From the Guidelines
To effectively address scar tissue buildup in frozen shoulder, I recommend a treatment plan that includes intra-articular injections with Triamcinolone, as it has been found to have significant effects on pain and improve range of motion, although the improvements in ROM may not be significant. When considering treatment options for frozen shoulder, it's essential to understand the various causes of poststroke shoulder pain, including adhesive capsulitis, traction/compression neuropathy, complex regional pain syndrome, shoulder trauma, bursitis/tendonitis, rotator cuff tear, and heterotrophic ossification 1. Key treatment interventions for shoulder pain include:
- Electrical stimulation
- Treatment with steroid injections/medication
- Exercise
- Shoulder positioning protocols
- Strapping the involved upper extremity
- Modalities including ice, heat, soft tissue massage, and mobilization Given the potential benefits of intra-articular injections, starting with this treatment option, combined with gentle exercises and modalities like heat and ice, can help manage pain and inflammation, and potentially improve range of motion. It's also important to note that the range of lateral rotation is a significant factor related to the onset/occurrence of shoulder pain, as found by Bohannon et al 1. Therefore, a comprehensive approach that addresses pain, inflammation, and range of motion, while considering the underlying causes of frozen shoulder, is crucial for effective management.
From the Research
Treatment Options for Frozen Shoulder
- Frozen shoulder is a common shoulder disorder characterized by a gradual increase of pain and limitation in range of motion of the glenohumeral joint 2
- Treatment modalities for frozen shoulder include medication, local steroid injection, physiotherapy, hydrodistension, manipulation under anesthesia, arthroscopic capsular release, and open capsular release 2
- Conservative management leads to improvement in most cases, but failure to obtain symptomatic improvement and continued functional disability after 3 to 6 months of conservative treatment are general indications for surgical management 2
Corticosteroid Injection Methods
- Corticosteroid injection methods, such as 4-site injection and rotator interval injection, have been shown to be effective in reducing pain and improving global function in patients with frozen shoulder 3
- A network meta-analysis found that 4-site injection was the most effective treatment for short-term outcomes, while rotator interval injection was the optimal treatment with moderate to high certainty 3
- Distension via rotator interval and intra-articular injection via anterior or posterior approaches also produced equivalent effects on symptom relief 3
Comparison of Treatments
- A systematic review and meta-analysis found that intra-articular corticosteroid injection was associated with statistical and clinical superiority compared with other interventions in the short-term for pain and function 4
- The addition of a home exercise program with simple exercises and stretches and physiotherapy to intra-articular corticosteroid injection may be associated with added benefits in the mid-term 4
- Early use of intra-articular corticosteroid in patients with frozen shoulder of less than 1-year duration is associated with better outcomes 4
Nonoperative Treatment
- Nonoperative treatment of frozen shoulder, including oral glucocorticoids, pregabalin, and a home exercise program, has been shown to be effective in improving pain and function 5
- A study found that glucocorticoid therapy combined with pregabalin and a home exercise program improved DASH, ASES, and Constant scores, as well as range of motion and pain, in patients with frozen shoulder 5
Diagnosis and Management
- Frozen shoulder is a common condition that causes pain and restriction of movement of the shoulder, and is resolved in most cases within 1 to 2 years 6
- Diagnosis is clinical based on global motion restriction and pain, and imaging plays an ancillary role to narrow the differential diagnosis 6
- Physical therapy, nonsteroidal anti-inflammatories, and injection therapies are standard treatments, although none have been shown to alter the long-term course of the condition 6