What is the initial treatment for a patient with frozen shoulder?

Initial Treatment for Frozen Shoulder

The initial treatment for frozen shoulder should combine physical therapy focused on stretching and mobilization exercises (particularly external rotation and abduction) with pain management using NSAIDs or acetaminophen. 1

First-Line Treatment Algorithm

Physical Therapy (Primary Intervention)

• Initiate gentle stretching and mobilization exercises immediately, with specific emphasis on external rotation and abduction movements 1
• Progress active range of motion gradually while restoring proper shoulder alignment and strengthening weak muscles in the shoulder girdle 1
• Avoid overhead pulley exercises—these encourage uncontrolled abduction and can worsen symptoms 1
• Early initiation is critical to prevent further loss of motion 1

Pain Management (Concurrent with Physical Therapy)

• Use NSAIDs (such as ibuprofen) or acetaminophen for pain control if no contraindications exist 1
• Pain management enables better participation in physical therapy exercises 1

Adjunctive Therapy

• Consider acupuncture as an adjunct to physical therapy, as it has demonstrated statistically significant improvement in shoulder symptoms 1

Treatment Timeline and Expectations

• Most patients respond well to this conservative combination approach, with gradual symptom resolution occurring over 12-18 months 2
• The condition is self-limiting and progresses through three stages: freezing (painful), frozen (adhesive), and thawing 3
• If no response to conservative treatment occurs after 6-9 months, consider advanced interventions 2

Advanced Interventions for Refractory Cases

For patients who fail initial conservative management:

• Hydrodilatation of the glenohumeral joint may be considered 1, 4
• Arthroscopic capsular release or manipulation under anesthesia are surgical options, though manipulation carries risks of humeral fracture or rotator cuff tear 2

Critical Pitfalls to Avoid

• Do not use overhead pulley exercises—they are contraindicated and may exacerbate symptoms 1
• Ensure proper diagnosis through clinical examination and consider imaging if indicated to rule out other shoulder pathologies 1
• Screen for diabetes mellitus and thyroid dysfunction, as these conditions are strongly associated with frozen shoulder and should be investigated in all patients 2, 5
• Monitor treatment compliance closely, as poor adherence leads to suboptimal outcomes 1