Journal of Rehabilitation Medicine 51-8 | Page 3

J Rehabil Med 2019; 51: 539–556 REVIEW ARTICLE CLINICAL EFFECTIVENESS OF NON-SURGICAL INTERVENTIONS FOR PRIMARY FROZEN SHOULDER: A SYSTEMATIC REVIEW Catherine MINNS LOWE, PhD 1 , Eva BARRETT, PhD 2 , Karen MCCREESH, PhD 3 , Neasa DE BÚRCA, MSc 4 and Jeremy LEWIS, PhD 1,5 From the 1 University of Hertfordshire, Hatfield, Hertfordshire, UK, 2 National University of Ireland Galway, Galway, Ireland, 3 School of Allied Health and Health Research Institute, University of Limerick, Limerick, Ireland, 4 Galway University Hospital, Galway, Ireland and 5 Central London Community Healthcare NHS Trust, London, UK Objective: To update an existing systematic review of randomized clinical trials evaluating the clinical effectiveness of non-surgical management inter- ventions 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 regis- ters. Abstracts were independently screened by 2 re- viewers and discussed. Data extraction: Two reviewers evaluated eligibility. Data were extracted by one reviewer and checked by another. Two reviewers evaluated risk of bias. Meta- analyses were not appropriate. Narrative analyses were performed for trials evaluated as low risk of bias. Results: Thirty trials were included, with the majori- ty of studies evaluated as being at high risk of poten- tial 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 met- hods, 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. Key words: frozen shoulder; primary; idiopathic; non-surgical treatment; systematic review. Accepted Jun 5, 2019; Epub ahead of print Jun 24, 2019 J Rehabil Med 2019; 51: 539–556 Correspondence address: Jeremy Lewis, School of Health and Social Work, College Lane Campus, University of Hertfordshire, Hatfield AL10 9AB, UK. E-mail: [email protected] F rozen shoulder (FS) is associated with prolonged shoulder disability and is often characterized by se- vere pain, loss of movement and disrupted sleep (1). The main priority for people experiencing FS is to achieve pain-free freedom of movement as soon as possible, and they are concerned about delays in receiving care and receiving contradictory advice regarding treatment (1). Estimates of incidence of FS range from 0.75% to 5.0% LAY 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 dry- ing 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. Inappro- priate treatment may not resolve the symptoms, may be associated with unnecessary expense, and may even cause harm. We have updated a review of the av- ailable literature to synthesize the findings of the avai- lable research so that we can make recommendations for the best current treatment alternatives to help people with frozen shoulder and for future research. of the population (2, 3) and are higher in people with diabetes (10–46%) (4, 6). Uncertainty remains regarding the distribution of FS between men and women (2), and whether FS is more common in women or is evenly distributed (3). Uncertainty also remains regarding the time course of FS: reports include a mean of 15 months (7), 30 months (8), and 41% of people with symptoms at 52 months (9). One case series (n  =  62) suggested that 50% of people reported mild shoulder pain and stiffness and 60% restricted range of movement at a mean of 84 months (10). A definitive understanding of the pathogenesis of FS remains elusive (11). Inflammation, fibrosis and contraction of the glenohumeral joint capsule are suggested to explain the symptoms (12) and may be triggered by increased expression of cytokines and neuropeptides (11). However, capsular contraction may not be the only explanation; a small pilot study (n  =  5) by Hollmann et al. (13) reported that, when given a general anaesthetic, people presenting with FS exhibited increased range of movement in shoulder elevation (minimum increase 55°, maximum 110°), suggesting that muscle guarding may partly explain the movement restriction in a percentage of people with FS. FS appears to be most common in people aged in their 50s and 60s (14), and so may relate to This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977 doi: 10.2340/16501977-2578