From the Guidelines
The initial management for a patient presenting with symptoms of frozen shoulder should focus on pain control and maintaining range of motion, with a multimodal approach including oral NSAIDs, gentle home exercise program, and physical therapy, as this approach has been shown to address both the inflammatory component and the capsular fibrosis that restricts movement. When considering the management of frozen shoulder, it is essential to prioritize interventions that improve range of motion and reduce pain, as these are critical for maintaining functional ability and quality of life. The use of oral NSAIDs such as ibuprofen 400-600mg three times daily or naproxen 500mg twice daily for 2-4 weeks can help reduce inflammation and pain, as suggested by 1. Additionally, a gentle home exercise program focusing on pendulum exercises, wall climbing with fingers, and cross-body stretches performed 3-5 times daily for 5-10 minutes each session can help maintain range of motion. Application of heat before exercises and ice afterward can also help manage pain. For patients with severe pain, a corticosteroid injection into the glenohumeral joint may provide significant relief and improve participation in physical therapy, as mentioned in 1. Physical therapy should be initiated early, typically 2-3 sessions weekly for 6-12 weeks, focusing on passive stretching and gradually progressing to active range of motion exercises. This approach is supported by the most recent and highest quality study, 1, which emphasizes the importance of gentle stretching and mobilization techniques, and gradually increasing active range of motion in conjunction with restoring alignment and strengthening weak muscles in the shoulder girdle. Key aspects of management include:
- Oral NSAIDs for pain and inflammation
- Gentle home exercise program for range of motion
- Physical therapy for passive and active range of motion exercises
- Corticosteroid injections for severe pain
- Heat and ice application for pain management.
From the Research
Frozen Shoulder Symptoms
- Painful and limited active and passive range of motion in the shoulder joint 2
- Characteristic history, clinical presentation, and recovery 2
- Three stages of progression: freezing (painful), frozen (adhesive), and thawing 3
Initial Management
- Nonoperative interventions:
- Patient education
- Modalities
- Stretching exercises
- Joint mobilization
- Corticosteroid injections 2
- Glenohumeral intra-articular corticosteroid injections have a significantly greater 4- to 6-week beneficial effect compared to other forms of treatment 2
- Exercise and manual techniques are progressed as the patient's irritability reduces 2
- Response to treatment is based on significant pain relief, improved satisfaction, and return of functional motion 2
Treatment Options
- Therapeutic exercises and mobilization are strongly recommended for reducing pain, improving range of motion (ROM), and function in patients with stages 2 and 3 of frozen shoulder 4
- Low-level laser therapy is strongly suggested for pain relief and moderately suggested for improving function but not recommended for improving ROM 4
- Corticosteroid injections can be used for stage 1 frozen shoulder 4
- Acupuncture with therapeutic exercises is moderately recommended for pain relief, improving ROM, and function 4
- Arthroscopic capsular release is an effective and safe alternative to manipulation in patients with a recalcitrant frozen shoulder 5