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Frozen shoulder, a common and debilitating shoulder complaint, has been the subject of uncertainty within the scientific literature and clinical practice. We performed an electronic PubMed search on all (1559) articles mentioning ‘frozen shoulder’ or ‘adhesive capsulitis’ to understand and qualify the range of naming, classification and natural history of the disease. We identified and reviewed six key thought leadership papers published in the past 10 years and all (24) systematic reviews published on frozen shoulder or adhesive capsulitis in the past five years. This revealed that, while key thought leaders such as the ISAKOS Upper Extremity Council are unequivocal that ‘adhesive capsulitis’ is an inappropriate term, the long-term and short-term trends showed the literature (63% of systematic reviews assessed) preferred ‘adhesive capsulitis’. The literature was divided as to whether or not to classify the complaint as primary only (9 of 24) or primary and secondary (9 of 24); six did not touch on classification. Furthermore, despite a systematic review in 2016 showing no evidence to support a three-phase self-limiting progression of frozen shoulder, 11 of 12 (92%) systematic reviews that mentioned phasing described a three-phase progression. Eight (33%) described it as ‘self-limiting’, three (13%) described it as self-limiting in ‘nearly all’ or ‘most’ cases, and six (25%) stated that it was not self-limiting; seven (29%) did not touch on disease resolution. We call for a data and patient-oriented approach to the classification and description of the natural history of the disease, and recommend authors and clinicians (1) use the term ‘frozen shoulder’ over ‘adhesive capsulitis’, (2) use an updated definition of the disease which recognizes the often severe pain suffered, and (3) avoid the confusing and potentially harmful repetition of the natural history of the disease as a three-phase, self-limiting condition. Cite this article: EFORT Open Rev 2020;5:273-279.DOI: 10.1302/2058-5241.5.190032

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Background: Several functional outcome scores have been proposed for the evaluation of shoulder instability. Most are multiple-item questionnaires, which can be time-consuming and difficult for patients to understand, as well as leading to lack of compliance. The Single Assessment Numeric Evaluation (SANE) score is a single question that has recently gained widespread acceptance based on its simplicity and correlation with more complex scoring systems. The purpose of this study was to assess the correlation of a new modified version of the SANE score, the SANE-instability score, with the Rowe score after treatment for shoulder instability. Materials and methods: We prospectively evaluated a consecutive series of 253 patients (268 shoulders) treated surgically or nonoperatively for shoulder instability between November 2017 and November 2019, for whom the Rowe and SANE-instability scores were collected before treatment and/or after treatment. The SANE-instability score was assessed with the following question: ''What is the overall percent value of your shoulder if a completely stable shoulder represents 100%?'' Correlations were tested using the Pearson coefficient (r) and interpreted as very high (r ¼ 0.90-1.00), high (r ¼ 0.70-0.89), moderate (r ¼ 0.50-0.69), low (r ¼ 0.30-0.49), or negligible (r ¼ 0.00-0.29). Subgroup analyses were also performed to observe correlation variations according to follow-up length (before treatment and at 6, 12, 26, 52, and 104 weeks after treatment), patient age (<20, 20-29, 30-39, or !40 years), and type of treatment (nonoperative or surgical). Results: The overall correlation between the SANE-instability and Rowe scores was high (r ¼ 0.85, P < .001). Subgroup analyses revealed that the correlation between the 2 scores was high before treatment (r ¼ 0.74); moderate at 6 and 12 weeks after treatment (r ¼ 0.66 and r ¼ 0.57, respectively); and then high at 26, 52, and 104 weeks after treatment (r ¼ 0.75, r ¼ 0.75, and r ¼ 0.78, respectively) (P < .001). The correlation was high across all types of treatment (r ¼ 0.76-0.85), high for patients aged ! 20 years (r ¼ 0.80-0.86), and very high for patients aged < 20 years (r ¼ 0.93) (P < .001). Conclusion:This study demonstrated a significant correlation between the SANE-instability and Rowe scores before and after treatment, as well as across all patient age groups and treatments. Owing to its high simplicity, the SANE-instability score could be used as an alternative to the Rowe score for patient follow-up at various time points.Institutional review board approval was obtained from the Association des Medicins du Canton de Geneve et Societe Medicale (no. 12-26).

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