From the Guidelines
The initial management of adhesive capsulitis (frozen shoulder) should focus on pain control and maintaining range of motion through conservative measures, including exercise and modalities such as ice, heat, and mobilization, as outlined in the management of adult stroke rehabilitation care guideline 1. The management of adhesive capsulitis involves a multifaceted approach to alleviate pain and preserve shoulder mobility. Key considerations include:
- Exercise: Gentle stretching exercises performed 2-3 times daily to maintain and gradually increase shoulder mobility, with a focus on pain-free lateral rotation, as this factor is significantly related to the onset of shoulder pain 1.
- Modalities: The use of ice, heat, soft tissue massage, and mobilization to manage pain and improve range of motion, as these interventions are recommended for the treatment of shoulder pain in the context of stroke rehabilitation 1.
- Pain management: While the provided evidence does not specifically recommend oral NSAIDs or corticosteroid injections for adhesive capsulitis, intra-articular injections (such as Triamcinolone) have been found to have significant effects on pain in the context of shoulder pain management, suggesting a potential role in the treatment of adhesive capsulitis 1. It is essential to note that the evidence provided is from the context of stroke rehabilitation, but the principles of pain management and maintaining range of motion are applicable to the management of adhesive capsulitis in general. Given the potential benefits and the lack of strong evidence against these interventions, a conservative approach emphasizing exercise, modalities, and pain management should be the initial strategy for managing adhesive capsulitis, with the understanding that the condition's natural course may span 1-3 years and that early intervention can help prevent further capsular fibrosis and shortening.
From the Research
Initial Management for Adhesive Capsulitis
The initial management for adhesive capsulitis, also known as frozen shoulder, typically involves conservative measures and aggressive physical therapy 2. The goal of any treatment is to reduce pain and restore shoulder movement 3.
Treatment Options
Some of the treatment options for adhesive capsulitis include:
- Nonsteroidal anti-inflammatory drugs
- Short-term oral corticosteroids
- Intra-articular corticosteroid injections
- Physiotherapy
- Acupuncture
- Hydrodilatation 4
- Ultrasound-assisted hydrodistention of the glenohumeral joint combined with targeted exercise 3
Efficacy of Physiotherapy Interventions
Physiotherapy interventions have been shown to be effective in improving pain, range of motion, and functional status in patients with adhesive capsulitis 5. However, the efficacy of one treatment modality over another is uncertain.
Corticosteroid Injections
Corticosteroid injections, such as triamcinolone acetonide, can provide significant pain relief and improvement in shoulder function 6. A dose of 20mg of triamcinolone acetonide has been shown to be sufficient to elicit symptom relief in patients with severe adhesive capsulitis 6.
Combination Therapy
Combining physiotherapy with corticosteroid injections may provide greater improvement than physiotherapy alone 4. Ultrasound-assisted hydrodistention of the glenohumeral joint combined with targeted exercise has also been shown to be effective in improving pain relief, reducing disability, and increasing range of motion in subjects with stage 1 and 2 adhesive capsulitis 3.