Non-surgical management is the initial treatment of choice for frozen shoulder. Common treatments include exercise, physical therapy, oral anti-inflammatory medication, and corticosteroid injections into the joint. The effects of most treatments are primarily short-term, focusing on alleviating symptoms such as shoulder pain and reduced joint movement. Corticosteroid injections appear to provide the greatest short-term improvements in pain and range of motion, while long-term outcomes tend to be similar for most non-operative treatments. Non-surgical treatment may continue for months, with more complex treatments such as extracorporeal shock wave therapy, movement under anaesthesia, and hydrodilatation. Each of these treatments have been deemed effective but have had different benefits and drawbacks, meaning that clinicians and patients often decide together on the most appropriate treatment. Gentle movement-based approaches may be used to help maintain mobility and manage discomfort during recovery, such as Tai Chi and the Feldenkrais Method. Most people (around 90%) can see their symptoms resolve with nonsurgical management alone. If conservative measures have no effect and the condition is long-lasting, or if evidence suggests surgical intervention, there are several operative procedures that can be used. This systematic review and meta-analysis found that combining acupuncture with physical therapy may reduce pain and improve shoulder range of motion more than physical therapy alone in patients with frozen shoulders. Exercise and manual techniques are kept limited when pain is high, and gradually increased as pain subsides. Especially in the painful (freezing) stage of adhesive capsulitis, it is recommended that stretching exercises not exceed the threshold of pain and be kept short (1–5 seconds).
Other non-operative interventions Nerve block at the suprascapular nerve (SSNB) is a minimally invasive procedure that can provide significant pain relief and functional improvement by directly blocking the main nerve for sensation to the shoulder (
suprascapular nerve). There is some evidence that SSNB is superior to corticosteroid injections and physical therapy. Hydrodilatation has also been combined with SSNB, but seems to provide no additional benefit. Surgical evaluation of other potential problems with the shoulder, e.g.,
subacromial bursitis or
rotator cuff tear, may be needed. Rotator cuff tears that exist alongside adhesive capsulitis can be addressed during the same surgery.
Manipulation under anesthesia Performed in isolation or during capsular release surgery, manipulation under anaesthesia is a procedure that aims to directly break up adhesions in the shoulder by manually moving the arm. General anesthesia is given to prevent pain and resistance during the procedure. While manipulation under anaesthesia without capsular release surgery appears similarly effective and can be more cost-efficient, the procedure carries additional risk of fracture, dislocation, tendon rupture, and nerve injury.
Post-operative management After surgery, it is recommended that rehabilitative physical therapy begin within 24–72 hours and continue 2-3 times per week for at least 6 weeks. Physical therapy is utilized to regain range of motion and prevent stiffness. Range of motion exercises, such as passive and active assisted exercises, are used first to provide mobility to the joints while preventing further stress/damage to the healing tissues. Stretching exercises are usually added later, followed by strengthening exercises. == Prognosis ==