A Comprehensive View of Frozen Shoulder: A Mystery Syndrome

Abstract

Frozen shoulder is a common epidemiological affliction. Data acquired from people who suffer from this type of damage in other joints such as the hip, wrist and ankle also exist; although these syndromes are less common. Treatment for frozen shoulder is primarily physical (physiotherapy, manual therapy), secondary medical (corticosteroid injections) and finally surgical but with limited success. The difficulty in treating this type of condition successfully lies in the lack of knowledge about the risk factors involved and the pathophysiology underlying this mysterious syndrome. This review gives an overview of the current scientific position of frozen shoulder in terms of evolutionary factors, etiology, the different mechanisms of action involved, current treatment options and other possible interventions based on recent discoveries of pathophysiological mechanisms. The overall objective is to clarify several unknown aspects of a syndrome that affects up to 5% of the world's population.

Risk Factors for the Onset of Frozen Shoulder in Middle-Aged and Elderly Subjects Within 1 Year of Discharge From a Hospitalization That Involved Intravenous Infusion: A Prospective Cohort Study

“…Accumulating evidence suggests that diabetes and hypertension are risk factors for the onset of frozen shoulder ( 1 , 23 , 24 ). Specifically, frozen shoulder occurs 2–5 times more frequently in individuals with diabetes compared to those without ( 25 , 26 ).…”

“…In addition to pain, frozen shoulder can cause a gradual reduction in the range of motion of the shoulder joint, which seriously impacts all areas of an affected individual's work and life. Globally, the incidence of frozen shoulder is estimated at 2–5% ( 1 ). In 1934, Codman introduced the term “frozen shoulder” ( 2 ).…”

“…Common interventions for frozen shoulder include physical therapy, acupuncture, manipulation, orally administered medications, local steroid injection, manual release under anesthesia, and arthroscopic capsular release ( 7 ). These approaches may be successful in the short-term; however, symptoms such as shoulder pain and limited mobility gradually worsen with time ( 1 , 8 ). There is no cure for frozen shoulder, as there is no recognized effective treatment; therefore, research should focus on identifying risk factors for frozen shoulder, which will broaden knowledge about prevention and treatment and reduce the incidence of frozen shoulder.…”

“…The Upper Limb Committee of the International Society of Arthroscopy, Knee Surgery and Orthopedic Sports Medicine (ISAKOS) classify frozen shoulder as primary (idiopathic) or secondary (shoulder trauma [fracture, dislocation, and soft tissue injury]; non-traumatic osteoarthritis, rotator cuff injury, calcific tendinitis, prolonged immobilization of the shoulder joint after surgery, injury to the cervical spine or brachial plexus) ( 6 , 9 , 10 ). Risk factors for primary frozen shoulder include diabetes, Dupuytren's contracture, thyroid disease, myocardial infarction, and Parkinson's disease ( 1 ). In other studies, the incidence of frozen shoulder has been associated with occupational factors, whereby individuals working at high altitudes, handling heavy objects and performing manual labor are more likely to suffer from frozen shoulder ( 11 ).…”

Causes of Shoulder Dysfunction in Diabetic Patients: A Review of Literature

“…In this context, a recent review presents a systemic view on the pathogenesis of frozen shoulder, including insulin resistance, low-grade inflammation, and chronic hypoxia. These mechanisms, together with the influence of modern life, including a sedentary lifestyle, and the partial or complete absence of range of motion of the shoulders in general and of the non-dominant shoulder, suggest that the pathology of FS is systemic [51,52].…”