Frozen Shoulder: Injections, Procedures, and Comprehensive Treatment

What injection is given for frozen shoulder?

For frozen shoulder (adhesive capsulitis), the primary injection given is typically a corticosteroid injection, often combined with a local anesthetic. This injection aims to reduce inflammation and pain within the shoulder joint capsule, facilitating improved range of motion.

Understanding Frozen Shoulder

Frozen shoulder, medically known as adhesive capsulitis, is a debilitating condition characterized by progressive pain and stiffness in the shoulder joint. It occurs when the connective tissue surrounding the glenohumeral joint (the shoulder capsule) becomes inflamed, thickened, and rigid, restricting movement. The condition typically progresses through three stages:

• Freezing Stage: Gradual onset of pain, with increasing stiffness.
• Frozen Stage: Pain may decrease, but stiffness is significant, severely limiting range of motion.
• Thawing Stage: Gradual improvement in range of motion over time, which can take months to years.

While the exact cause is often unknown (idiopathic), it can be associated with immobility, diabetes, thyroid disorders, and certain shoulder injuries or surgeries. The primary goal of treatment is to manage pain and restore mobility.

The Primary Injection: Corticosteroids

The most common and effective injection for frozen shoulder is an intra-articular corticosteroid injection.

• Mechanism of Action: Corticosteroids are powerful anti-inflammatory medications. When injected directly into the joint capsule, they reduce the inflammation and swelling of the synovial lining and the thickened capsule itself. This reduction in inflammation helps alleviate pain and can temporarily improve the elasticity of the joint capsule, making movement less painful and facilitating physical therapy. A local anesthetic (like lidocaine) is usually mixed with the corticosteroid to provide immediate pain relief.
• Administration: The injection is typically performed by a physician (orthopedic surgeon, sports medicine physician, or rheumatologist) using imaging guidance (ultrasound or fluoroscopy) to ensure accurate placement within the glenohumeral joint capsule. This precision is crucial for maximizing effectiveness and minimizing potential side effects.
• Benefits:
  • Pain Reduction: Significant decrease in shoulder pain, especially in the early "freezing" stage.
  • Improved Sleep: Pain relief often allows for better sleep quality, which is frequently disrupted by shoulder pain.
  • Facilitated Rehabilitation: By reducing pain, the injection makes it possible for patients to more effectively participate in physical therapy, which is paramount for restoring range of motion.
• Potential Side Effects & Considerations: While generally safe, corticosteroid injections carry some risks:
  • Temporary Pain Flare: Some individuals may experience a temporary increase in pain for 24-48 hours after the injection.
  • Infection: A rare but serious risk.
  • Skin Discoloration or Fat Atrophy: At the injection site.
  • Tendon Weakening: Repeated injections in the same area can potentially weaken tendons, though this is less common with intra-articular shoulder injections for frozen shoulder.
  • Blood Sugar Spike: Individuals with diabetes may experience a temporary rise in blood glucose levels.
  • Limited Number of Injections: Due to potential side effects, physicians typically limit the number of corticosteroid injections into a single joint over a given period.

Other Potential Injections and Procedures

While corticosteroids are the mainstay, other procedures or injections may be considered:

• Hydrodilatation (Distension Arthrography): This procedure is often performed in conjunction with a corticosteroid injection. It involves injecting a large volume of sterile saline solution (sometimes mixed with corticosteroid and anesthetic) into the joint capsule. The goal is to physically stretch and distend the thickened, contracted capsule, potentially breaking up adhesions and increasing joint volume. This can provide a more immediate improvement in range of motion than corticosteroids alone.
• Platelet-Rich Plasma (PRP) Injections: PRP involves injecting a concentrated solution of a patient's own platelets, which contain growth factors, into the affected area. While PRP has shown promise in some musculoskeletal conditions, its efficacy for frozen shoulder is still under investigation and not yet a standard treatment. Research is ongoing to determine its role in reducing inflammation and promoting tissue healing in adhesive capsulitis.
• Hyaluronic Acid Injections: These injections (often used for osteoarthritis) are generally not indicated for frozen shoulder. Frozen shoulder is primarily an inflammatory and fibrotic condition of the joint capsule, not a loss of cartilage or synovial fluid viscosity, which is what hyaluronic acid addresses.

The Role of Injections in a Comprehensive Treatment Plan

It is crucial to understand that injections for frozen shoulder are rarely a standalone cure. They are most effective when integrated into a comprehensive treatment plan that prioritizes physical therapy.

• Facilitating Physical Therapy: The primary benefit of injections is to reduce pain and inflammation to a level that allows the patient to actively participate in and tolerate the stretching and strengthening exercises essential for restoring shoulder mobility. Without the pain relief provided by injections, many patients find the necessary physical therapy too painful to perform effectively.
• Pain Management Bridge: Injections can serve as a bridge to allow for more aggressive and effective rehabilitation, helping to break the cycle of pain-stiffness-pain.
• Not a Permanent Solution: The effects of corticosteroid injections are temporary, typically lasting weeks to a few months. Long-term recovery and restoration of full range of motion depend heavily on consistent and appropriate physical therapy and home exercise programs.

Important Considerations and When to Seek Medical Advice

If you suspect you have frozen shoulder or are experiencing persistent shoulder pain and stiffness, it is imperative to consult with a healthcare professional. A proper diagnosis is essential, as other shoulder conditions can mimic the symptoms of frozen shoulder.

Your physician will discuss the most appropriate treatment options based on your specific condition, the stage of your frozen shoulder, your overall health, and your response to previous treatments. While injections can be a powerful tool in managing frozen shoulder, they are one component of a multi-faceted approach aimed at restoring your shoulder's function and quality of life.