Frozen shoulder treatment

A trial, Anti Freaze-F into the use of anti-TNF for early (painful) stage frozen shoulder is under way in Oxford and other centra in the UK. More information can be found on the trial website.

Pain Relief – anti-inflammatory drugs such as ibuprofen, naproxen, co-codamol, paracetamol and similar medications. 

 Physiotherapy – mobilising shoulder exercises, or Codman’s exercises (with or without holding a weight of up to 2.5kg in the affected hand) as described by your physiotherapist, done four times daily for 20-30 minutes at the time to prevent freezing up completely and slowly increase mobility. 

There are many reports of success with the Niel-Asher technique performed by a qualified practitioner, but we are not aware of independent clinical trials comparing this method to regular physiotherapy.

Steroid injection into the shoulder joint – This can be done to reduce pain and inflammation, and to make exercising easier. Normally the injection will contain a steroid and a local anaesthetic to give fast pain relief. On its own it is not a cure, exercise is still essential.

Hydrodilatation – saline fluid mixed in with the steroid injection, to stretch the joint capsule and increase mobility. Not widely used in the UK. Can be painful in the short term (don’t drive afterwards).

Arthrosopic joint release – A procedure done under general anaesthetic, where scar tissue in the capsule is released using an arthroscope. (An arthroscope is a tiny camera in a tube and scalpels, etc. can also be passed down the tube. This is keyhole surgery.

Mobilisation under anaesthetic – In these cases where exercises are not having the desired effect, the patient can be given a general anaesthetic and the surgeon will manipulate the arm to break down the scar tissue in the joint capsule. Used as last resort but can give good results very quickly.

Collagenase injections -Trials of collagenase for frozen shoulder were halted in 2022 as initial results did not show a significant improvement.

For more information on treatments, this website is very informative.

Dorsal Nodules 

Radiotherapy can give  softening of the lumps and reduction in size, and reduce the pain. Usually if the palm of the hand is treated with radiotherapy the field is enlarged to cover these nodules as well.

 Collagenase injections– again some softening of lumps in several cases, but larger risk of tendon or ligament damage than underneath the hand as the structures are a lot closer to each other; and surgery, which can be effective but all risk associated with it- swelling, infection, finger stiffness after.

Steroid injections can help reduce the size of the nodules as well as the pain. In most cases they are given as one-off injections and some patients require a general anaesthetic for this.

Garrod’s pads

If they are causing serious problems surgery has been used, recently successes have been reported with laser treatments. Usually they are left alone.