Frozen Shoulder Part 2. What are my treatment options?

What can I do to heal a frozen shoulder?

Part 2. What are my treatment options?

There are a number of treatment options for a frozen shoulder.

You may decide to do nothing and let nature take its course. This could take a long time and be very painful – it is definitely not advisable as you may not regain full movement in your shoulder. You can seek treatment through the NHS, and there is the option of getting treatment from an alternative practitioner such as an osteopath.

If you go to your doctor for treatment, there are a number of options under the NHS depending on what stage your frozen shoulder has reached.

1. Early stage treatments

In the early stages you may be given painkillers, such as paracetamol, or a combination of paracetamol and codeine. If your pain is more severe, your GP may recommend or prescribe a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen. As well as easing pain, NSAIDs help reduce inflammation in your shoulder capsule. However they do not appear to affect disease progression and there are side effects associated with NSAIDs, so they are not recommended for long term use.

Your doctor may offer you a corticosteroid injection in your shoulder joint. Corticosteroids help reduce pain and inflammation. However they will not cure your condition and your symptoms may gradually return. Having too many corticosteroid injections may damage your shoulder, so they would not normally be offered more than three times.

After the initial, painful stage, when stiffness is the main symptom, your GP may suggest you start shoulder exercises, and you may be referred to a physiotherapist. Physiotherapists use a number of techniques to help you maintain movement and flexibility in your shoulder. If you are referred to a physiotherapist, they may offer stretching exercises, massage or thermotherapy with warm or cold packs.

2. Surgery

Surgery is only offered for frozen shoulder in the frozen stage and when symptoms are severe, causing significant problems and when other treatments have not worked after six months. There are two surgical procedures for a frozen shoulder:

Manipulation under anaesthesia (MUA)

With this procedure you will be given a general anaesthetic and then your arm will be moved so as to stretch and tear adhesions in the joint capsule. In addition, you will usually have corticosteroid and local anaesthetic injected into your shoulder joint. Afterwards, you will need physiotherapy to help maintain mobility in your shoulder. However there is a small risk of injury associated with MUA, including fracture to the humerus, dislocation, muscle injuries, tears to the joint and nerve injury, as well as increased pain postoperatively. And the operation is not always successful as in some patients, especially diabetics, the adhesions return, causing a loss of mobility and pain.

Arthroscopic capsular release

Arthroscopic capsular release is a type of keyhole surgery. The surgeon will carry out the procedure after making a small incision. A special probe is used to open up the 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.

Capsular release involves cutting and removing the thickened, swollen inflamed abnormal capsule, and has greater precision than MUA. The results are successful in over 80% of patients and the freedom from pain is quicker than MUA. Arthroscopic capsular release also allows the surgeon to look around the shoulder joint with the arthroscope for any other lesions or injuries.  Capsular release is safer and more effective than MUA for people who have developed a resistant stiff (frozen) shoulder after injury, trauma or fractures, as well as for diabetics.

As with manipulation, after having arthroscopic capsular release you will need physiotherapy. This will help you regain a full range of movement in your shoulder joint.

There is very little quality research into the effectiveness of the different shoulder interventions, and surgery in particular. According to Mathias Nagy, patients in the frozen and thawing phase may benefit from more intense physiotherapy and/or distension injections, whilst surgical intervention with MUA or arthroscopic release should be reserved for refractory cases.

References:

https://www.nhs.uk/Conditions/Frozen-shoulder/Pages/Treatment.aspx

Nagy MT et al., The Frozen Shoulder: Myths and Realities. Open Orthop J. 2013; 7: 352–355.

Maund E, et al., Management of frozen shoulder: a systematic review and cost-effectiveness analysis. Health Technol Assess. 2012;16(11):1-264


Sorrel Pindar, Registered Osteopath

If you’re suffering from a frozen shoulder, give us a call, on 01234 409538 or you can email me: sorrel@oxalisosteopathy.co.uk


Categories: Osteopathy.