Frozen Shoulder Syndrome Not Responding to Conservative Treatment
When frozen shoulder syndrome fails to improve after an extended course of conservative management, a structured interventional approach becomes the appropriate next step toward lasting pain relief and restoration of shoulder movement.
When Conservative Treatment Has Failed
This protocol is indicated when prior treatment — including oral analgesics, intraarticular or oral corticosteroids, extracorporeal shock wave therapy, structured shoulder physiotherapy, and hydrodilatation of the glenohumeral joint — has not achieved gradual resolution of shoulder pain and stiffness, or meaningful improvement in range of motion and function over a period of 12–18 months.
Next-Step Approach
For refractory frozen shoulder, the evidence supports an interventional procedure targeting the fibrosed capsulo-ligamentous complex of the shoulder — either a manipulation-based technique or a surgical approach performed under anaesthesia. The complete protocol, including selection criteria, procedural sequence, and post-procedure management, is available in the full regimen.
Treatment Goals
Lasting shoulder pain relief and gains in shoulder range of motion.
References
DOI: 10.1007/s43465-021-00351-3
- Invasive operative methods (manipulation or surgical release of capsule) to improve function in patients with primary FS are recommended only when an extended conservative treatment for a period of 6–9 months fails to provide significant relief to the patient.
- MUA is a method wherein fibrosed capsulo-ligament complex of shoulder, which is a hindrance in regaining ROM, is forcibly broken by manoeuvring the shoulder across the ROM under anaesthesia.
- Although all high-quality clinical studies have failed to reveal any major advantage of ACR over MUA; of late, ACR has emerged as 'preferred' surgical option for the treatment of refractory FS as ACR allows controlled and precise release of fibrosed capsule–ligament complex under vision avoiding the said complications of MUA under the same anaesthetic burden.
- Post MUA or ACR, authors prefer to inject 40 mg of Triamcinolone along with 10 ml of 0.25% Bupivacaine to minimise post-procedure inflammation and pain.
- Many studies have shown excellent short-, mid- and long-term results both in terms of lasting pain relief and ROM gains with ACR.
- Many studies have reported good to excellent long-term clinical outcome after MUA.
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