Recommended Treatment Approach for Frozen Shoulder
The recommended first-line treatment for frozen shoulder (adhesive capsulitis) is physical therapy with gentle stretching and mobilization exercises focusing on external rotation and abduction, combined with pain management using NSAIDs or acetaminophen. 1, 2
Initial Treatment Phase
- Physical therapy with stretching and mobilization exercises should be initiated early to prevent further loss of motion and is strongly recommended for reducing pain, improving range of motion (ROM), and function in patients with frozen shoulder 1, 3
- Focus should be on gradually increasing active range of motion while restoring alignment and strengthening weak muscles in the shoulder girdle 2
- NSAIDs or acetaminophen should be used for pain control if there are no contraindications 1
- Avoid overhead pulley exercises as they encourage uncontrolled abduction and may worsen symptoms 1, 2, 4
- Patient education on proper positioning and home exercises is crucial in the initial phase 1
Second-Line Interventions
- Intra-articular corticosteroid injections (such as triamcinolone) can provide significant pain relief for patients who don't respond adequately to first-line treatments 2, 5
- Acupuncture with therapeutic exercises is moderately recommended as an adjunct therapy for pain relief and improving ROM and function 1, 3
- Low-level laser therapy can be strongly considered for pain relief and moderately suggested for improving function (though not recommended for improving ROM) 3
Advanced Interventions for Refractory Cases
- Hydrodilatation of the glenohumeral joint may be considered for cases that don't respond to conservative measures 1, 5
- Botulinum toxin injections into the subscapularis and pectoralis muscles can be used when pain is related to spasticity 2
- For Complex Regional Pain Syndrome (CRPS) or Shoulder-Hand Syndrome associated with frozen shoulder, an early course of oral corticosteroids (30-50 mg daily for 3-5 days, tapering over 1-2 weeks) is recommended 2
Treatment Considerations Based on Stage
- For stage 1 (freezing/painful phase): Focus on pain management with corticosteroid injections and gentle ROM exercises 3, 6
- For stages 2 and 3 (frozen/adhesive and thawing phases): Therapeutic exercises and mobilization are strongly recommended 3
- Ultrasound guidance is recommended for injection-based therapy, although not required 6
Treatment Pitfalls to Avoid
- Delaying treatment initiation can lead to further loss of motion and prolonged disability 2
- Using overhead pulleys increases the risk of developing hemiplegic shoulder pain and should be avoided 2, 4
- Immobilization, such as with arm slings and wraps, can contribute to frozen shoulder development and should be minimized 4
- Ultrasound for pain relief, improving ROM, or function is not recommended based on current evidence 3
Monitoring and Follow-up
- Regular assessment of tone, strength, and changes in soft tissue length should be performed to track progress 2
- Most cases of frozen shoulder resolve within 1-2 years, though appropriate treatment can improve symptoms and function during this period 6
- Lateral rotation range has been identified as the factor most significantly related to shoulder pain onset and should be closely monitored 4