What is the recommended treatment for a patient presenting with frozen shoulder symptoms?

Treatment for Frozen Shoulder Symptoms

Physical therapy with stretching and mobilization exercises focusing on external rotation and abduction, combined with pain management using NSAIDs or acetaminophen, is the recommended first-line treatment for patients presenting with frozen shoulder symptoms. 1

Clinical Presentation and Diagnosis

• Frozen shoulder (adhesive capsulitis) presents with significant stiffness and pain in the shoulder joint that limits range of motion 1
• The condition typically progresses through three phases: freezing (painful), frozen (adhesive), and thawing phases 2
• Diagnosis is primarily clinical based on global motion restriction and pain 2
• Ultrasound may be considered as a diagnostic tool to evaluate shoulder soft tissue injury 3

First-Line Treatment Approach

• Physical Therapy Interventions:

  • Therapeutic exercises and mobilization are strongly recommended for reducing pain, improving range of motion, and function 4
  • Focus on gentle stretching and mobilization techniques, particularly increasing external rotation and abduction 3
  • Active range of motion should be increased gradually while restoring alignment and strengthening weak muscles in the shoulder girdle 3
  • Regular exercise programs have demonstrated effectiveness for managing symptoms 1
  • Avoid overhead pulley exercises as they are not recommended and may worsen symptoms 3, 1

• Pain Management:

  • NSAIDs (such as ibuprofen) or acetaminophen should be used for pain relief if there are no contraindications 3, 1
  • These medications help control pain and facilitate participation in physical therapy 5

Second-Line and Adjunctive Treatments

• Corticosteroid Injections:

  • Subacromial corticosteroid injections can be used when pain is related to inflammation in the subacromial region 3
  • Ultrasound guidance is recommended for injection-based therapy, although not required 2

• Other Modalities:

  • Acupuncture with therapeutic exercises is moderately recommended for pain relief, improving range of motion and function 1, 4
  • Low-level laser therapy is strongly suggested for pain relief and moderately suggested for improving function 4
  • Electrotherapy can help provide short-term pain relief 4
  • Deep heat can be used for pain relief and improving range of motion 4
  • Ultrasound therapy alone for pain relief, improving range of motion, or function is not recommended 4

• Advanced Interventions:

  • For refractory cases, hydrodilatation of the glenohumeral joint may be considered 6
  • Botulinum toxin injections may be considered for cases where spasticity contributes to pain and limited motion 3

Treatment Considerations

• Early intervention is crucial to prevent further loss of motion 1
• The condition is often self-limiting and typically resolves within 1-2 years 2
• Treatment outcomes are similar regardless of whether the right or left shoulder is affected 7
• Combination therapy (physical therapy, exercise, and manual techniques) is more effective than single modalities 7
• Monitor for treatment compliance as poor adherence can lead to suboptimal outcomes 1

Treatment Algorithm

1. Initial Phase (First 4-6 weeks):

   • Physical therapy with gentle stretching and ROM exercises
   • NSAIDs or acetaminophen for pain control
   • Patient education on proper positioning and home exercises

2. If inadequate response after 4-6 weeks:

   • Consider corticosteroid injection
   • Intensify physical therapy program
   • Add adjunctive treatments like acupuncture or low-level laser therapy

3. For persistent cases (beyond 3 months):

   • Consider hydrodilatation
   • Evaluate for other contributing factors
   • Continue with modified physical therapy program