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 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 fiveyears or more.

A number of different treatments can be used to treat frozen shoulder, although it's 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 firststage 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 shouldn't stop moving altogether.

Painkillers

If you're in pain, you may be prescribed painkillers, such as:

• paracetamol
• a combination of paracetamol and codeine
• a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen

Some painkillers are also available frompharmacies without a prescription. Always follow the manufacturer's instructions and make sure you're 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.

They may also be given with a local anaesthetic .

These injections can help relieve pain and improve the movement in your shoulder. However, injections won'tcure your condition and your symptoms may gradually return.

Corticosteroid injections won't be usedafter 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'll need at leastthreeto fourweeks between these.

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.

Shoulder exercises

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 physiotherapistcan giveyou some simple exercises to do every day at home that won't damage your shoulder any more.

Physiotherapy

Aphysiotherapistcanuse a number of techniques to keep the movement and flexibility in your shoulder. If you're referred to one, you may have treatments including:

• stretching exercises that use specific techniques to move the joint in all directions
• massage
• thermotherapy, with warm or cold temperature packs

There's no clinical evidence to showthat certain other treatmentsare effective in treating frozen shoulder, including:

• transcutaneous electrical nerve stimulation (TENS)
• Shiatsu massage
• acupuncture

Read moreabout physiotherapy .

Surgery and procedures

It's uncommon to need surgery for a frozen shoulder, but it may be recommended if your symptoms are severe and other treatments haven't 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

Ifyou're finding the pain and movement restriction difficult to cope with, you can have your shoulder manipulated (moved) while you're 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.

After the procedure you'll usually have corticosteroid and local anaesthetic injected into your shoulder joint to help reduce any pain or swelling.

You cannormally go home the same day. Physiotherapy is usually recommended afterwards to help maintain mobility in your shoulder.

Arthroscopic capsular release

Arthroscopic capsular releaseis an alternative procedure to manipulation. It's a type of minimally invasive or "keyhole" surgery, carried out under general anaesthetic,where two or three small incisions are madearound your shoulder.

The surgeon willinsert athin 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'll 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's 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'll be awake while it's carried out, but your shoulder will be numbed.

It may be performed by a specialist orthopaedic surgeon using a local anaesthetic and corticosteroids, or saline with corticosteroids. X-ray guidance may sometimes be needed.

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's some evidence that hydrodilatation may result in less pain and greater movement, although the effects may be no better than a corticosteroid injection.