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Frozen shoulder

Jul 25, 2019

Frozen shoulder caused by stiffness of shoulder joint and inflammation. It leads to pain and reduced range of movement. Generally, affects patients over 50 years of age and increasingly likely in situations leading to reduced shoulder movements (stroke, mastectomy, injury).

Medications:

  • Start Tab. Dolokind MR (Aceclofenac 100 mg, Paracetamol 325 mg, Chlorzoxazone 250 mg) 1 tablet twice a day for 5 days.
  • Add tab. Pantakind 40 (Pantoprazole 40 mg) 1 tablet a day for 7 days for gastric protection.
  • Gel Powergesic 2X (Diclofenac 2.32%, Methyl Salicylate 10%, Menthol 5% w/w) to be applied over painful area thrice a day for 7 days.
  • If patient is not diabetic or hypertensive – 6 days course of steroid – Tab. Zempred 4 (Methylprednisolone 4 mg)
    Day 1 – 2 tablets before breakfast, 1 tablet each after lunch, dinner and 2 tablets at bedtime (total dose 24 mg per day).
    Day 2 – 1 tablet before breakfast, 1 tablet each after lunch and dinner, 2 tablets at bedtime (total dose 20 mg per day).
    Day 3 – 1 tablet before breakfast, 1 tablet each after lunch, dinner and at bedtime (total dose 16 mg per day).
    Day 4 – 1 tablet before breakfast, 1 tablet each after lunch and at bedtime (total dose 12 mg per day).
    Day 5 – 1 tablet before breakfast and at bedtime (total dose 8 mg per day).
    Day 6 – 1 tablet before breakfast (total dose 4 mg per day).

 General advice:

  • Advice rest and warm fomentation during acute phase.
  • Later advice regular shoulder exercises at home to improve range of movements.
  • Local ultrasound therapy might help.
  • Dietary supplements such as turmeric and ginger may help to a minor degree.
  • In diabetic patients ensure good control of blood sugars.
  • Consider application of kinesiology tape to reduce local strain.

Investigations:

  • X ray shoulder – to rule out arthritis in the joint.
  • Ultrasound scan of shoulder – to identify evidence of full or partial thickness tendon rupture. It may also identify evidence of subacromial compression.

Referral:

Consider referral to physiotherapy to improve range of movements. If there is no improvement in pain or range of movements with above treatments, then consider referral to orthopaedic surgeon.