From the Guidelines
Frozen shoulder syndrome, also known as adhesive capsulitis, should be treated with a combination of pain management, physical therapy, and corticosteroid injections, as these interventions have been shown to improve range of motion and reduce pain intensity 1. The treatment of adhesive capsulitis typically begins with pain management using NSAIDs like ibuprofen (400-800mg three times daily) or naproxen (250-500mg twice daily) for 2-4 weeks.
- Physical therapy is essential and should be started early, focusing on gentle stretching and range-of-motion exercises performed 2-3 times daily for 10-15 minutes each session.
- For severe pain, corticosteroid injections into the shoulder joint, such as Triamcinolone, may provide temporary relief and improve range of motion 1.
- In persistent cases lasting over 6 months, more invasive options include hydrodilatation (stretching the joint capsule with fluid injection), manipulation under anesthesia, or arthroscopic surgery to release the tight capsule. The condition occurs when the capsule surrounding the shoulder joint becomes inflamed and thickened, causing the characteristic pain and restricted movement.
- People with diabetes, thyroid disorders, or those who've experienced prolonged shoulder immobilization are at higher risk for developing this condition.
- Electrical stimulation and modalities such as ice, heat, and soft tissue massage may also be considered as part of a comprehensive treatment plan 1. The goal of treatment is to improve range of motion, reduce pain, and prevent long-term disability, with most cases resolving within 1-3 years, even without treatment, though the recovery process can be accelerated with appropriate intervention 1.
From the Research
Diagnosis of Adhesive Capsulitis (Frozen Shoulder Syndrome)
- Adhesive capsulitis, also known as frozen shoulder syndrome, is characterized by a gradual increase in pain and limitation in range of motion of the glenohumeral joint 2.
- The condition is often classified into primary (idiopathic) and secondary frozen shoulder, with secondary frozen shoulder further divided into systemic, extrinsic, and intrinsic subcategories 3.
- Diagnosis is typically based on a characteristic history, clinical presentation, and recovery, with patients often demonstrating painful and limited active and passive range of motion 3.
Treatment of Adhesive Capsulitis (Frozen Shoulder Syndrome)
- Treatment modalities for frozen shoulder include medication, local steroid injection, physiotherapy, hydrodistension, manipulation under anesthesia, arthroscopic capsular release, and open capsular release 2.
- Conservative management, such as physiotherapy and oral glucocorticoids, can lead to improvement in most cases, with failure to obtain symptomatic improvement and continued functional disability after 3 to 6 months of conservative treatment indicating a need for surgical management 2, 4.
- Nonoperative interventions, including patient education, modalities, stretching exercises, joint mobilization, and corticosteroid injections, can also be effective in managing frozen shoulder 3.
- A rehabilitation model based on evidence and intervention strategies matched with irritability levels has been proposed, with exercise and manual techniques progressed as the patient's irritability reduces 3.
- Physiotherapy exercises, such as those targeted at adhesive capsulitis, can be used in combination with common analgesics to manage frozen shoulder 5.
- Glucocorticoid therapy combined with pregabalin and a home exercise program has been shown to be an effective treatment for frozen shoulder, particularly in the first stage of the condition 4.