From the Guidelines
Treatment for shoulder adhesive capsulitis (frozen shoulder) should prioritize a combination of pain management and physical therapy, with corticosteroid injections considered for persistent pain, as supported by the most recent and highest quality study 1. The management of shoulder adhesive capsulitis involves several key components, including:
- Pain control with nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen for 2-4 weeks
- Physical therapy with gentle stretching exercises focusing on forward flexion, external rotation, internal rotation, and cross-body adduction, held for 30 seconds and repeated 5 times each session, twice daily
- Heat application before exercises and ice afterward to manage discomfort
- Consideration of corticosteroid injections into the glenohumeral joint for persistent pain, as recommended by the Canadian stroke best practice recommendations 1 In severe cases that don't respond to conservative treatment after 3-6 months, more invasive options may be considered, including hydrodilatation, manipulation under anesthesia, or arthroscopic capsular release. Recovery from shoulder adhesive capsulitis typically takes 12-18 months, with most improvement occurring in the first 6 months, highlighting the importance of early intervention to shorten the natural course of this condition 1.
The use of intra-articular corticosteroid injections is supported by studies such as 1, which found significant effects on pain and improvement in range of motion, although the improvements in range of motion were not significant. However, the most recent and highest quality study 1 provides the best guidance on the management of shoulder adhesive capsulitis, and its recommendations should be prioritized in clinical practice.
It is also important to note that other studies, such as 1 and 1, provide additional information on the treatment of glenohumeral osteoarthritis, but are not directly relevant to the management of shoulder adhesive capsulitis. Therefore, the recommendations from these studies should not be considered when developing a treatment plan for shoulder adhesive capsulitis.
In clinical practice, the treatment of shoulder adhesive capsulitis should be individualized to each patient, taking into account their specific needs and circumstances. However, the principles outlined above, based on the most recent and highest quality study 1, should guide the development of an effective treatment plan.
From the Research
Treatment Options for Shoulder Adhesive Capsulitis (Frozen Shoulder)
- The treatment for shoulder adhesive capsulitis, also known as frozen shoulder, typically involves conservative management options, including:
- Suprascapular nerve block (SSNB)
- Intra-articular corticosteroid (IACS) injection
- Hydrodilatation
- Physical therapy 2
- Combining SSNB with physical therapy and/or IACS injection, as well as combining IACS injection with physical therapy, have been shown to improve shoulder pain, range of motion (ROM), and function 2
- Intra-articular corticosteroid injections have been found to be effective in reducing pain and improving ROM, particularly in the short term 3
- Conservative treatment, including a single intra-articular glenohumeral injection of local anesthetic and corticosteroid, as well as supervised physical therapy, has been shown to result in good clinical outcomes with a low incidence of surgical intervention 4
- Oral and intra-articular injections of cortisone have been found to lead to significant improvement and comparable results in the treatment of adhesive capsulitis of the shoulder, with intra-articular injections showing superior results in objective shoulder scores, range of motion, and patient satisfaction 5
- Physical therapy exercises, used in combination with common analgesics, can be an effective treatment option for adhesive capsulitis, targeting the three stages of the condition: freezing, frozen, and thawing 6
Factors Associated with Treatment Outcomes
- Younger patients have been found to have a better response to treatments, while older patients and those with diabetes may be more likely to develop contralateral disease 4
- Patients with diabetes have been found to have a decrease in Shoulder Activity Scale score at final follow-up, highlighting the importance of considering underlying health conditions when developing treatment plans 4
- Physical therapy has been shown to reduce the use of a second injection as part of treatment, emphasizing the importance of incorporating physical therapy into treatment algorithms 4