treatment

Last edited 04/2022 and last reviewed 05/2022

Management of frozen shoulder may be non surgical or surgical.

Non surgical

  • oral analgesics
    • non-steroidal anti-inflammatory drugs (NSAIDs) are used to relieve pain and improve range of motion
  • physiotherapy
    • used as the first line treatment for frozen shoulder
    • especially useful  in the stiffness phase
    • typically includes combinations of advice and education,  manual therapy and exercises, thermotherapy, and electrotherapy
    • graded physiotherapy programmes (movements within the comfort zone) have been shown to have a better long term outcome than high intensity (movements at the limits of pain tolerance) programmes
  • oral corticosteroid
    • is not considered routinely for the management due to
      • short period of positive effects (do not last beyond 6 weeks)
      • their potential for serious adverse effects
  • intra articular steroids
    • can induce short-term pain relief and improvement in range of motion
    • effect usually only lasts for a maximum of 6 weeks
    • a single corticosteroid injection for up to a year in duration may accelerate improvements in pain and function by some weeks  
    • more effective when given  earlier in the course of the disease
    • a single steroid injection in combination with physiotherapy is effective in reducing both pain and disability associated with frozen shoulder (2)
  • hydrodilatation
    • injection of up to 40 ml of sterile saline solution usually together with corticosteorids to distend the joint capsule

Surgical

  • considered in patients with refractory symptoms after adequate conservative treatment
  • surgical options include
    • manipulation under anaesthesia (MUA) - generally results in notable improvement in shoulder function and range of motion within three months
    • capsular release - this has proved useful in refractory cases

In general, treatment of frozen shoulder should be tailored according to the stage of the condition

  • painful freezing phase
    • main aim is pain relief – NSAIDs
    • physiotherapy
    • steroid injection
  • adhesive phase
    • steroid injections are not indicated
    • aggressive stretching exercises should be the focus to regain the range of motion
  • the UK FROST trial compared manipulation under anaesthetic, arthroscopic capsular release, and early structured physiotherapy with intra-articular corticosteroid injections, and found that none of the interventions were clinically superior (4)

Reference:

Related pages:

injection of the shoulder