to the shoulder for 15 minutes before stretching exercises and ice for 15-20 minutes after activity to reduce inflammation
- Physical therapy with gentle stretching exercises performed 2-3 times daily, focusing on external rotation, internal rotation, and forward flexion, holding each stretch for 30 seconds 1
- Corticosteroid injections, such as methylprednisolone 40mg with lidocaine, into the shoulder joint for temporary relief during the painful freezing phase 1
- For severe cases unresponsive to conservative treatment, more invasive options like hydrodilatation, manipulation under anesthesia, or arthroscopic surgery to release the tight capsule may be considered It is essential to note that recovery from frozen shoulder can take 1-3 years, but most patients regain significant function with appropriate treatment 1. The condition involves inflammation and thickening of the shoulder capsule, which restricts movement, so treatments aim to reduce inflammation and gradually restore range of motion through consistent stretching. In cases where pain is thought to be related to spasticity, injections of botulinum toxin into the subscapularis and pectoralis muscles could be used 1. Additionally, subacromial corticosteroid injections can be used in patients when pain is thought to be related to injury or inflammation of the subacromial region (rotator cuff or bursa) in the hemiplegic shoulder 1.
From the Research
Treatment Options for Frozen Shoulder
- Physical therapy interventions (PTI) are strongly recommended for reducing pain, improving range of motion (ROM), and function in patients with stages 2 and 3 of frozen shoulder 2
- Therapeutic exercises and mobilization are effective in improving ROM and function 2, 3
- Low-level laser therapy is strongly suggested for pain relief and moderately suggested for improving function, but not recommended for improving ROM 2
- Corticosteroid injections can be used for stage 1 frozen shoulder 2, 4
- Acupuncture with therapeutic exercises is moderately recommended for pain relief, improving ROM, and function 2
- Electro-therapy can help in providing short-term pain relief 2
- Continuous passive motion is recommended for short-term pain relief, but not for improving ROM or function 2
- Deep heat can be used for pain relief and improving ROM 2
- Ultrasound is not recommended for pain relief, improving ROM, or function 2
- Oral glucocorticoids, such as methylprednisolone, can be effective in treating frozen shoulder, especially when combined with a home exercise program and pregabalin 4
- Nonoperative treatment, including oral glucocorticoids, physical therapy, and home exercise programs, can be effective in treating frozen shoulder 4, 5
Physical Therapy for Frozen Shoulder
- Physical therapy exercises, such as therapeutic exercises and mobilization, can be used to improve ROM and function in patients with frozen shoulder 2, 3
- Physical therapy can be used in combination with common analgesics to treat frozen shoulder 3
- A systematic review of randomized controlled trials is needed to evaluate the effectiveness and safety of physical therapy for the treatment of frozen shoulder 6
Medications for Frozen Shoulder
- Nonsteroidal anti-inflammatory drugs (NSAIDs) and oral glucocorticoids can be used to treat frozen shoulder 3, 4, 5
- Corticosteroid injections can be used to treat stage 1 frozen shoulder 2, 4
- Pregabalin can be used in combination with oral glucocorticoids and a home exercise program to treat frozen shoulder 4