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Adhesive capsulitis - Treating frozen shoulder

NHS Choices Medical Reference

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Treatment for a frozen shoulder will vary depending on the stage of the condition and  severity of your pain and stiffness.

A frozen shoulder may get better naturally, but recovery is often slow and may take at least 18-24 months.

The aim of treatment is to keep your shoulder joint as pain free and mobile as possible while your shoulder heals.

Early stage

The first stage of a frozen shoulder is the most painful stage. Therefore, treatment is mainly focussed on relieving the pain.

During this stage, your GP may recommend that you avoid movements that make the pain worse, such as stretching overhead. However, you should not stop moving altogether.

Painkillers

If you are in pain, you may be prescribed painkillers, such as paracetamol, or a combination of paracetamol and codeine.

Some painkillers, such as paracetamol, are also available over-the-counter from pharmacies. Always follow the manufacturer's instructions to ensure the medication is suitable for you and that you are taking the correct dose.

If your pain is more severe, your GP may recommend or prescribe a non-steroidal anti-inflammatory drug (NSAID). As well as easing pain, NSAIDs help reduce swelling in your shoulder capsule. They are most effective when taken regularly, rather than when symptoms are most painful.

There are some side effects associated with NSAIDs. See the patient information leaflet that comes with your medication for more information about possible side effects.

Read more about NSAIDs.

Corticosteroid injections

If you have severe frozen shoulder, painkillers may not be enough to control the pain. If this is the case, it may be possible to have a corticosteroid injection in your shoulder joint.

Corticosteroids are medicines that contain hormones (powerful chemicals that have a wide range of effects on the body). They help reduce pain and inflammation. Corticosteroids may also be given with local anaesthetic (painkilling medication).

Corticosteroid injections can help relieve pain and improve the movement in your shoulder. However, injections will not cure your condition and your symptoms may gradually return.

Corticosteroid injections will not be used after the pain has faded from your shoulder and only the stiffness remains.

Having too many corticosteroid injections may damage your shoulder, so you may only be able to have this type of treatment up to three times. You will need at least 3-4 weeks between injections. 

Read more about corticosteroids.

Later stages

After the initial, painful stage, stiffness is the main symptom of a frozen shoulder. At this time, your GP may suggest you start shoulder exercises, and you may be referred to a physiotherapist.

Shoulder exercises

If you have a frozen shoulder, it is important to keep your shoulder joint mobile with regular, gentle exercise. Not using your shoulder can cause muscles to waste and may make stiffness worse. Therefore, if you can, continue to use your shoulder as normal.

However, if your shoulder is very stiff, exercise may be painful. Your GP or physiotherapist can give you exercises you can do without further damaging your shoulder.

Physiotherapy

A physiotherapist can use a number of techniques to help you maintain movement and flexibility in your shoulder. If you are referred to a physiotherapist, you may have treatments such as:

  • stretching exercises using specific techniques to move the joint in all directions
  • massage
  • thermotherapy with warm or cold temperature packs

There is no clinical evidence to show that other treatments, such as transcutaneous electrical nerve stimulation (TENS), Shiatsu massage or acupuncture are effective in treating frozen shoulder.

Read more about physiotherapy.

Surgery

It is uncommon to need surgery for frozen shoulder but it may be recommended if your symptoms are severe, causing significant problems and other treatments have not worked after six months.

If this is the case, you may be referred to an orthopaedic surgeon (a specialist in conditions that affect the bones and joints).

There are two possible surgical procedures which are explained in more detail below.

Manipulation

You can have your shoulder manipulated (moved) while you are under general anaesthetic (painkilling medication that puts you to sleep).

During the procedure, your shoulder will be moved in a controlled way and stretched while you are asleep. In addition, you will usually have corticosteroid and local anaesthetic injected into your shoulder joint.

Afterwards, you will usually require physiotherapy to help maintain mobility in your shoulder. Manipulation may be used if you are finding the pain in your shoulder and the resulting disability difficult to cope with.

Arthroscopic capsular release

Arthroscopic capsular release is an alternative procedure to manipulation. It is a type of keyhole or non-invasive surgery. The surgeon will carry out the procedure after making a small incision that is less than 1cm (0.4in) long.

Your surgeon will use a special probe to open up your contracted shoulder capsule. They will then remove any bands of scar tissue that have formed in your shoulder capsule, which should greatly improve your symptoms.

As with manipulation, after having arthroscopic capsular release surgery you will need physiotherapy. This will help you regain a full range of movement in your shoulder joint.

In some people, stiffness in shoulder may return despite manipulation or surgery and further treatment may be necessary.

Medical Review: April 26, 2012
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