Frozen Shoulder Treatment
Your questions answered by experts...
Frozen Shoulder Treatment Questions Answered On This Page...
How is a Frozen Shoulder treated?
Frozen shoulder treatment needs to target the stage of the frozen shoulder symptoms. To treat a pain dominant frozen shoulder an ultrasound guided steroid injection or shoulder hydrodilatation is effective. To treat a stiffness dominant frozen shoulder some gentle physical therapy exercises may help but the resolution will be largely down to the passage of time...
What treatments exist for a Frozen Shoulder?
No treatment. As this website explains, there is no definite need to seek active treatment for a frozen shoulder as most cases will resolve without treatment. However, understandably given pain levels are normally intense early in the condition and disability significant due to significant shoulder stiffness many people do seek active treatment.
Ultrasound guided corticosteroid injections and a modified version of this injection known as a shoulder hydrodilatation or shoulder hydrodistention procedure are both are very effective at reducing pain from a frozen shoulder.
Physical therapy exercises may play a role in restoring optimal shoulder flexibility and strength but only once pain levels have reduced significantly. Starting shoulder mobility exercises and other forms of physical therapy on a painful and inflamed shoulder joint may make a pain dominant frozen shoulder worse.
Surgery aimed at releasing the adhesions and fibrosis (scar tissue) within the shoulder capsule. This procedure is effective at increasing shoulder range of motion when the above treatments have failed. The surgery, known as arthroscopic capsular release surgery involves entering the shoulder via keyholes and using specialised instrumentation heating away and releasing the scar tissue within the shoulder capsule. Once released the surgeon will then perform some manipulations of the shoulder while the patient is under anaesthetic to improve the range of motion.
Can frozen shoulder be treated/ cured?
Answer:
The majority of frozen shoulders will significantly improve without treatment but this may take 2-3 years. To speed up improvements in pain and shoulder stiffness, an intra-articular shoulder joint steroid injection or a shoulder hydrodilatation are both effective treatments.
Explanation:
Research has demonstrated that the vast majority of frozen shoulders will improve without any active treatment if given enough time. Therefore, to investigate whether active treatments are effective for this condition, researchers have needed to compare certain treatments against the timeline of the condition without treatment (as a control group) or against another treatment.
Non surgical treatments can be broadly defined as:
Physiotherapy
Frozen shoulder steroid injection
Frozen shoulder hydrodilatation
Many studies and in recent years several systematic reviews of these studies have been conducted with differing methodology. The consistent conclusions favour that there are no significant differences in the longer term for patients whether they undergo no active treatment, physiotherapy, corticosteroid injection or a hydrodilatation procedure.
However, given the significant and disabling nature of a frozen shoulder in the early months of the condition it is worth noting the results of treatments in the short to medium term. Several reviews have reported a timeline of results with regards to pain levels and shoulder function. The results of these studies are inconsistent but indicate:
Frozen shoulder corticosteroid injection or hydrodilatation significantly improve pain and increase shoulder range of motion in the short and medium term (generally measured 3-6 months after injection).
A shoulder hydrodilatation and intra-articular (within the shoulder joint) corticosteroid injection both yield very similar results in the short and medium term with one possible difference:
There may be a slight further benefit to shoulder external rotation range of motion in the short term following a shoulder hydrodilatation procedure vs a corticosteroid injection.
Articles:
Challoumas, D., Biddle, M., McLean, M. and Millar, N.L., 2020. Comparison of treatments for frozen shoulder: a systematic review and meta-analysis. JAMA Netw Open 2020; 3: e2029581. Link to article
Lin, M.T., Hsiao, M.Y., Tu, Y.K. and Wang, T.G., 2018. Comparative efficacy of intra-articular steroid injection and distension in patients with frozen shoulder: a systematic review and network meta-analysis. Archives of physical medicine and rehabilitation, 99(7), pp.1383-1394. Link to article
Rex, S.S., Kottam, L., McDaid, C., Brealey, S., Dias, J., Hewitt, C.E., Keding, A., Lamb, S.E., Wright, K. and Rangan, A., 2021. Effectiveness of interventions for the management of primary frozen shoulder: a systematic review of randomized trials. Bone & Joint Open, 2(9), pp.773-784. Link to article
Zhang, J., Zhong, S., Tan, T., Li, J., Liu, S., Cheng, R., Tian, L., Zhang, L., Wang, Y., Liu, F. and Zhou, P., 2021. Comparative efficacy and patient-specific moderating factors of nonsurgical treatment strategies for frozen shoulder: an updated systematic review and network meta-analysis. The American Journal of Sports Medicine, 49(6), pp.1669-1679. Link to article
What is a hydrodilatation of the shoulder?
There is good evidence that a frozen shoulder corticosteroid injection under ultrasound guidance and a frozen shoulder hydrodilatation are effective in reducing pain and improving range of motion (more quickly than if a frozen shoulder is left without treatment)
However, there is no consistent evidence that a frozen shoulder hydrodilatation is any more effective than a standard frozen shoulder corticosteroid injection.Answer:
A frozen shoulder hydrodilatation is a type of injection which uses a combination of corticosteroid, local anaesthetic and saline (salt water) aimed within the shoulder joint (glenohumeral joint). The saline is added to increase the volume injected with the aim of distending and stretching areas of stiffness within the shoulder joint capsule. For this reason, the procedure is sometimes called a frozen shoulder hydrodistention.
A shoulder hydrodilatation is performed identically to a frozen shoulder corticosteroid injection with the only difference being the addition of saline to the corticosteroid and local anaesthetic. Standard volumes used by most clinicians are as follows:
Shoulder hydrodilatation (1ml steroid, 5-10 ml local anaesthetic, 20-25ml saline)
Shoulder corticosteroid injection: (1ml steroid, 4ml local anaesthetic)
The skill in obtaining a good result from a shoulder hydrodilatation or corticosteroid injection is accurate needle placement which should ensure filling of fluid within the shoulder joint (glenohumeral joint capsule). To ensure this, shoulder joint injections should all be performed under ultrasound guidance for accurate needle placement.
The below video demonstrates a needle passing right to left and injecting within the glenohumeral (shoulder) joint capsule...
The below video demonstrates a needle passing centrally and injecting within the glenohumeral (shoulder) joint capsule...
There is good evidence that a frozen shoulder corticosteroid injection under ultrasound guidance and a frozen shoulder hydrodilatation are effective in reducing pain and improving range of motion (more quickly than if a frozen shoulder is left without treatment)
However, there is no consistent evidence that a frozen shoulder hydrodilatation is any more effective than a standard frozen shoulder corticosteroid injection.
What are the best frozen shoulder exercises?
Answer:
Online Physio Expert will enable you to access evidence based, HD quality video exercises for each stage of a frozen shoulder. Online PhysioExpert’s exercise ladders also allow you to progress yourself at each stage according to your pain levels and stiffness…
Frozen Shoulder Exercises - HD exercise videos & information (onlinephysioexpert.com)
Contact - Chris Pruvey (Musculoskeletal Specialist)
Booking enquiries for a frozen shoulder ultrasound guided injection or hydrodilatations
