Frozen shoulder or adhesive capsulitis is a common cause of shoulder pain. It affects mostly women above the age of forty but can happen to both men and women of any age in rare circumstances.

Frozen shoulder is much more common in diabetics than in the rest of the population - some research studies suggest that it is six times more frequent in those who need to take insulin for diabetes treatment

Details of treatment options for frozen shoulder are given below.

 Before I start discussing how to treat frozen shoulder, I think it's important to consider the other medical conditions that can sometimes mimic it - present in a very similar way in other words.

For an experienced doctor or therapist it's not usually too difficult to reach an accurate diagnosis just by listening to the patients story and then examining the shoulder - but it is important to at least consider whether any of the following conditions could be present:

• Rheumatoid arthritis - this can affect the shoulder but it's more likely to affect the small joints of the hands or feet
• Osteoarthritis - sometimes develops in the shoulder joint but is more common at the nearby acromioclavicular joint or in the neck
• A tear in the rotator cuff muscles of the shoulder with the development of a secondary frozen shoulder - this is sometimes called "rotator cuff arthropathy" and is a particular problem in those who have had a significant shoulder injury.
• Referred pain from the neck or elsewhere in the body
• Serious disease like cancer or infection - these are very rare around the shoulder but do occur very occasionally

For the most part there is no need to arrange any investigation in the initial assessment of frozen shoulder pain but your doctor might organise blood tests, x-rays, ultrasound scans, MRI scans or even special scans with injection of die into the joint if he or she is worried about other possible conditions

There are many options available for the treatment of a frozen shoulder problem but before deciding what might be best for you, it's important to remember that the condition will recover on its own in nearly every case. Even if you choose not to have any treatment you can relax in the knowledge that nature will make sure a good recover occurs

In my experience it's also true that about a third of people opt to have no treatment at all. Once they know the diagnosis and realise that there is nothing seriously wrong, they are quite happy just to sit tight and let nature fix things for them. They may need no more than the occasional simple painkiller on days when they expect to be active.

These are listed in no particular order:

• Oral painkillers - we know from research and experience that nature will make sure your frozen shoulder recovers - although it can take up to two years to do it. Taking oral painkillers like ibuprofen or paracetamol / tylenol can take the edge off the discomfort while nature is sorting things out for you
• Oral steroid tablets - several good recent research articles have suggested that using oral steroid tablets early in the frozen shoulder condition ( in what's called stage one) can result in marked pain relief and a shorter recovery time. This research seems promising although a bit more work is needed before oral steroid tablets are used routinely
• Steroid Injection Treatment for Frozen Shoulder - works best in the frozen phase of frozen shoulder, when the joint is really gummed up, painful and very, very stiff. This is sometimes called Stage Two. Injections provide pain relief in most cases but sometimes fail to make any impact on the stiffness.
• Physical therapy - hands on treatment for a frozen shoulder is a good option if you are in the thawing out phase - also called Stage three. By that time the pain is becoming less severe and the joint is beginning to get some of its flexibility back. A physiotherapist, osteopath or chiropractor can use heat, moblisation and stretches at this phase as a means of improving your stiffness and your day to day function. There's some evidence that if you try to use physical therapy in stage one of the condition it can cause more inflammation and thus more pain.
• Complementary therapy or Alternative therapy - this group includes treatments such as acupuncture, reflexology, homeopathy and herbal treatments. Many people with frozen shoulder use these treatments and find them very helpful - but there are no good quality research studies about them and that means it's hard to know how to select the treatment likely to work best for you
• Manipulation under anesthetic - becoming a very popular option again. This was first used as a frozen shoulder treatment in the 1950's but then fell out of favor. Recent years have seen an upsurge again in its use with good results in many cases.
• Hydrodilatation or Hydrodistension - also sometimes called Distension Arthrogram. The principle behind this treatment is that the joint capsule in a frozen shoulder is very tight - and stuck to the bone and joint underneath. To counteract this warm salty water (saline solution) is injected under some pressure and the capsule filled up to near bursting point. Can you imagine what it's like when you fill up a childs balloon from the bath tap? Same idea here with the shoulder. The stretching effect of the warm water releases a lot of the sticky adhesions and frees up the joint range of movement. A non aggressive, relatively painless and useful treatment
• Frozen Shoulder Surgery In years gone by the only operation available was an "open procedure" where the surgeon opened up the joint and worked inside to free it up. The results were not very good and the technique fell from common use. In recent years a new keyhole surgery approach has developed and many hospitals around the world now offer what's called an "arthroscopic release procedure" - the drawback is that you need to have a general anesthetic but the outcome results are very good for many people

This Hub was written by Doctor Gordon Cameron - the expert prepared to go the extra mile with you to ensure that you get better more quickly

You can read more about frozen shoulder treatment on Doctor Cameron's website - you can also download expert reports and a comprehensive ebook all about shoulder pain and how to treat it.