Gentle thawing of the frozen shoulder: A prospective study of supervised neglect versus intensive physical therapy in seventy-seven patients with frozen shoulder syndrome followed up for two years

Diercks, Ron L.; Stevens, Martin

doi:10.1016/j.jse.2004.03.002

Cited by 277 publications

(211 citation statements)

References 21 publications

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“…These exercises primarily influence different regions of the synovial/CLC and have been used in supervised physical therapy programs and an HEP in patients with frozen shoulder. 20,28,39,55,104 Aggressive stretching beyond the pain threshold resulted in inferior outcomes in patients with frozen shoulder, particularly if performed in the early phase of the condition. 28 As the synovitis/angiogenesis and pain reduce, the fibrotic connective tissue wall is reached (stage 3).…”

Section: Level 5 J Orthop Sportsmentioning

confidence: 99%

“…20,28,39,55,104 Aggressive stretching beyond the pain threshold resulted in inferior outcomes in patients with frozen shoulder, particularly if performed in the early phase of the condition. 28 As the synovitis/angiogenesis and pain reduce, the fibrotic connective tissue wall is reached (stage 3). Tissue stress is progressed primarily by increasing stretch frequency and duration, while keeping the intensity in tolerable limits.…”

Section: Level 5 J Orthop Sportsmentioning

confidence: 99%

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Frozen Shoulder: Evidence and a Proposed Model Guiding Rehabilitation

Kelley¹,

McClure²,

Leggin³

2009

J Orthop Sports Phys Ther

207

171

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Frozen shoulder, or adhesive capsulitis, describes the common shoulder condition characterized by painful and limited active and passive range of motion (ROM). Frozen shoulder is reported to affect 2% to 5% of the general population, 4,13,64,88 increasing to 10% to 38% in patients with diabetes and thyroid disease. 4,5,13,64,71,88 Individuals with primary frozen shoulder are commonly between 40 and 65 years old, 79,82,83 and the incidence appears higher in females than males. 4,9,43,64,71,109 The occurrence of frozen shoulder in 1 shoulder increases the risk of contralateral shoulder involvement by 5% to history, clinical presentation, and recovery. Codman 22 described frozen shoulder as "a condition difficult to define, difficult to treat, and difficult to explain from the point of view of pathology." Nevaiser 80 introduced the term adhesive capsulitis to describe the inflamed and fibrotic condition of the capsuloligamentous tissue. The term frozen shoulder will be used, because it encompasses both primary frozen shoulder (adhesive capsulitis) and secondary frozen shoulder related to systemic disease and extrinsic or intrinsic factors, excluding cerebral vascular accident, proximal humeral fracture, and causative rotator cuff or labral pathology. This paper will present an overview of the classification, etiology, pathology, examination, and plan of care for frozen shoulder.T he absence of standardized nomenclature for frozen shoulder causes confusion in the literature. Lundberg 64 first described a classification system identifying primary frozen shoulder as idiopathic and secondary frozen shoulder as posttraumatic. Nash and Hazelman 77 expanded the classification system by including diseases such as diabetes mellitus, myocardial infarction, or various neurologic disorders under secondary frozen shoulder. Zuckerman 128 proposed a classification schema where primary 34%, and simultaneous bilateral shoulder involvement occurs as often as 14% of the time. 16,39,64,107 To date, the etiology of frozen shoulder remains unclear; however, patients typically demonstrate a characteristic Frozen shoulder or adhesive capsulitis describes the common shoulder condition characterized by painful and limited active and passive range of motion. The etiology of frozen shoulder remains unclear; however, patients typically demonstrate a characteristic history, clinical presentation, and recovery. A classification schema is described, in which primary frozen shoulder and idiopathic adhesive capsulitis are considered identical and not associated with a systemic condition or history of injury. Secondary frozen shoulder is defined by 3 subcategories: systemic, extrinsic, and intrinsic. We also propose another classification system based on the patient's irritability level (low, moderate, and high), that we believe is helpful when making clinical decisions regarding rehabilitation intervention. Nonoperative interventions include patient education, modalities, stretching exercises, joint mobilization, and corticosteroid injections. Gle...

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Section: Level 5 J Orthop Sportsmentioning

confidence: 99%

Section: Level 5 J Orthop Sportsmentioning

confidence: 99%

Frozen Shoulder: Evidence and a Proposed Model Guiding Rehabilitation

Kelley¹,

McClure²,

Leggin³

2009

J Orthop Sports Phys Ther

207

171

View full text Add to dashboard Cite

show abstract

“…However, the natural course of a frozen shoulder is obscure owing to scanty literature [2,5,17]. Codman stated 77 years ago, ''even the most protracted cases recover with or without treatment in about two years'' [3].…”

Section: Introductionmentioning

confidence: 99%

The Natural History of Idiopathic Frozen Shoulder: A 2- to 27-year Followup Study

Vastamäki

Kettunen

Vastamäki

2012

Clinical Orthopaedics &Amp; Related Research

128

115

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Background The natural history of spontaneous idiopathic frozen shoulder is controversial. Many studies claim that complete resolution is not inevitable. Based on the 40-year clinical experience of the senior author, we believed most patients with idiopathic frozen shoulder might have a higher rate of resolution than earlier thought. Questions/purposes We determined the length of symptoms, whether spontaneous frozen shoulder recovered without any treatment, and whether restored ROM, pain relief, and function persisted over the long term. Methods We retrospectively reviewed 83 patients treated for frozen shoulder (84 shoulders; 56 women) 2 to 27 years (mean, 9 years) after initial consultation. The mean age at onset of symptoms was 53 years. Fifty-one of the 83 patients (52 shoulders) were treated with observation or benign neglect only (untreated group), and 32 had received some kind of nonoperative treatment before the first consultation with the senior author (nonoperative group). We also evaluated all 20 patients (22 shoulders; 13 women) with spontaneous frozen shoulder who underwent manipulation under anesthesia during the same time (manipulation group). The mean age of these patients was 49 years. The minimum followup was 2 years (mean, 14 years; range, 2-24 years). We determined duration of the disease, pain levels, ROM, and Constant-Murley scores. Results The duration of the disease averaged 15 months (range, 4-36 months) in the untreated group, and 20 months (range, 6-60 months) in the nonoperative group. At last followup the ROM had improved to the contralateral level in 94% in the untreated group, in 91% in the nonoperative group, and in 91% in the manipulation group. Fifty-one percent of patients in the untreated group, 44% in the nonoperative group, and 30% in the manipulation group were totally pain free at rest, during the night, and with exertion. Pain at rest was less than 3 on the VAS in 94% of patients in the untreated group, 91% in the nonoperative group, and 90% of the manipulation group. The Constant-Murley scores averaged 83 (86%) in the untreated group, 81 (77%) in the nonoperative group, and 82 (71%) in the manipulation group, reaching the normal age-and gender-related Constant-Murley score. Conclusions We found 94% of patients with spontaneous frozen shoulder recovered to normal levels of function and motion without treatment.

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“…Most orthopedists prescribe physical therapy as a mainstay of treatment, despite a lack of strong evidence to support its use [74]. Some studies demonstrate that physical therapy may be more helpful early in the disease process [67].…”

Section: Treatmentmentioning

confidence: 99%

“…Bulgen et al [68] and Carette et al [69] found no difference in objective shoulder scores following participation in a dedicated course of physical therapy using active range of motion and a variety of mobilization techniques over a period of six weeks to a year. Diercks et al [74] showed that gentle physical therapy, using passive mobilization and stretching, provided better outcomes than aggressive manipulation, such as supportive therapy and exercise with pain limits. Despite physical therapy and pharmacologic treatment, surgical intervention consisting of an arthroscopic capsular release is required in 10% of cases [75].…”

Section: Treatmentmentioning

confidence: 99%