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Treatment for frozen shoulder

Many treatments have been tried and continue to be offered, with the likely outcome that frozen shoulder goes through its natural history on its own, with treatments having little effect.

With a modern understanding of the causes of frozen shoulder, treatments can be directed at stretching, rupturing or removing the tight fibrosed tissues.

Physiotherapy

Physiotherapy for frozen shoulder concentrates on passive and active exercises for the shoulder joint.

Other treatments include accessory techniques to improve joint mechanics and electrical techniques such as interferential and TENS. The effectiveness of these techniques has not been demonstrated.

Treatment can include warming up the tissues, pendulum exercises, stretching techniques with overhead pulleys, a walking stick and a towel to simulate drying the back. These movements force the shoulder against the restrictions and attempt to stretch out the contracted tissues.

Steroid injections

Injections of corticosteroid are commonly given for shoulder problems, but the effectiveness of this treatment is not clear.

Manipulation under anaesthetic (MUA)

Surgical opinion about manipulation has varied over the years, with many doctors feeling the risks outweighed the benefits. Modern work has shown there can be significant benefits to manipulation, in both range of motion and pain relief. However, diabetic people show less benefit and so may be less suitable for this procedure.

Open surgery

Ozaki described open (ie not keyhole) surgical release of frozen shoulder in 17 patients. Bunker showed later that if the coracohumeral ligament was cut then the shoulder would release immediately, with manipulation into outward rotation sometimes being required. Afterwards, physiotherapy is indicated to maintain the range of motion gained by the operation.

Arthroscopic surgery

Various surgeons have published work on this technique, and it seems to be useful for patients who do not respond to normal treatments or manipulation.


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