Treatment for a frozen shoulder varies depending on the stage of the condition and the severity of your pain and stiffness. The aim of treatment is to keep your joint as mobile and pain free as possible while your shoulder heals.
A frozen shoulder usually resolves itself over a period of 18 to 24 months. While treatment will not necessarily speed up your recovery, it can make it more bearable.
Early stage
The early stage of a frozen shoulder is the most painful stage (see Frozen shoulder - symptoms).
If you are in the early stage of frozen shoulder, your GP may recommend that you avoid movements that make the pain worse, such as stretching overhead. However, do not stop moving altogether.
Treatment during this stage is mainly focussed on relieving the pain.
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 (OTC) in pharmacies. Always follow the manufacturer’s instructions to ensure that 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 will help reduce the swelling in your shoulder capsule. NSAIDs are most effective when taken regularly, rather than as and when the 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 the possible side effects.
Do not take NSAIDs if you have:
- asthma (a condition that affects the lungs)
- high blood pressure (hypertension)
- kidney or heart problems
See the Health A-Z topic about NSAIDs for more information.
Corticosteroid injections
If you have a severe case of frozen shoulder, treatment using painkillers may not be enough to control the pain. If this is the case, you may be able to have corticosteroids injected into and around your shoulder joint.
Corticosteroids are medicines that contain hormones (groups of powerful chemicals that have a wide range of effects on the body). They help to reduce swelling and pain. Corticosteroids may also be given with local anaesthetic (painkilling medication).
Corticosteroid injections can help relieve pain and improve the movement in your shoulder. However, the injections cannot cure your condition and your symptoms will gradually return. Corticosteroid injections will also not be used once the pain has faded from your shoulder and only the stiffness remains.
Too many corticosteroid injections can cause damage to your shoulder, so you may only be able to have this type of treatment up to three times in one year. You will need at least three to four weeks between injections.
See the Health A-Z topic about Corticosteroids for more information on this type of medication.
Later stages
After the initial, painful stage, stiffness is the main symptom of a frozen shoulder. At this time, your GP may suggest that you start doing shoulder exercises, and they may refer you for specialist treatment from a physiotherapist (a healthcare professional who is trained in the use of physical methods, such as massage and manipulation, to promote healing).
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 your 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 that you can do without further damaging your shoulder.
Physiotherapy
If you are referred to a physiotherapist, they will help you maintain movement and flexibility in your shoulder using a number of techniques. You may have treatments such as:
Shiatsu massage is also becoming increasingly popular as a complementary physiotherapy for frozen shoulder. However, there is no clinical evidence to prove its effectiveness.
See the Health A-Z topic about Physiotherapy for more information.
Transcutaneous electrical nerve stimulation (TENS)
Transcutaneous electrical nerve stimulation (TENS) is a type of physiotherapy that may help ease the pain of frozen shoulder. It numbs the nerve endings in your spinal cord that control pain, so that you can no longer feel it.
Treatment with TENS is usually given by a physiotherapist. Small electrical pads (electrodes) will be applied to the skin over your shoulder. These will deliver small pulses of electricity from the TENS machine. Your physiotherapist can control the strength of the pulses and how long they last.
Alternative therapies
Some alternative therapies, such as acupuncture (a treatment that involves inserting fine needles into your skin at certain points on the body) claim to relieve or prevent the symptoms of a frozen shoulder.
However, the lack of evidence supporting their effectiveness means that more research is needed before they can be recommended.
If you decide to use herbal remedies, check with your GP first because some remedies, such as St John’s Wort, can react unpredictably with other medication or make it less effective.
Surgery
Surgery for frozen shoulder is rarely necessary, but you may be referred for surgery if other treatments have not worked after six months. You could be referred to:
- an orthopaedic surgeon, who specialises in conditions that affect the bones and muscles
- a rheumatologist, who specialises in conditions that affect the muscles 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 (a painkilling medication that makes you unconscious). During this procedure, your shoulder is gently moved and stretched while you are asleep.
Afterwards, you will usually require physiotherapy to help maintain mobility in your shoulder. Manipulation may be used if you are finding the pain and disability from your shoulder difficult to cope with.
Arthroscopic capsular release
An alternative procedure to manipulation is arthroscopic capsular release. This is a type of keyhole or non-invasive surgery. The surgeon will carry out the procedure after making an incision (cut) that is less than 1cm (0.4in) long.
During arthroscopic capsular release surgery, 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, you will need to have physiotherapy after arthroscopic capsular release surgery. This is to help you regain a full range of movement in your shoulder joint.
