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

Treatment of Frozen Shoulder (Adhesive Capsulitis)

The most effective treatment for frozen shoulder includes physical therapy focusing on stretching and mobilization techniques, particularly targeting external rotation and abduction movements, combined with pain management strategies such as NSAIDs and corticosteroid injections when appropriate. 1

Initial Management Approach

• Physical therapy with stretching and mobilization techniques should be initiated as early as possible to prevent progression of adhesive capsulitis 2, 3
• Avoid overhead pulleys as they encourage uncontrolled abduction and can worsen shoulder pain 1
• NSAIDs (such as ibuprofen) can be used for pain relief if there are no contraindications 1, 3
• Remove constricting items like jewelry and tight clothing around the affected shoulder to accommodate swelling 1

Physical Therapy Interventions

• Focus on gradually increasing active range of motion while restoring alignment and strengthening weak muscles in the shoulder girdle 1, 2
• Specifically target external rotation and abduction movements, which are most significantly related to shoulder pain onset and prevention of frozen shoulder 1, 2
• Therapeutic exercises combined with mobilization techniques are strongly recommended for reducing pain and improving function in stages 2 and 3 of frozen shoulder 3, 4
• Protect the affected shoulder from trauma during rehabilitation, as this can reduce the frequency of shoulder-hand syndrome 1

Adjunctive Treatments

• Intra-articular corticosteroid injections (such as Triamcinolone) can significantly reduce pain, especially in early stages 1
• Functional electrical stimulation may be beneficial for improving shoulder lateral rotation 1
• Low-level laser therapy can be considered for pain relief and improving function 3
• Modalities including ice, heat, and soft tissue massage can help manage pain 1

Advanced Interventions for Refractory Cases

• For patients who fail conservative treatment (typically after at least 12 weeks of physical therapy), arthroscopic capsular release may be considered 5
• Arthroscopic capsular release has shown substantial gains in shoulder range of motion and diminished pain in patients with recalcitrant frozen shoulder 5
• Avoid manipulation under anesthesia as it has been associated with joint damage and may be no more effective than physical therapy 6

Treatment Based on Stage of Frozen Shoulder

• Stage 1 (Freezing/Painful): Focus on pain management with corticosteroid injections and gentle range of motion exercises 3, 7
• Stage 2 (Frozen/Adhesive): Emphasize more aggressive stretching and mobilization techniques combined with pain management 3, 4
• Stage 3 (Thawing): Continue with stretching exercises and gradually increase strengthening activities 4

Common Pitfalls to Avoid

• Prolonged immobilization can contribute to frozen shoulder development and should be avoided 2
• Overhead pulleys can increase pain and should not be used 1
• Delaying treatment can lead to longer recovery times and potentially poorer outcomes 2, 6
• Aggressive manipulation without proper technique can cause additional tissue damage 6

While frozen shoulder is often self-limiting, appropriate intervention can significantly reduce pain, improve function, and potentially shorten the duration of symptoms 4, 7.