What is the treatment for frozen shoulder (adhesive capsulitis)?

Treatment of Frozen Shoulder (Adhesive Capsulitis)

Physical therapy combined with pain management using NSAIDs and corticosteroid injections is the most effective approach for treating frozen shoulder, with treatment tailored to the specific stage of the condition. 1

Understanding Frozen Shoulder

Frozen shoulder (adhesive capsulitis) is a common condition characterized by progressive shoulder stiffness and pain that typically progresses through three stages:

1. Freezing stage (painful phase): Increasing pain and decreasing range of motion (4-6 months)
2. Frozen stage (adhesive phase): Continued stiffness with improving pain (4-6 months)
3. Thawing stage: Gradual improvement in range of motion (4-6 months)

Stage-Based Treatment Approach

Stage 1: Freezing (Painful Phase)

• Pain management is the priority:
  • NSAIDs (ibuprofen, naproxen) or acetaminophen for pain relief 2, 1
  • Intra-articular corticosteroid injections (triamcinolone) for significant pain 2, 1
  • Ice therapy for acute inflammation 1
  • Avoid overhead pulley exercises which can worsen symptoms 2, 1

Stage 2: Frozen (Adhesive Phase)

• Focus on maintaining and improving mobility:
  • Gentle stretching and mobilization techniques focusing on external rotation and abduction 2, 1
  • Active range of motion exercises gradually increased 2
  • Heat therapy to improve tissue elasticity 1
  • Consider subacromial corticosteroid injections if pain persists 2

Stage 3: Thawing Phase

• Emphasis on restoration of function:
  • Progressive stretching exercises
  • Strengthening of shoulder girdle muscles
  • Functional exercises to restore normal movement patterns

Interventional Options

If symptoms persist after 4-6 weeks of conservative management:

1. Corticosteroid injections:

   • Intra-articular injections show significant effects on pain 2, 1
   • Subacromial injections when inflammation of the subacromial region is present 2

2. More aggressive interventions (for refractory cases):

   • Suprascapular nerve blocks 2
   • Distension arthrography
   • Manipulation under anesthesia
   • Arthroscopic capsular release (for severe cases not responding to conservative treatment)

Physical Therapy Protocol

• Gentle stretching exercises focusing on external rotation and abduction 2, 1
• Avoid overhead pulley exercises as they can worsen symptoms 2
• Neuromuscular electrical stimulation (NMES) may be beneficial 2, 1
• Eccentric strengthening exercises combined with thermal therapy 1
• Scapular stabilization exercises to improve overall shoulder function 1

Important Considerations

• Approximately 80% of patients recover completely within 3-6 months with appropriate conservative treatment 1
• Early intervention is crucial to prevent progression and complications 1
• Avoid shoulder immobilization with arm slings or wraps as this can worsen the condition 1
• Patients with diabetes may have a more prolonged and severe course

When to Consider Surgical Intervention

• Persistent severe pain and functional limitation despite 3-6 months of conservative treatment
• Significant disability affecting quality of life
• Failure to progress with conservative management

By following this stage-based approach and combining appropriate physical therapy with pain management strategies, most patients with frozen shoulder will experience significant improvement in pain and function over time.