From the Guidelines
Frozen shoulder, also known as adhesive capsulitis, is best treated with a combination of pain management, physical therapy, and time, focusing on gentle stretching exercises and strengthening the shoulder muscles, as recommended by recent clinical guidelines 1. The primary approach involves over-the-counter pain relievers such as ibuprofen (400-800 mg three times daily) or naproxen (250-500 mg twice daily) to manage pain and inflammation.
- Alongside this, a structured physical therapy program is crucial, typically lasting 6-12 weeks, with sessions 2-3 times per week.
- The therapy should focus on gentle stretching exercises to improve range of motion and strengthen the shoulder muscles, with particular emphasis on external rotation and abduction. For more severe cases, a corticosteroid injection into the shoulder joint, such as triamcinolone (40 mg) or methylprednisolone (40-80 mg), may be recommended, usually limited to 2-3 injections spaced at least a month apart, as suggested by guidelines for managing shoulder pain 1. At home, patients should apply heat or cold packs to the shoulder for 15-20 minutes, 3-4 times daily, to help manage pain and improve flexibility. The condition typically progresses through three stages: freezing (increasing pain and stiffness), frozen (reduced pain but significant stiffness), and thawing (gradual improvement in range of motion), which can last 1-3 years, and understanding this progression helps manage expectations and treatment plans. Frozen shoulder occurs when the capsule surrounding the shoulder joint becomes inflamed and thickened, restricting movement, and the recommended treatments aim to reduce this inflammation, break down adhesions in the joint capsule, and gradually restore range of motion, as supported by clinical practice guidelines 1. It's worth noting that the evidence from the study on glenohumeral osteoarthritis 1 does not directly address the treatment of adhesive capsulitis, and therefore, the recommendations are based on the more relevant guideline for managing adult stroke rehabilitation care 1, which provides specific advice on preventing and treating shoulder pain, including frozen shoulder.
From the Research
Diagnosis of Adhesive Capsulitis (Frozen Shoulder)
- The diagnosis of frozen shoulder is based on pattern recognition and physical examination 2
- 'Rule-in' and 'rule-out' criteria can be used to increase the likelihood of the frozen shoulder diagnosis 2
- People with Diabetes Mellitus and thyroid disorders have a higher risk of developing a frozen shoulder 2
Treatment of Adhesive Capsulitis (Frozen Shoulder)
- Common conservative treatments include nonsteroidal anti-inflammatory drugs, oral glucocorticoids, intra-articular glucocorticoid injections and/or physical therapy 3
- Physical therapy exercises targeted at adhesive capsulitis can be used in combination with common analgesics 3
- Arthroscopic capsular release is more effective in pain relief than conservative treatment in patients with frozen shoulder 4
- Physiotherapy and intraarticular steroid injection also outperformed physical therapy and NSAID treatment in terms of pain relief 4
- Recommended physical therapy interventions include mobilization techniques and exercises, with tissue irritability guiding intensity 2
- Other potential interventions include proprioceptive neuromuscular facilitation, mirror therapy, pain neuroscience education, high-intensity interval training, and lifestyle changes 2