2. How do you treat frozen shoulder?
Treatment options for frozen shoulder include symptomatic control, injection, physiotherapy and surgery.
As discussed in my previous article, frozen shoulder (or adhesive capsulitis) is often a self-limiting condition. This means that if symptoms are not too severe, it is reasonable to simply wait for the problem to resolve, though this can take some time. Symptoms may be treated with pain-killers and activity modification.
The use of steroid injections to treat frozen shoulder is somewhat controversial. They can provide some pain relief, but this is typically short-lived (on average 4-6 weeks). They may be more effective in the very early stages of the capsulitis before the shoulder has stiffened up too much.
Most people with frozen shoulder find that physiotherapy is just too painful. However it can be beneficial in the thawing phase, once the shoulder is less painful, in order to restore range of movement. The emphasis then should be on gentle stretches followed by strengthening and core stability exercises as range of movement improves.
Surgery for frozen shoulder
The main indication for frozen shoulder surgery is persistent severe pain which is not controlled by pain-killers. As frozen shoulder is often a self-limiting condition, it is really up to the individual to decide whether they wish to simply sit it out, or whether they would rather have an operation to speed up their recovery.
People whose symptoms fail to improve after 18-24 months may also wish to consider surgery.
Several operations can be used to treat frozen shoulder. These include a simple manipulation under anaesthetic, hydrodilatation (injecting steroids and saline under pressure), and arthroscopic (keyhole) capsular release. The problem with the first two procedures is that they tend to just rupture the capsule in its weakest area. I therefore usually recommend an arthroscopic release as this allows the tight capsule to be released in a much more controlled and thorough fashion. After all of these surgical treatments, it is vital to get the shoulder moving straight away in order to minimise recurrent scarring and stiffness. Most people find that pain and movement improve significantly after surgery, but full recovery can still take six to twelve months.