The Shoulder

J Bone Joint Surg [Am] 1992 Jun;74(5):738-746

Frozen shoulder. A long-term follow-up.

Shaffer B, Tibone JE, Kerlan RK

Kerlan-Jobe Orthopaedic Clinic, Inglewood, California 90301.

Sixty-two patients (sixty-eight shoulders) who had been treated non-operatively for idiopathic frozen shoulder were evaluated subjectively and objectively at two years and two months to eleven years and nine months of follow-up (average, seven years). Thirty-one (50 per cent) of these patients still had either mild pain or stiffness of the shoulder, or both. The range of motion averaged 161 degrees of forward flexion, 157 degrees of forward elevation, 149 degrees of abduction, 65 degrees of external rotation, and internal rotation to the level of the fifth thoracic spinous process. Thirty-seven (60 per cent) of the sixty-two patients still demonstrated some restriction of motion as compared with study-generated control values (calculated as the average motion, in each plane, for the thirty-seven unaffected shoulders of the patients who had unilateral disease)& #046; Ten patients had restriction of forward flexion; eight, of forward elevation; seventeen, of abduction; twenty-nine, of external rotation; and ten, of internal rotation. However, when the motion of each affected shoulder of thirty-seven patients who had unilateral involvement was compared with that of the unaffected contralateral shoulder, eleven (30 per cent) demonstrated some restriction. None of these patients had restriction of forward flexion; two had restriction of forward elevation; two, of abduction; seven, of external rotation; and seven, of internal rotation. The patients who had substantial restriction in three planes or more were thirteen times more likely to be men (p greater than 0.05). Marked restriction, when it was present, was most commonly in external rotation. Only seven patients (11 per cent) reported mild functional limit ation.

Ann Rheum Dis 1984 Jun;43(3):361-364

Frozen shoulder: a long-term prospective study.

Binder AI, Bulgen DY, Hazleman BL, Roberts S

As the natural history of frozen shoulder is poorly documented, a prospective study of 40 patients followed up for 40-48 months (mean 44 months) is described. The range of movement was significantly less than age- and sex-matched controls. Objective restriction was severe in five patients and mild in a further 11. Patients were often unaware that shoulder range was impaired. Dominant arm involvement, manual labour, and mobilisation physiotherapy were associated with a less satisfactory outcome. We conclude that, while objective restriction persists, there is little functional impairment in the late stage of frozen shoulder.

Scand J Rheumatol 1975;4(4):193-196

The natural history of the frozen shoulder syndrome.

Reeves B

A prospective study has been made of 49 patients with the frozen shoulder syndrome (as distinct from tendinitis, calcific deposits and frozen shoulders occurring after coronary infarction or with pulmonary tuberculosis) of whom forty-one have been followed up for 5-10 years, always to their greatest recovery. There were three consecutive stages: pain, stiffness, and recovery. The stiffness stage was usually related to the duration of the recovery stage. The total duration was longer than is generally supposed (an average total of 30.1 months in contrast to about 18 months as often postulated). Generally speaking, the longer the stiffness stage is, the longer is the recovery stage. In 4 patients the second shoulder became similarly affected, 6 months to 7 years after the first, and followed a similar chronological sequence to the first. After greatest recovery, slight restriction of movement was found in more than half the cases, but in only 3, all of long duration, was the restriction a handicap. Arthrography, carried out on both shoulders in all patients during the recovery stage, showed in the affected shoulder fewer rotator cuff defects than expected at this age and fewer (four) than in the contralateral one (twenty-three); seemingly, the condition leads to the obliteration of some defects.

J Orthop Sports Phys Ther 1996 Mar;23(3):216-22

Thawing the frozen shoulder: the "patient" patient.

Miller MD, Wirth MA, Rockwood CA Jr

Department of Orthopedics, US Air Force Academy Hospital, Colorado, USA.

Many different modalities have been advocated for the treatment of frozen shoulder (adhesive capsulitis), some of which can be associated with complications and morbidity. We retrospectively reviewed 50 patients with adhesive capsulitis treated by the senior author over a 10-year period. Treatment consisted of closely monitored home therapy using moist heat and antiinflammatory medication, and a physician-directed rehabilitation program. Without exception, every patient regained a significant amount of motion and returned to activities of daily living without pain.