1. Presentation and referral

1. Rule out other stiff shoulder conditions confirmed by early X-rays as appropriate
   1. Osteoarthritis: follow available guidelines
   2. Locked dislocation: if significant trauma and dislocation confirmed, make urgent referral to hospital
2. Have the symptoms persisted for more than 6 weeks from onset?
3. Consider patient history, age, risk factors for shoulder stiffness, whether the other side has been affected by frozen shoulder
4. Optimise management for risk factors (e.g., thyroid disase & diabetes), consider investigating those with no previous diagnosis
5. Confirm loss of active and passive external rotation of 50% or more compare to the unaffected size (for unilateral involvement)
6. For bilateral involvement, confirm capsular pattern of movement – shrugging of shoulder (scapular elevation) with active and passive forward arm elevation

1. Analgesia
2. Activity modification
3. Rest
4. Shoulder mobilisation advice

Refer the patient for two x-ray views (true anterior posterior and axillary views if not already done) to exclude other causes of shoulder stiffness

Note – Ultrasound scans (USS) and MRI are not indicated in primary care

Note – Diagnosis should occur within 12 weeks* from first presentation or onset of symptoms

*Timeframes are indicative of minimum standards

1. Watch this short video on treatment options
2. Consider glenohumeral steroid injection (if indicated or unless contraindicated) provided by a trained GP, First Contact Practitioner (FCP) or Advanced Physiotherapy Practitioner (APP)
3. Provide Patient Booklet and exercises
4. Refer for further physiotherapy following injection

Note – Physiotherapy should start within 2 weeks* of receiving an injection

*Timeframes are indicative of minimum standards