C K Wong1, W N Levine2, K Deo3, R S Kesting3, E A Mercer3, G A Schram3, B L Strang3. 1. Department of Rehabilitation & Regenerative Medicine, Columbia University Medical Center, New York, NY, USA. Electronic address: ckw7@cumc.columbia.edu. 2. New York Presbyterian-Columbia University Medical Center, New York, NY, USA. 3. Columbia University Program in Physical Therapy, New York, NY, USA.
Abstract
BACKGROUND: In 1940s, it was proposed that frozen shoulder progresses through a self-limiting natural history of painful, stiff and recovery phases, leading to full recovery without treatment. However, clinical evidence of persistent limitations lasting for years contradicts this assumption. OBJECTIVES: To assess evidence for the natural history theory of frozen shoulder by examining: (1) progression through recovery phases, and (2) full resolution without treatment. DATA SOURCES: MEDLINE, PubMed, EBSCO CINAHL and PEDro database searches augmented by hand searching. STUDY SELECTION: Cohort or randomised controlled trials with no-treatment comparison groups including adults with frozen shoulder who received no treatment and reporting range of motion, pain or function for ≥6 months. DATA EXTRACTION: Reviewers assessed study eligibility and quality, and extracted data before reaching consensus. Limited early range-of-motion improvements and greater late improvements defined progression through recovery phases. Restoration of normal range of motion and previous function defined full resolution. RESULTS: Of 508 citations, 13 articles were reviewed and seven were included in this review. Low-quality evidence suggested that no treatment yielded some, but not complete, improvement in range of motion after 1 to 4 years of follow-up. No evidence supported the theory of progression through recovery phases to full resolution without treatment. On the contrary, moderate-quality evidence from three randomised controlled trials with longitudinal data demonstrated that most improvement occurred early, not late. LIMITATIONS: Low-quality evidence revealed the weakness of longstanding assumptions about frozen shoulder. CONCLUSION: Contradictory evidence and a lack of supporting evidence shows that the theory of recovery phases leading to complete resolution without treatment for frozen shoulder is unfounded.
BACKGROUND: In 1940s, it was proposed that frozen shoulder progresses through a self-limiting natural history of painful, stiff and recovery phases, leading to full recovery without treatment. However, clinical evidence of persistent limitations lasting for years contradicts this assumption. OBJECTIVES: To assess evidence for the natural history theory of frozen shoulder by examining: (1) progression through recovery phases, and (2) full resolution without treatment. DATA SOURCES: MEDLINE, PubMed, EBSCO CINAHL and PEDro database searches augmented by hand searching. STUDY SELECTION: Cohort or randomised controlled trials with no-treatment comparison groups including adults with frozen shoulder who received no treatment and reporting range of motion, pain or function for ≥6 months. DATA EXTRACTION: Reviewers assessed study eligibility and quality, and extracted data before reaching consensus. Limited early range-of-motion improvements and greater late improvements defined progression through recovery phases. Restoration of normal range of motion and previous function defined full resolution. RESULTS: Of 508 citations, 13 articles were reviewed and seven were included in this review. Low-quality evidence suggested that no treatment yielded some, but not complete, improvement in range of motion after 1 to 4 years of follow-up. No evidence supported the theory of progression through recovery phases to full resolution without treatment. On the contrary, moderate-quality evidence from three randomised controlled trials with longitudinal data demonstrated that most improvement occurred early, not late. LIMITATIONS: Low-quality evidence revealed the weakness of longstanding assumptions about frozen shoulder. CONCLUSION: Contradictory evidence and a lack of supporting evidence shows that the theory of recovery phases leading to complete resolution without treatment for frozen shoulder is unfounded.
Authors: Michel Gcam Mertens; Mira Meeus; Olivier Verborgt; Eric H M Vermeulen; Ruud Schuitemaker; Karin M C Hekman; Donald H van der Burg; Filip Struyf Journal: Rheumatol Int Date: 2021-09-06 Impact factor: 2.631
Authors: Christopher Kevin Wong; Bryanna L Strang; Galen A Schram; Elizabeth A Mercer; Rebecca S Kesting; Kabi S Deo Journal: J Man Manip Ther Date: 2018-03-26
Authors: Riki Patel; Ivan Urits; John Wolf; Anu Murthy; Elyse M Cornett; Mark R Jones; Anh L Ngo; Laxmaiah Manchikanti; Alan D Kaye; Omar Viswanath Journal: Psychopharmacol Bull Date: 2020-10-15
Authors: Anna Jungwirth-Weinberger; Christian Gerber; Glenn Boyce; Thorsten Jentzsch; Simon Roner; Dominik C Meyer Journal: Orthop J Sports Med Date: 2018-02-06
Authors: Milos Lesevic; John T Awowale; Thomas E Moran; David R Diduch; Stephen F Brockmeier; Brian C Werner Journal: Orthop J Sports Med Date: 2021-07-13