From the Guidelines
Frozen shoulder treatment should prioritize a combination of pain management, physical therapy, and potentially corticosteroid injections, with a focus on improving range of motion and reducing inflammation. When considering treatment options for adhesive capsulitis (frozen shoulder), it's essential to prioritize interventions that address pain, inflammation, and restricted movement.
Treatment Options
- Pain management: Over-the-counter medications like ibuprofen (400-800mg three times daily) or naproxen (250-500mg twice daily) for 2-3 weeks can help alleviate pain, as supported by general medical knowledge.
- Physical therapy: Gentle stretching exercises performed 2-3 times daily, focusing on forward flexion, external rotation, and internal rotation of the shoulder, are crucial for improving range of motion 1.
- Corticosteroid injections: Intra-articular injections, such as triamcinolone, have been found to have significant effects on pain and can improve range of motion, although the improvements may not be significant 1.
Additional Interventions
- Modalities: Ice, heat, and soft tissue massage can be used to reduce pain and inflammation.
- Functional electrical stimulation (FES) and strengthening exercises may also be considered to improve range of motion and prevent further complications. It's essential to note that while some studies suggest the use of electrical stimulation and shoulder strapping, the evidence is not strong enough to support these interventions as primary treatments for frozen shoulder 1.
Severe Cases
For severe cases unresponsive to conservative treatment, manipulation under anesthesia or arthroscopic capsular release may be considered, although these options should be reserved for cases where other treatments have failed. Recovery from frozen shoulder can take 1-3 years, but most patients experience significant improvement with appropriate treatment, which aims to reduce inflammation and gradually restore range of motion through consistent stretching.
From the Research
Treatment Options for Adhesive Capsulitis (Frozen Shoulder)
The treatment options for adhesive capsulitis (frozen shoulder) include:
- Physiotherapeutic interventions, such as therapeutic exercises and mobilization, which are strongly recommended for reducing pain, improving range of motion (ROM), and function in patients with stages 2 and 3 of frozen shoulder 2
- Low-level laser therapy, which is strongly suggested for pain relief and moderately suggested for improving function, but not recommended for improving ROM 2
- Corticosteroid injections, which can be used for stage 1 frozen shoulder 2
- Acupuncture with therapeutic exercises, which is moderately recommended for pain relief, improving ROM, and function 2
- Electro-therapy, which can help in providing short-term pain relief 2
- Continuous passive motion, which is recommended for short-term pain relief, but not for improving ROM or function 2
- Deep heat, which can be used for pain relief and improving ROM 2
- Intra-articular injection, which improved pain and shoulder function to a greater extent than placebo 3
- Capsular distension, which showed the highest ranking for pain relief and functional improvement 3
- Extracorporeal shockwave therapy, which showed potential benefits for multiple outcomes 3
- Laser therapy, which also showed benefits for pain relief and functional improvement 3
- Hydroplasty, which has potential to provide rapid relief of pain and immediate improvement of shoulder function for patients with adhesive capsulitis 4
Non-Surgical Treatment Strategies
Non-surgical treatment strategies for frozen shoulder include:
- Physical therapy, which can be used in combination with common analgesics 5
- Nonsurgical interventions, such as intra-articular injection, capsular distension, and extracorporeal shockwave therapy, which have been shown to be effective in improving pain and shoulder function 3
- Physical therapy alone, which has been reported to be effective in the treatment of frozen shoulder, but its effectiveness is still inconclusive 6
Patient-Specific Moderating Factors
Patient-specific moderating factors, such as disease stage, time of assessment, adjunctive therapies, female sex, and diabetes, can affect the effectiveness of treatment for frozen shoulder 3