From the Guidelines
Intra-articular injections, such as Triamcinolone, have been found to have significant effects on pain relief in frozen shoulder, and should be considered as a primary treatment option. Treatment options for pain relief in frozen shoulder include a combination of interventions, such as electrical stimulation, exercise, and modalities including ice, heat, soft tissue massage, and mobilization 1. According to the study by Price and Pandyan, patients who received electrical stimulation had no change in pain intensity, compared with the control group; however, there was a significant treatment effect in favor of pain-free lateral rotation 1.
Some key points to consider when treating frozen shoulder pain include:
- Intra-articular injections, such as Triamcinolone, have been found to have significant effects on pain relief 1
- Exercise, including gentle stretching exercises, should be started early to maintain range of motion
- Modalities including ice, heat, soft tissue massage, and mobilization can provide temporary relief
- Electrical stimulation may have a significant treatment effect in favor of pain-free lateral rotation 1
It's also important to note that the range of lateral rotation is a significant factor related to the onset/occurrence of shoulder pain, as considered by Bohannon et al 1. A multimodal approach combining medication with physical therapy typically yields the best results, as the condition usually resolves over time even without treatment.
From the Research
Treatment Options for Pain Relief in Frozen Shoulder
The treatment options for pain relief in frozen shoulder include:
- Physiotherapy: helps improve range of motion and reduce pain 2, 3, 4
- Intra-articular corticosteroid injection: provides short-term pain relief and improvement in range of motion 2, 5, 4
- Arthrographic distension/hydrodilatation with corticosteroid: provides medium-term and long-term improvements in range of motion and pain relief 2, 5
- Oral glucocorticoids: can be effective in the first stage of frozen shoulder, especially when combined with pregabalin and a home exercise program 6
- Rotator interval injection: can be an effective treatment option, especially when combined with distension 5
Comparison of Treatment Options
Studies have compared the effectiveness of different treatment options for frozen shoulder, including:
- Intra-articular corticosteroid injection vs. physiotherapy: intra-articular corticosteroid injection was associated with statistical and clinical superiority in the short-term for pain and function 4
- Arthrographic distension/hydrodilatation with corticosteroid vs. intra-articular corticosteroid injection: arthrographic distension/hydrodilatation with corticosteroid provides superior pain relief in the short term and improvement in range of motion across all time frames 2
- Rotator interval injection vs. distension: rotator interval injection and distension had equivalent effects on symptom relief 5
Recommendations for Treatment
Based on the available evidence, the following recommendations can be made:
- Intra-articular corticosteroid injection can be considered as a first-line treatment option for frozen shoulder, especially in the short-term 4
- Arthrographic distension/hydrodilatation with corticosteroid can be considered as a treatment option for patients who do not respond to intra-articular corticosteroid injection or who require longer-term pain relief 2, 5
- Physiotherapy and home exercise programs can be used in conjunction with other treatment options to improve range of motion and reduce pain 2, 3, 4