What is the most effective treatment for frozen shoulder?

Abstract

What is the most effective treatment for frozen shoulder? professor of orthopaedic surgery reader in orthopaedics senior research fellow

Idiopathic frozen shoulder

“…It is a general belief that frozen shoulder resolves spontaneously after 1-3 years, 9 although there is a paucity of long-term follow up data to support this. 10 symptoms, with 7-15% having some degree of permanent loss of movement. 6,11 On the basis of a study of patients with frozen shoulder with a mean follow-up of 4.4 years, only 59% of patients had normal or near-normal shoulders as defined by no or minimal symptoms.…”

“…Many studies show benefit either alone or in conjunction with physiotherapy and/or a home-based exercise program. 8,10,21,22 Glenohumeral joint injection performed in the early stages of frozen shoulder by the primary care physician, with the necessary skills and equipment, can provide significant improvement in passive range of movement. 8,23 Figure 1 identifies the anatomical landmarks required to ensure the injection is located within the glenohumeral joint.…”

“…Hydrodilatation has been shown to be effective when used alone or in combination with physiotherapy. 10,17 The author has found the addition of 5-10 mL of 0.5% bupivacaine, included within the maximum volume of 40 mL, to be effective in providing short-term pain relief and allowing for pain-free physiotherapy and exercises following this procedure. Prior to the procedure taking place, the usual medication administration safeguards must be adhered to including checking for allergies, medication contraindications, medication side effects and dosage recommendations.…”

The Effectiveness of Physiotherapy in Idiopathic or Primary Frozen Shoulder: a Systematic Review and Meta-Analysis

“…In this pathologic mechanism the capsule does not become adhered to the humerus, but the contracted capsule holds the humeral head tightly against the glenoid fossa, causing a progressive loss of the physiological movements (15). Based on this and on the absence of a significant correlation between joint space capacity and restricted ROM, some authors reported that tightness of capsule and soft tissues around bring to a proportional motion restriction, more in external rotation than internal rotation (38). Many authors divide the natural course of the disease in three stages (1)(2)(3)6,12,13,16,17): stage I (freezing or painful stage) of 3-9 months, characterized by pain and progressive reduction of function and joint mobility; stage II (frozen stage) of 4-12 months which may not lead to increased pain but to a strong limitation of movements and ROM particularly external rotation, frontal flexion and abduction; stage III (thawing stage) of 12-42 months characterized by a progressive rise and recovery of movements and ROM.…”

Tissue inflammation signatures point towards resolution in adhesive capsulitis

“…SIR, Frozen Shoulder is a remarkable example of a severe, yet self-limiting, inflammatory and fibrotic condition affecting the shoulder joint capsule. Patients experience pain and restricted shoulder joint motion for up to 3 years, severely limiting activities and disrupting quality of life [1]. The disease mechanisms are poorly understood and there are no truly effective therapies for symptomatic patients.…”