Clinical effectiveness of non-surgical interventions for primary frozen shoulder: A systematic review

Abstract

Frozen shoulder commonly affects people aged around 50 years and is associated with substantial levels of shoulder pain and stiffness that may last for many years. Many people with frozen shoulder report that simple activities, such as dressing, and washing or drying their hair, become almost impossible. The condition may adversely affect the ability to work and frequently causes severe interruptions to sleep. The reasons why up to 5% of the population develop frozen shoulder are unknown. Many treatments, often lacking sound research evidence, have been recommended. Inappropriate treatment may not resolve the symptoms, may be associated with unnecessary expense, and may even cause harm. We have updated a review of the available literature to synthesize the findings of the available research so that we can make recommendations for the best current treatment alternatives to help people with frozen shoulder and for future research. Objective: To update an existing systematic review of randomized clinical trials evaluating the clinical effectiveness of non-surgical management interventions for people with primary frozen shoulder in terms of pain, movement, self-reported function and disability, quality of life, recovery time, return to work and recreation, and adverse events. Data sources: Cochrane CENTRAL, SCI and MEDLINE, CENTRAL between 1 January 2010 and June 2017, plus reference lists of included trials and trial registers. Abstracts were independently screened by 2 reviewers and discussed. Data extraction: Two reviewers evaluated eligibility. Data were extracted by one reviewer and checked by another. Two reviewers evaluated risk of bias. Metaanalyses were not appropriate. Narrative analyses were performed for trials evaluated as low risk of bias. Results: Thirty trials were included, with the majority of studies evaluated as being at high risk of potential bias. Only 4 trials were evaluated as being at low risk of bias and this, plus the variety of participants included/excluded in trials and the variety of methods, interventions and outcomes used across the trials provided limited new evidence to inform the non-surgical management and treatment of people with frozen shoulder. Conclusion: Substantial evidence gaps remain for the non-surgical treatment of people with frozen shoulder.

The effectiveness of hydrodistension and physiotherapy following previously failed conservative management of frozen shoulder in a UK primary care centre

“…Substantial gaps in the evidence continue to remain for the nonsurgical treatment of patients with frozen shoulder (Lowe, Barrett, McCreesh, De Burca, & Lewis, 2019).…”

Joint mobilization for frozen shoulder

“…The common nonsurgical treatments include medication, physical therapy, exercise, manipulation under anesthesia, steroid injections, or nerve blocks, which can temporarily relieve symptoms, but have inaccurate results, are prone to recurrence, have drug side effects, and have long treatment intervals and poor patient compliance. [10,11] The Mulligan joint release procedure is a new manipulative technique created by Brain R Mulligan for joint Mulligan joint release is a new manipulative technique created by Brain R Mulligan for joint dysfunction, which can restore normal joint gliding and improve symptoms within a short treatment period. [12] Arthrodesis is highly valued by patients for its efficacy, ease of use, and excellent prognosis.…”

Long-Term Outcomes Following Manipulation Under Anaesthetic for Patients with Primary and Secondary Frozen Shoulder

“…11,12 In 1872 Duplay first described the use of manipulation under anaesthetic (MUA) to treat a condition then known as "péri-arthrite scapula-humérale" which has since gone on to be a first-line treatment after non-surgical management (analgesia, corticosteroid injections, exercise programmes and physiotherapy). [13][14][15][16] MUA for FS provides relief of symptoms and improvement in ROM. 9,11,[17][18][19][20][21] A recent multicentre trial (UKFROST) concluded that it was the most cost-effective treatment in comparison with physiotherapy or arthroscopic release when assessed at twelve months from treatment.…”