TREATMENTS FOR FROZEN SHOULDER
As discussed earlier, the course of frozen shoulder is broken down into four different stages, each characterized by levels of pain and pathological changes. Therefore, it is important to cater treatment strategies to address the specific stage of the condition. Pain begins to build during the early stage and continues to increase until it peaks at the frozen stage. Providing patients with pain relief during these stages is a top priority. 56 Specifically, the CPG (Clinical Practice Guideline) from the American Physical Therapy Association recommends therapy during the early inflammatory stages (six-eight weeks) to help manage pain and provide patient education. 14 Addressing pain will
enable patients to continue to do their daily activities while at the same time allowing for exercise and some mobilization techniques. As the condition progresses to the frozen stage and the range of motion is lost, the treatment strategy should be adjusted to focus on regaining function and increasing the range of motion. By the thawing stage, pain is minimal so therapy can continue to focus on functional improvements. 56 Pain relief in frozen shoulder can be managed by various mechanisms including nonsteroidal anti-inflammatories, corticosteroids (oral and injectable), short wave diathermy, ultrasound, heat therapy, electrotherapy, and shockwave and laser therapy. 14, 56,61
Corticosteroid injection 57 • Superior to placebo and physiotherapy in the short-term (up to 12 weeks). • There was no difference in outcomes between corticosteroid injection and oral nonsteroidal anti-inflammatory drugs at 24 weeks. • Generally safe, with infrequent and minor side effects. • Usually performed during early stages when pain is the predominant presentation.
Arthrographic joint distension 58 • Joint distention, also referred to as guided hydrodilatation, is a treatment performed by injecting mixed, diluted corticosteroid and local anesthetic into the contracted glenohumeral joint space. • This is performed under ultrasound guidance to achieve hydraulic capsular distension (or rupture) and reduce inflammation and pain. • Commonly followed by physiotherapy for continued joint mobilization and ROM work.
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