Treating frozen shoulder
Treatment for a frozen shoulder will vary, depending on the stage of the condition and the severity of your pain and stiffness.
A frozen shoulder may get better over time on its own without treatment, but recovery is often slow and can take at least 18 to 24 months. In some people, the condition may not improve for 5 years or more.
A number of different treatments can be used to treat frozen shoulder, although it is uncertain how effective they are and which is best.
The treatments described below can help reduce shoulder pain and keep the joint mobile while the shoulder heals.
Early stage treatments
The first stage of a frozen shoulder is the most painful. Therefore, treatment is mainly focused on relieving the pain.
During this stage, your GP may recommend avoiding movements that make the pain worse, such as stretching. However, you should not stop moving altogether.
If you are in pain, you may be prescribed painkillers, such as paracetamol, a combination of paracetamol and codeine or a non-steroidal anti-inflammatory drug (NSAID).
Some painkillers, such as paracetamol and ibuprofen, are also available from pharmacies without a prescription. Always follow the manufacturer’s instructions and make sure you are taking the correct dose.
Taking painkillers, particularly NSAIDs, in the long term can increase your risk of side effects. See the patient information leaflet that comes with your medication for more information.
Read more about the side effects of NSAIDs.
If painkillers are not helping control the pain, it may be possible to have a corticosteroid injection in your shoulder joint.
Corticosteroids are medicines that help reduce pain and inflammation. They may also be given with a local anaesthetic.
These 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 gone from your shoulder and only the stiffness remains.
Having too many corticosteroid injections may damage your shoulder, and the injections often become less effective over time, so your doctor may recommend having no more than three injections. You will need at least three to four weeks between these.
Read more about corticosteroids.
Later stage treatments
After the initial painful stage, stiffness is the main symptom of a frozen shoulder. Your GP may suggest stretching exercises, and you may also be referred to a physiotherapist.
If you have a frozen shoulder, it's important to keep your shoulder joint mobile with regular, gentle stretching exercises. Not using your shoulder could make the stiffness worse, so you should continue to use it as normal.
However, if your shoulder is very stiff, exercise may be painful. Your GP or physiotherapist can give you some simple exercises to do every day at home that won't damage your shoulder any more.
A physiotherapist can use a number of techniques to keep the movement and flexibility in your shoulder. If you are referred to one, you may have treatments including:
- stretching exercises that use specific techniques to move the joint in all directions
- 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 and procedures
It is uncommon to need surgery for a frozen shoulder, but it may be recommended if your symptoms are severe and other treatments have not worked after six months.
If this happens, you may be referred to an orthopaedic surgeon (a specialist in conditions that affect the bones and joints). Some of the procedures used to treat frozen shoulder are described below.
Manipulation under anaesthetic
If you are finding the pain and movement restriction difficult to cope with, you can have your shoulder manipulated (moved) while you are under general anaesthetic.
During this procedure, your shoulder will be moved, in a controlled way, to stretch the sleeve (shoulder capsule) surrounding the shoulder joint. You will usually have corticosteroid and local anaesthetic injected into your shoulder joint to help reduce any pain or swelling.
You can normally go home the same day. Physiotherapy is usually recommended afterwards to help maintain mobility in your shoulder.
Arthroscopic capsular release
Arthroscopic capsular release is an alternative procedure to manipulation. It is a type of minimally invasive or "keyhole" surgery, carried out under general anaesthetic, where two or three small incisions are made around your shoulder.
The surgeon will insert a thin tube containing a light and camera (arthroscope) into one of the incisions, so they can see inside your shoulder. A special probe that emits high-frequency radio waves is inserted through the other incisions, and this is used to divide or cut out the thickened parts of the shoulder capsule. Opening up the shoulder capsule in this way should greatly improve your range of movement.
As with manipulation, you can usually go home the same day you have this operation, and you will probably need physiotherapy afterwards to help you regain a full range of movement in your shoulder joint. Stretching exercises need to be continued for at least three months after surgery.
Shoulder stiffness may return, despite manipulation or surgery, and further treatment may be necessary.
Arthrographic distension (hydrodilatation)
Although it is less commonly performed than the operations described above, a procedure called arthrographic distension or hydrodilatation may sometimes be recommended to treat your frozen shoulder.
This treatment is carried out under local anaesthetic, which means you will be awake while it is carried out, but your shoulder will be numbed.
A special fluid called contrast medium, which shows up clearly on X-rays, will be injected into your shoulder joint at the beginning of the procedure. Under continuous X-ray guidance, a mixture of saline, corticosteroid and local anaesthetic is then injected into the shoulder joint.
This procedure usually only takes about 15 minutes, and you can go home the same day. As with the other procedures described above, physiotherapy may be recommended afterwards to help you regain a good range of movement in your shoulder.
There is some evidence that hydrodilatation may result in less pain and greater movement, although the effects may be no better than a corticosteroid injection.
Page last reviewed: 17/03/2014
Next review due: 17/03/2016