From the Research
Treatment for adhesive capsulitis (frozen shoulder) typically involves a multimodal approach focused on pain management and restoration of shoulder mobility, with the most recent and highest quality study suggesting that a combination of manual therapy and exercise may not be as effective as glucocorticoid injection in the short-term, but can provide similar effects to sham ultrasound in terms of overall pain, function, and quality of life, with greater patient-reported treatment success and active range of motion 1. The initial treatment includes pain control with NSAIDs like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily), along with acetaminophen (1000mg three to four times daily) as needed.
- Physical therapy is crucial and should be performed 2-3 times weekly for 6-12 weeks, focusing on gentle stretching exercises and progressive range of motion activities.
- Home exercises should be done daily.
- For persistent pain, corticosteroid injections into the glenohumeral joint (typically 40mg methylprednisolone or equivalent with local anesthetic) may provide relief, usually limited to 2-3 injections several weeks apart, as supported by a study that found glucocorticoid therapy combined with pregabalin and a home exercise program to be an effective treatment in the first stage of frozen shoulder 2. In severe cases that don't respond to conservative treatment after 3-6 months, more invasive options include hydrodilatation (capsular distension), manipulation under anesthesia, or arthroscopic capsular release, with a study suggesting that arthroscopic capsular release has gained popularity over the years and offers a predictably good treatment in patients with adhesive capsulitis 3. Most cases resolve with conservative management within 1-3 years, though some patients may have residual limitations, and early intervention is important as treatment is most effective during the painful freezing phase rather than the later frozen phase when inflammation has subsided but stiffness persists, as discussed in a comprehensive review of adhesive capsulitis 4 and a case report on the function of osteopathic medicine in the treatment of adhesive capsulitis 5.