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

Abstract

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.

Idiopathic Unilateral Frozen Shoulder

“…Duration of the disease averaged 15 months in untreated group. 15 While this study showed the improvement in the restricted abduction ROM in a shorter period of time using a combination of Kaltenborn and ROM exercises.…”

Patient-reported measures of quality of life and functional capacity in adhesive capsulitis

“…They concluded that adhesive capsulitis worsened the diabetics' quality of life. 18 The course of this disease is prolonged, 14,19 greatly impairing sleep and the patients' everyday activities and, therefore, their physical, psychological and social QoL as reflected in the various WHOQOL-BREF domains before SSNB treatment. Baums et al used the SF-36 to examine the QoL of adhesive capsulitis patients before surgical release and found that the physical component was considerably affected.…”

Is there a short-term benefit from an intra-articular steroid injection in female patients with adhesive capsulitis of the shoulder treated with physiotherapy?

“…Vastamäki et al clearly showed that the length of symptoms and restriction of motion are shorter than originally described, and the focus of the present study was to specifically investigate the effect of a single corticosteroid injection in the symptomatic stage in patients with both pain and stiffness. 34 The inclusion of a placebo group would have been beneficial to investigate the effect of natural recovery and resolution of pain, but given the retrospective nature of the project, this was not possible. Finally, six experienced musculoskeletal physiotherapists assessed range of motion.…”