Comprehensive Guide to Diagnosing and Treating Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis, is a condition that causes pain and stiffness in the shoulder joint, limiting its range of motion. It generally develops gradually and can severely impact daily activities such as reaching overhead or behind the back. Understanding the available treatment choices and when to seek help can empower patients to manage symptoms, reduce discomfort, and regain function.

Diagnosis and Initial Medical Approaches for Frozen Shoulder

Diagnosing frozen shoulder typically involves a combination of taking a detailed medical history, physical examination, and imaging tests such as X-rays or ultrasound to rule out other causes of shoulder pain. Early-stage management often includes pain relief and anti-inflammatory medications such as NSAIDs. Gentle physical therapy is commonly recommended to help maintain range of motion and prevent further stiffness. Identifying frozen shoulder early is important, as timely intervention can reduce the duration and severity of symptoms.

Non-Surgical Treatment Strategies for Frozen Shoulder

Most cases of frozen shoulder can be successfully managed without surgery. The mainstay of treatment is a tailored physiotherapy programme aimed at gradually restoring shoulder mobility. Exercises to stretch and strengthen the shoulder are combined with manual therapy techniques administered by a healthcare professional. Corticosteroid injections into the shoulder joint may be offered to reduce inflammation and pain. Other options include heat therapy, which helps relax the muscles, and the use of transcutaneous electrical nerve stimulation (TENS) to manage pain. Commitment to non-surgical treatments generally leads to steady improvement over several months.

When Surgical Options Are Considered

Surgical intervention is rarely required but can be an option if non-surgical treatments fail to provide relief after several months. The most common surgical procedure is capsular release, which can be performed via keyhole (arthroscopic) surgery. During this operation, the tight and thickened shoulder capsule is cut to restore mobility. Another option is manipulation under anaesthesia, where the shoulder is gently moved through its range of motion while the patient is asleep, helping to break up adhesions. Following surgery, a structured rehabilitation programme is crucial to maintain movement gains and prevent recurrence.

Preventing Frozen Shoulder and When to Seek Help

Patients with diabetes, thyroid problems, or those recovering from shoulder injuries are at higher risk of developing frozen shoulder. Early intervention and regular gentle movement after injury or surgery can help reduce the risk. Seeking prompt medical advice if you experience persistent shoulder stiffness or pain is vital to initiate the right treatment early. It is important not to ignore symptoms, as untreated frozen shoulder can lead to ongoing pain, reduced function, and even long-term disability. Practising recommended home exercises, maintaining overall shoulder health, and keeping follow-up appointments will all contribute to a successful recovery.

FAQ on Treatment for Frozen Shoulder

What is the fastest way to recover from frozen shoulder?

Recovery speed varies by individual, but early physiotherapy, consistent daily stretching, and possibly a corticosteroid injection can accelerate recovery. Following your physiotherapist's advice exactly is crucial.

Are home remedies effective for frozen shoulder?

Home remedies such as gentle stretching, applying heat or cold packs, and over-the-counter pain relievers can help manage symptoms, but professional medical guidance is essential to avoid making stiffness worse.

When should I consider surgery for frozen shoulder?

Surgery is considered only if there is no significant improvement after 6–12 months of non-surgical management, especially if pain and stiffness significantly affect daily life despite active rehabilitation.

Can frozen shoulder resolve on its own?

In some cases, frozen shoulder will gradually improve without extensive treatment, but this can take up to two to three years. Medical supervision is recommended to ensure movement is restored safely.

Is frozen shoulder linked to any medical conditions?

Yes, it is more common in people with diabetes, thyroid disorders, heart disease, or those who have had shoulder injuries or surgery. Maintaining control over these conditions can help reduce risks.

What activities should be avoided with frozen shoulder?

Avoid sudden or forceful movements that could worsen pain or cause injury. Focus on gentle, controlled movements and consult your physiotherapist before starting any exercise routine.

References

• Wong CK, Levine WN, Deo K, Kesting RS, Mercer EA, Schram GA, Flatow EL, Bigliani LU, Ahmad CS. Natural history of frozen shoulder: fact or fiction? A systematic review. Archives of Physical Medicine and Rehabilitation. 2017 Feb;98(2):234-245.
• Hanchard NC, Goodchild L, Thompson J, O’Brien T, Davison D, Richardson C. Evidence-based clinical guidelines for the diagnosis, assessment and physiotherapy management of contracted (frozen) shoulder: quick reference guide. Physiotherapy. 2012 Sep;98(3):285-295.