What is the initial treatment for a patient with frozen shoulder (adhesive capsulitis)?

Initial Treatment for Frozen Shoulder (Adhesive Capsulitis)

Start with physical therapy focused on stretching and mobilization exercises targeting external rotation and abduction, combined with NSAIDs or acetaminophen for pain control. 1

First-Line Treatment Algorithm

Physical Therapy (Primary Intervention)

• Gentle stretching and mobilization techniques are the cornerstone of initial management, specifically targeting external rotation and abduction movements 1, 2
• Gradually increase active range of motion while restoring proper alignment and strengthening weak muscles in the shoulder girdle 1
• Initiate treatment early to prevent further loss of motion 1
• If full shoulder function is not achieved by 6-8 weeks, formal physical therapy should be instituted 1

Pain Management (Concurrent with Physical Therapy)

• NSAIDs (such as ibuprofen) or acetaminophen should be used for pain relief if no contraindications exist 1, 2
• The American College of Physicians specifically recommends this combination approach of physical therapy with pain management 1

Critical Interventions to AVOID

• Do not use overhead pulleys - they encourage uncontrolled abduction and are associated with the highest incidence of developing shoulder pain 3, 1, 2
• Avoid shoulder immobilization, arm slings, or wraps as these can worsen the condition 1

Additional Treatment Considerations

Adjunctive Therapies

• Acupuncture has demonstrated statistically significant improvement in shoulder symptoms and can be considered alongside physical therapy 1
• Local cold therapy may provide pain relief based on expert consensus 1
• Regular exercise programs have proven effective for managing musculoskeletal symptoms 1

Patient Education

• Educate patients on proper positioning and home exercises from the initial phase 1, 2
• Emphasize treatment compliance as poor adherence leads to suboptimal outcomes 1

When to Escalate Treatment

If patients show minimal improvement after 6-12 weeks of conservative treatment, consider:

• Intra-articular corticosteroid injections (Triamcinolone) for significant pain relief 3, 2
• Hydrodilatation of the glenohumeral joint for refractory cases 1
• Surgical options (manipulation under anesthesia or arthroscopic capsular release) after 6-9 months of failed conservative treatment 4, 5

Common Pitfalls

• Delaying treatment initiation leads to further loss of motion 2
• Misdiagnosis - ensure proper evaluation to rule out other shoulder pathologies before assuming adhesive capsulitis 1
• Using overhead pulleys increases risk of hemiplegic shoulder pain 2

Expected Timeline

• Most patients respond well to conservative treatment with gradual resolution of symptoms in 12-18 months 4
• Recent evidence shows persistent functional limitations if left untreated, challenging the older belief of complete spontaneous resolution 5