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