‘Frozen shoulder’ is ill-defined. How can it be described better?

Abstract

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

Prediction of Shoulder Stiffness After Arthroscopic Rotator Cuff Repair

“…3 POSS was recorded as an AE of the deep soft tissue event group when accompanied by restricted passive ROM with or without pain experienced for more than 12 weeks exceeding normal postoperative pain or stiffness and thus labeled by the operating surgeons either as capsulitis, frozen shoulder, or adverse shoulder stiffness. 1 Involved surgeons reported that their decision for treatment of POSS was mainly driven by severe shoulder pain at rest, notably at night, associated with passive motion limitation in abduction or flexion, and external rotation with the elbow at the body side. Additional treatments for POSS, including pain medication, physical therapy, corticoid infiltration, or a new surgical intervention (capsule release) were documented, and the severity of each POSS event was categorized according to an adapted version of the Clavien-Dindo classification, 18 which ranges from grade 1 (event not requiring pharmacological treatment or surgical, endoscopic, and radiological intervention) to grade 5 (event leading to death).…”

Depression and Anxiety Are Associated With Worse Subjective and Functional Baseline Scores in Patients With Frozen Shoulder Contracture Syndrome: A Systematic Review

“…Recovery from FSCS remains controversial in the literature. FSCS is sometimes reported as self-limiting pathology, or that need of care 10 , 11 and the time for symptoms resolution ranged from few months to two years. 10 , 12 , 13 Moreover, although some patients report complete symptom resolution, others report residual range of motion impairments and pain.…”

“…FSCS is sometimes reported as self-limiting pathology, or that need of care 10 , 11 and the time for symptoms resolution ranged from few months to two years. 10 , 12 , 13 Moreover, although some patients report complete symptom resolution, others report residual range of motion impairments and pain. 10 , 14 Despite reports of a three-phased evolution of the disease (freezing, frozen, and thawing), there exists no strong evidence supporting this kind of subclassification 10 in terms of prognostic or diagnostic value.…”

Electroacupuncture for the treatment of frozen shoulder: A systematic review and meta-analysis

“…In the multifactorial disease frozen shoulder (FS), patients often have shoulder pain with limited active and passive mobility of the shoulder ( 1 ). The prevalence of frozen shoulder ranges from 2 to 5%, and most cases occur between the ages of 40 and 65 years ( 2 , 3 ).…”