From the Guidelines
The recommended treatment for frozen shoulder typically involves a combination of pain management, physical therapy, and in some cases, more invasive interventions. Initially, pain control with nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) is advised, along with applying heat or ice to the affected area 1. Physical therapy is crucial and should include gentle stretching exercises performed daily to maintain and improve range of motion. A typical regimen includes:
- Pendulum exercises
- Wall climbing with fingers
- Cross-body reaches Each exercise should be held for 20-30 seconds and repeated 5-10 times daily. For more severe cases, corticosteroid injections (such as triamcinolone 40mg or methylprednisolone 40-80mg) into the shoulder joint can provide temporary relief 1. If conservative treatments fail after 3-6 months, more invasive options may be considered, including hydrodilatation (joint distension with saline), manipulation under anesthesia, or arthroscopic capsular release. Recovery from frozen shoulder can take 1-3 years, with most patients experiencing gradual improvement as the condition progresses through its freezing, frozen, and thawing phases. The treatment approach should be adjusted based on the phase of the condition and individual response to therapy. It is also important to note that the use of overhead pulleys should be avoided, as they can encourage uncontrolled abduction and potentially worsen the condition 1. In contrast, gentle stretching and mobilization techniques, such as those focused on external rotation and abduction, can help prevent frozen shoulder and shoulder-hand pain syndrome 1. Overall, a comprehensive treatment plan that incorporates pain management, physical therapy, and potentially more invasive interventions can help improve outcomes for patients with frozen shoulder.
From the Research
Treatment Options for Frozen Shoulder
The recommended treatment for frozen shoulder includes a variety of options, 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
Comparison of Treatment Options
Studies have compared the effectiveness of different treatment options for frozen shoulder, including:
- A systematic review and cost-effectiveness analysis, which found that steroid combined with physiotherapy was the only treatment showing a statistically and clinically significant beneficial treatment effect compared with placebo for short-term pain 3
- A meta-analysis, which found that hydrodilatation with corticosteroids is the most effective conservative management for frozen shoulder, providing advantages over placebo in short-term pain relief, ROM, and shoulder function 4
- A protocol for systematic review of randomized controlled trials, which aims to evaluate the effectiveness and safety of physical therapy alone for the treatment of frozen shoulder 5
Physical Therapy in the Management of Frozen Shoulder
Physical therapy plays an important role in the management of frozen shoulder, with exercises targeted at adhesive capsulitis, which can be used in combination with common analgesics 6. The effectiveness of physical therapy for frozen shoulder is still inconclusive, and further studies are needed to determine its effectiveness and safety 5.
Key Findings
Key findings from the studies include:
- Therapeutic exercises and mobilization are effective in reducing pain, improving ROM, and function in patients with stages 2 and 3 of frozen shoulder 2
- Hydrodilatation with corticosteroids provides medium-term and long-term improvements in ROM over intra-articular CSI and physiotherapy 4
- Physical therapy alone may be effective in the treatment of frozen shoulder, but further studies are needed to determine its effectiveness and safety 5