An overview of effective and potential new conservative interventions in patients with frozen shoulder

Mertens, Michel Gcam; Verborgt, Olivier; Vermeulen, E.; Schuitemaker, R.; Hekman, Karin M.C.; Burg, Donald H van der; Struyf, Filip

doi:10.1007/s00296-021-04979-0

Cited by 18 publications

(11 citation statements)

References 104 publications

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“…This may explain the lack of change in psychosocial variables. Future studies could explore the role of pain neuroscience education in this population as recently recommended by some authors [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Many treatments have been proposed for FS including conservative (i.e., manual therapy) [ 7 ] and non-conservative approaches (i.e., arthroscopic capsular release) [ 8 ]. The most common and recommended physical therapy interventions used for treating these patients are mobilization techniques and exercises, while the utility of other suggested interventions such as aerobic exercise, lifestyle changes, or pain neuroscience education is still hypothetical [ 9 ]. To date, none of these interventions has demonstrated to have an influence on the natural history of this condition, therefore innovative research seems necessary [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A Central Nervous System Focused Treatment Program for People with Frozen Shoulder: A Feasibility Study

Horno

Dueñas

Lluch

et al. 2022

IJERPH

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Background: Frozen shoulder (FS) is a highly disabling pathology of poorly understood etiology, which is characterized by the presence of intense pain and progressive loss of range of motion (ROM). The aim of this study is to evaluate the feasibility and clinical impact of a CNS-focused treatment program for people with FS. Methods: 10 subjects with primary FS received a 10-week CNS-focused intervention including sensory discrimination training and graded motor imagery techniques delivered as clinic sessions (60 min) and home therapy (30 min five times per week). Measurements were taken at baseline, after a 2-week “washout” period, after treatment, and at three months follow-up. The Shoulder Pain and Disability Index (SPADI) was the primary outcome. Secondary measures were feasibility-related outcomes, self-reported shoulder pain, active and passive range of motion, two-point discrimination threshold (TPDT), left/right judgement task (LRJT), fear-avoidance (Tampa Scale for Kinesiophobia), pain catastrophization (Pain Catastrophizing Scale), and pain sensitization (Central Sensitization Inventory). A Student’s t-test was used to assess the “washout” period. A repeated measure analysis of variance (ANOVA) was used to evaluate within-subjects’ differences for all outcome measures in the different assessment periods and a pairwise analysis was used to compare between the different assessment points. Statistical significance was set at p < 0.05. Results: 70% of participants completed the treatment. No significant changes were found after “washout” period except for TPDT (p = 0.02) and SPADI (p = 0.025). Improvements in self-reported shoulder pain (p = 0.028) and active shoulder flexion (p = 0.016) were shown after treatment (p = 0.028) and follow-up (p = 0.001) and in SPADI at follow-up (p = 0.008). No significant changes were observed in TPDT, LRJT, fear-avoidance, pain catastrophization, and pain sensitization. Conclusions: a CNS-focused treatment program might be a suitable approach to improve pain and disability in FS, but further research is needed to draw firm conclusions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Central Nervous System Focused Treatment Program for People with Frozen Shoulder: A Feasibility Study

Horno

Dueñas

Lluch

et al. 2022

IJERPH

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“…Further study is clearly warranted to determine if endogenous pain inhibitory systems are indeed involved in manual therapeutic interventions around the shoulder. However, for patients with FS who are in their first high irritability stage, the use of passive mobilization or capsular stretching can be counterproductive and can even increase the inflammatory response 105 . However, a study comparing a combination of manual mobilisations and shoulder exercises to a glucocorticoid injection found that the physiotherapeutic combination probably results in less improvement in the short term but a similar number of adverse events 106 , although no clinically important differences were noted at 6 or 12 months.…”

Section: [H2] Non-operative Managementmentioning

confidence: 99%

Frozen shoulder

Millar

Meakins

Struyf

et al. 2022

Nat Rev Dis Primers

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Frozen shoulder is a common debilitating disorder characterized by shoulder pain and progressive loss of shoulder movement. Frozen shoulder is frequently associated with other systemic conditions or occurs following periods of immobilization, and has a protracted clinical course, which can be frustrating for patients as well as health care professionals. FS is characterised by fibroproliferative tissue fibrosis, whereby fibroblasts, producing predominantly type I and type III collagen, transform into myofibroblasts (a smooth muscle phenotype), which are accompanied by inflammation, neoangiogenesis and neoinnervation, resulting in shoulder capsular fibrotic contractures and the associated clinical stiffness.Diagnosis is heavily based on physical examination and can be difficult depending on the stage of disease or if concomitant shoulder pathology is present. Management consists of physiotherapy, therapeutic modalities such as steroid injections, anti-inflammatory medications, hydrodilation and surgical interventions; however, their effectiveness remains unclear. Facilitating translational science should aid in development of novel therapies to improve outcomes among individuals with this debilitating condition.

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“…Many pharmacological and non-pharmacological approaches are used for the treatment of this condition, including oral medications, physical therapy modalities and therapeutic exercises. 13,14 Among pharmacological treatments, corticosteroid injection is commonly administered to people with painful shoulder for reducing inflammation, pain and improving overall functioning of upper limbs. These effects seem to speed up the start of therapeutic exercise for reaching a faster functional recovery.…”

Section: What Are the Impli C Ati On S Of The Co Chr Ane E Viden Ce F...mentioning

confidence: 99%

“…Several diseases, particularly rotator cuff disease and adhesive capsulitis, are diagnosed in patients who complain of shoulder pain, range of motion impairment, and functional limitation, resulting in poor QoL. Many pharmacological and non‐pharmacological approaches are used for the treatment of this condition, including oral medications, physical therapy modalities and therapeutic exercises 13,14 . Among pharmacological treatments, corticosteroid injection is commonly administered to people with painful shoulder for reducing inflammation, pain and improving overall functioning of upper limbs.…”

Section: What Are the Implications Of The Cochrane Evidence For Pract...mentioning

confidence: 99%

Is image‐guided glucocorticoid injection better than blind injection for shoulder pain? A Cochrane Review summary with commentary

Iolascon

Paoletta

2022

Int J of Rheum Dis

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An overview of effective and potential new conservative interventions in patients with frozen shoulder

Cited by 18 publications

References 104 publications

A Central Nervous System Focused Treatment Program for People with Frozen Shoulder: A Feasibility Study

A Central Nervous System Focused Treatment Program for People with Frozen Shoulder: A Feasibility Study

Frozen shoulder

Is image‐guided glucocorticoid injection better than blind injection for shoulder pain? A Cochrane Review summary with commentary

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