Frozen shoulder: What can help?

Photo of a woman having physiotherapy (PantherMedia / Wavebreakmedia ltd)

Frozen shoulder is a long-lasting and painful condition that can greatly affect everyday life. It gets better on its own at some point – but that sometimes takes quite a while. Medicine can relieve the pain, and stretching exercises may help to improve mobility.

In frozen shoulder, the shoulder gradually starts hurting over the course of several weeks. After a few months, the pain gets better but it becomes harder to move the shoulder. It may become so stiff that it's impossible to raise your arm. After a few more months, it gradually loosens up again.

It can take a long time for frozen shoulder to get completely better. A number of different treatments can help to relieve the pain and improve mobility.

When are the different treatments most suitable?

The way that frozen shoulder is treated depends on the symptoms and the phase of the condition:

  1. In the first phase, the aim is to relieve the pain. This usually involves treatment with steroid tablets or steroid injections. During this time, it's best to give the shoulder some rest, and to stop moving it if it hurts.
  2. In the second phase, the pain starts to go away, and the shoulder becomes stiffer. Now you can start to stretch the arm a little to loosen up the joint. But stretching and mobility exercises shouldn't be forced or painful.
  3. In the third phase, it gradually becomes easier to move the shoulder and it usually doesn't hurt much anymore. Now you can increase the intensity of the exercises in order to help with the healing process.

The length of the different phases varies greatly. Also, the shoulder may be painful and stiff at the same time, especially in the second phase. So it's difficult to make a general statement about when you should start with physiotherapy and movement exercises.

How can you relieve the pain yourself?

If you have a frozen shoulder, you can generally use your arm as you normally would and don't have to worry about harming it. But to keep the pain from getting worse, it's best to be careful and avoid sudden movements.

Many people use cold or heat packs to relieve shoulder pain. If you use these kinds of packs, it's important to protect your skin from extreme temperatures, for instance by using a towel. Cold can damage the skin too, like heat can.

Over-the-counter painkillers are also a popular option, especially non-steroidal anti-inflammatory drugs (NSAIDs). This group of medications includes diclofenac, ibuprofen and naproxen. NSAIDs relieve pain and reduce inflammation. They can be taken as tablets or applied to the shoulder in the form of a gel or cream. But they are less effective than steroids.

How effective is treatment with steroids?

Steroid tablets (oral steroids) can relieve pain and improve mobility in the shoulder. One study that looked into the effectiveness of taking steroid tablets for three weeks showed the following:

  • Symptoms improved in 48 out of 100 people who didn't use steroids.
  • Symptoms improved in 96 out of 100 people who used steroids.

In other words, the steroid tablets relieved the symptoms in an additional 48 out of 100 people.

Steroid tablets only work for as long as they are taken, though. And they aren't suitable for long-term use: When taken for a long period of time, they can increase the likelihood of weight gain and infections. They also increase the risk of various diseases, such as diabetes and osteoporosis.

Alternatively, steroids can be injected into the stiff joint. This can relieve the pain and improve mobility. The effect of injections lasts longer than that of steroid tablets.

But the pain may temporarily get worse just after an injection. A sudden sensation of heat with skin reddening (flushing) may be one unpleasant side effect of the injections. Some women also report menstruation problems after treatment. Injections are associated with a risk of infection in the joint too. A joint infection is a very rare but serious side effect.

Whether tablets or injections are more suitable will depend on things like which treatment you prefer and whether you have other medical conditions. For example, steroid tablets might not be an option for someone with diabetes.

Can injections to loosen or numb the joint help?

In a procedure known as hydrodilatation (also called arthrographic distension), a solution is injected into the joint after it has been numbed with a local anesthetic. The solution usually contains water, salt and a steroid. The aim is for the solution to dilate (stretch) the joint capsule and loosen the joint. You may be able to hear the solution in the joint afterwards.

Hydrodilatation can relieve the symptoms of frozen shoulder. But it isn't more effective than steroid injections. Because this treatment can be very painful at first, most doctors now advise against it.

There is also another injection-based treatment known as a nerve block. It involves injecting a local anesthetic into the nerve leading to the shoulder blade. There is hardly any research on the use of this treatment for frozen shoulder, though.

How can shoulder mobility be improved?

During the first phase of frozen shoulder, when pain is the main problem, people are advised to rest the shoulder. If you would like to try a gentle mobility exercise, you can do the following:

  • While standing, lean forward and hold on to a chair or table with your healthy arm.
  • Let the affected arm hang down and then carefully start to swing it in back-and-forth and circular motions, like a pendulum. It shouldn't feel too unpleasant.
  • You can also create this swinging motion by slightly moving your upper body without using the muscles in the arm.

More intensive physiotherapy is only recommended once the pain has subsided – in the second and third phases. You can then try to improve mobility by doing various exercises that move the shoulder in different directions. These include the following:

  • Armpit stretch: With the support of your healthy arm, lift the arm with the frozen shoulder up and rest it on a surface at about chest level. In this position, slowly bend your knees so that your armpit opens up and you can feel it stretching. Then stand up straight again.
  • External rotation stretch: Stand in a doorframe with the affected arm out to the side of your body, and the elbow bent at a 90-degree angle so that your forearm is parallel to the floor. Keep the upper arm at your side. Then place the palm of your hand on the doorframe to stop the arm from moving. Now turn your upper body away from the arm to stretch the shoulder.
  • Internal rotation stretch: Stand with your back to the doorframe. Place the back of your hand on the affected side against your bottom so that your arm is at a slight angle. Now lean the back of that elbow against the doorframe – gently "trapping" your elbow to keep it in place – and turn your upper body slightly inward towards the arm.

These exercises are typically repeated 10 to 20 times once or twice a day. It's important to start stretching slowly until you feel it, but without it hurting a lot.

These and other stretching and mobility exercises can also be demonstrated by a doctor or physiotherapist so that you can do them at home on a regular basis. More intensive exercises are possible in the final phase of frozen shoulder, for example using a rubber exercise band.

Previous research has shown that treatment with a combination of steroids and physiotherapy is the most effective way to reduce shoulder stiffness.

What other treatment options are there?

Physiotherapists sometimes treat frozen shoulder with ultrasound waves. This has not been proven to work, though. Acupuncture, laser therapy, magnetic field therapy and short-wave diathermy are also sometimes offered. But the effectiveness of these methods for treating frozen shoulder has not been looked into in high-quality studies.

It's important to know that both magnetic field therapy and short-wave diathermy produce magnetic fields that can cause problems in people who have any implanted electronic devices, such as pacemakers. So these treatments aren't an option for people who have implants.

Labels: Adhesive capsulitis, Frozen shoulder, M75, Muscles, bones and joints, Periarthritis