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Physiotherapy. 2017 Mar;103(1):40-47. doi: 10.1016/j.physio.2016.05.009. Epub 2016 Jun 21.

Natural history of frozen shoulder: fact or fiction? A systematic review.

Author information

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.

KEYWORDS:

Adhesive capsulitis; Outcome; Prognosis; Range of motion; Recovery phase

PMID:
27641499
DOI:
10.1016/j.physio.2016.05.009
[Indexed for MEDLINE]

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