Management of Frozen Shoulder
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 frozen shoulder. 1
Understanding Frozen Shoulder
- Frozen shoulder (adhesive capsulitis) is characterized by significant shoulder pain and progressive limitation in range of motion, impacting daily activities and quality of life 2
- The condition typically progresses through three stages: freezing (painful), frozen (adhesive), and thawing 3
- It is often self-limiting with gradual resolution of symptoms in 12-18 months with appropriate treatment 4
- Common risk factors include diabetes mellitus and thyroid disorders 4, 5
First-Line Treatment Approach
Physical Therapy
- Focus on gentle stretching and mobilization techniques, particularly increasing external rotation and abduction 1, 2
- Active range of motion should be increased gradually while restoring alignment and strengthening weak muscles in the shoulder girdle 1
- Regular exercise programs have demonstrated effectiveness for managing symptoms 2
- AVOID overhead pulley exercises as they can worsen symptoms 1, 2
Pain Management
- NSAIDs (such as ibuprofen) or acetaminophen should be used for pain relief if there are no contraindications 1, 2
- Patient education on proper positioning and home exercises is crucial in the initial phase 1
Second-Line Interventions
- Intra-articular corticosteroid injections can provide significant pain relief when first-line treatments are insufficient 2
- Acupuncture has demonstrated statistically significant improvement in shoulder symptoms and can be considered as an adjunct to physical therapy 1
Advanced Interventions for Refractory Cases
- For cases that don't respond to conservative treatment for 6-9 months, consider: 4
Special Considerations
- For Complex Regional Pain Syndrome (CRPS) or Shoulder-Hand Syndrome, an early course of oral corticosteroids may be recommended 2
- Patients should be screened for diabetes and thyroid dysfunction, as these conditions are commonly associated with frozen shoulder 5, 7
Treatment Pitfalls to Avoid
- Delaying treatment initiation can lead to further loss of motion 2
- Using overhead pulleys can increase the risk of developing hemiplegic shoulder pain 2
- Failure to maintain consistent physical therapy can lead to suboptimal outcomes 1
- Manipulation under anesthesia carries risks of fractures or rotator cuff tears 4