Frozen Shoulder: Treatment options

There are 2 main treatments for frozen shoulder, nonsurgical (conservative) and surgical treatment. Most frequently treatment for frozen shoulder is non-surgical, although a proportion of people do sometimes require or choose an operation.

There is no one agreed treatment option that has been shown to work. Ultimately the shoulder appears to go through the three phases described. The passage of time is often the best treatment. That said, there are treatments that can help you pass through each phase and control difficult areas for you, such as pain. Surgery can increase the range of motion and decrease pain and is generally very successful.

Non-surgical treatment

Painful phase
Pain medication and anti-inflammatory medicines will help to ease your symptoms of pain and stiffness. If your symptoms are mild, this may be enough to keep your condition manageable.

You can also try using heat, such as a hot water bottle, or cold (ice packs). Injections into the joint may also be offered if the pain continues. Physiotherapy at this stage is directed at pain relief (heat, cold and other pain relieving therapies such as electrotherapy). Forcing the joint to move can make it more painful and is best not pursued. You can try using a TENS machine (transcutaneous nerve stimulation) which some people find helpful, or try alternative therapies such as acupuncture.

Stiff phase
Once stiffness is more of a problem than pain, physiotherapy is indicated. You will be shown specific exercises to try and get the ball and socket moving. In addition, your therapist may move the joint for you, trying to regain the normal glides and rolling of the joint. These are known as joint mobilisations. Muscle based movement techniques may also be used.

If movement does not improve with these measures, physiotherapy will be discontinued, although it is appropriate to continue with the suggested
exercises to try and maintain the movement that you do have. Hopefully, as the recovery phase starts you will find that the movement gradually increases. This, again, can be a useful time to have physiotherapy to help maximise the movement. Click here to view exercises.

 

 

Surgical treatment

If you have significant chronic pain and stiffness Mr. Cole may offer you a surgical procedure. This is an arthroscopic (kehole) capsular release and ‘Manipulation under Anaesthetic ’(MUA). This involves a procedure which tries to release the loose bag (which is now tight) around your shoulder joint. The tight capsule may be released or removed. In addition the joint is stretched in certain directions to try and free the joint up. This can be done as a day case procedure. Physiotherapy is essential after the procedure.

Exercises
There are some examples of exercises to stretch your shoulder. They are a useful guide, however, Mr. Cole or your team of physiotherapists may suggest other exercises for your particular shoulder.

It is a good idea to exercise regularly, at least once or twice a day. You may find it easier to do so after a hot shower or bath. Using a hot water bottle is a good way of warming your shoulder up.

You may feel aching or stretching sensations when doing these exercises. Don’t worry, this is normal. However, it is not normal to experience severe and lasting pain (e.g. more than 30 minutes). If your exercises are too painful, cut down. If the pain is still severe discontinue the exercises and contact your physiotherapist or Mr. Cole.

When you do begin exercising, you will probably find that raising your arm forwards improves first. Getting your hand behind your lower back, however, is often the last movement to return.