Shoulder Pain Management

Frozen Shoulder

Frozen shoulder is generally treated with pain relievers with the goal of restoring motion and function. Treatment is tailored to the stage of the disease on presentation. Frozen shoulder can be effectively treated in the primary care setting. In patients who present during the adhesive phase, stiffness rather than pain is the primary problem. In these patients, a more aggressive therapy program aimed at restoring motion and function is generally better tolerated.

Treatment Options
• NSAIDs and analgesics as necessary
• Range-of-motion activities up to patient tolerance levels
• Vigorous therapy after pain resolves
• Rarely requires manipulation under anesthesia
• Place patient into a structured physical therapy program that consists of active, assisted range-of-motion exercises as well as gentle, passive stretching exercises in all planes of motion.¹

Key Clinical Points
• Most patients present during the initial painful inflammatory phase. In these cases, treatment should be initially directed at pain relief.
• NSAIDs and acetaminophen are the primary means of analgesia.
• Intra-articular and subacromial corticosteroids may reduce synovitis and can be helpful in augmenting oral pain regimens.
• Oral steroids have shown no long-term benefit and should not be used routinely.
• Pain control is essential because it enables patients to more readily participate in an exercise program aimed at restoring motion.¹

Patient Considerations

Patient education about early detection and treatment options can help ease patient fears of permanent disability and encourage compliance with prescribed therapy. Although the natural history is one of resolution, patients should be cautioned that they might never regain full range-of-motion of the affected shoulder. It is important to remember that regardless of the etiology of frozen shoulder, most patients will regain improved motion and function when treated with a structured exercise program and appropriate analgesia. In patients who fail to improve after 6 months of organized therapy, referral to an orthopaedic surgeon for possible manipulation under anesthesia or capsular release is indicated.

Clinical Course

The clinical course of the patient with frozen shoulder is to gradually return to near normal function. However, this is a difficult course and may take 6 to 24 months and be associated with episodes of pain. After the initial symptoms begin to resolve, persistent effort must be directed to regaining motion.

Know When to Refer
• Fracture
• Anterior and/or posterior dislocation
• Septic shoulder
• Rotator cuff tears
• Patient not responding to conservative treatment after 6 months

References