Range of motion at baseline predict patient reported outcome measures in frozen shoulder patients treated with injections and rehabilitation

Abstract

Frozen shoulder is a common shoulder concern with a prevalence of 2-5 per cent in the general population that affects the shoulder joint between the ages of 40 and 60, mostly in female subjects, manifesting in progressive loss of glenohumeral movements associated with intense pain. The pathological process consists of a fibroproliferative tissue fibrosis and an inflammation of the synovial membrane. Although the pathophysiology of this condition has been deeply studied, the mechanisms underpinning remain poorly understood. Frozen shoulder manifests clinically as shoulder pain with progressive restricted movement, both active and passive, in the absence of trauma, along with normal radiographic scans of the glenohumeral joint. It classically progresses through 3 overlapping stages of pain (stage 1, lasting 2-9 months), stiffness (stage 2, lasting 4-12 months) and recovery (stage 3, lasting 5-24 months); however, up to day seems that pain-predominant and stiff-predominant phases could be more usefull in treatment modality choice and managing. The medical management has not been defined with a wide spectrum of operative and nonoperative treatments available. The most widely used treatments are local steroid and/or anesthetic injections, stretching, active and passive mobilization, physiotherapy, hydrodistension, capsular release; hoverver, he goals of the treatment are pain management, shoulder function restoration and improvement in quality of life. Based on the best available evidence it appears that the use of corticosteroid injections plus physiotherapy has been associated with better outcomes above all in terms of early benefit in ER ROM with clinical significance as long as 6 weeks of treatments. Nevertheless, it remains unclear which parameters influence the prognosis of the pathology. So that, the aim of this study was to investigate whether a range of motion superior to 90 degree forward flexion in scapular plane, External Rotation (ER) at arm by side ( lower than 30 per cent, between 30 and 60 per cent, 90 per cent or more than contralateral side) and abduction ( lower than 30 per cent, between 30 and 60 per cent, 90 per cent or more than contralateral side) at baseline would predict best treatment outcome as measured by SPADI, NRS for Pain (night, at rest and in activity) and change in ROM in patients diagnosed with frozen shoulder