What medications are used to treat frozen shoulder?

Medications for Frozen Shoulder

NSAIDs (such as ibuprofen or naproxen) or acetaminophen are the first-line medications for pain control in frozen shoulder, and should be used in conjunction with physical therapy focusing on external rotation and abduction exercises. 1, 2

First-Line Pharmacologic Management

Oral Analgesics:

• NSAIDs (ibuprofen, naproxen) or acetaminophen should be initiated immediately if no contraindications exist 3, 1, 2
• These medications enable participation in physical therapy by providing adequate pain control 2
• NSAIDs should be used at the lowest effective dose for the shortest duration necessary 4
• Important caveat: NSAIDs carry cardiovascular and gastrointestinal risks, particularly with prolonged use, older age, or concurrent corticosteroid/anticoagulant therapy 4

Second-Line Injectable Therapies

When oral medications provide inadequate relief after initial conservative management:

Intra-articular Corticosteroid Injections:

• Triamcinolone injections into the glenohumeral joint provide significant pain relief and are particularly effective in stage 1 (freezing phase) frozen shoulder 3, 2
• These injections demonstrate superior pain control compared to oral NSAIDs in the acute phase, though long-term outcomes may not differ 3
• One comparative study in diabetic patients showed equivalent efficacy between intra-articular corticosteroids and NSAIDs at 24 weeks 5

Subacromial Corticosteroid Injections:

• Reserved for cases where pain relates specifically to subacromial inflammation (rotator cuff or bursa involvement) 3, 2

Botulinum Toxin Injections:

• Can be considered when pain is thought to be related to spasticity in the subscapularis and pectoralis muscles 3, 2
• This is a more specialized intervention typically reserved for specific presentations

Oral Corticosteroids for CRPS

For Complex Regional Pain Syndrome (shoulder-hand syndrome):

• An early course of oral corticosteroids starting at 30-50 mg daily for 3-5 days, then tapering over 1-2 weeks, can reduce swelling and pain 3

Critical Treatment Algorithm

1. Initiate immediately: NSAIDs or acetaminophen + physical therapy with stretching/mobilization 1, 2
2. If inadequate response after 3-6 months: Consider intra-articular corticosteroid injection 2, 6
3. Avoid: Prolonged immobilization, overhead pulleys (highest risk of worsening pain), and delayed treatment initiation 1, 2

Important Caveats

Corticosteroid Concerns:

• Peritendinous or intratendinous corticosteroid injections may inhibit healing and reduce tensile strength, potentially predisposing to spontaneous rupture 3
• The role of inflammation in chronic tendinopathies is unclear, making the benefit-risk ratio of corticosteroids debatable for chronic cases 3

NSAID Limitations:

• Most chronic tendinopathies involve degenerative changes rather than active inflammation, potentially limiting NSAID effectiveness beyond analgesia 3
• Topical NSAIDs eliminate gastrointestinal hemorrhage risk while maintaining pain relief efficacy 3

Medication Alone is Insufficient:

• All pharmacologic interventions must be combined with physical therapy emphasizing external rotation and abduction, as external rotation is the single most critical factor in preventing and treating shoulder pain 3, 2
• Medications serve primarily to facilitate participation in therapeutic exercises, which are the cornerstone of treatment 1, 2, 7