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Frozen Shoulder The Latest Systematic Review

Affecting an estimated 2% to 5% of the general population, adhesive capsulitis (also known as frozen shoulder) ranks as the leading cause of pain at the shoulder joint among the middle-age and older.1

 In this debilitating condition, the capsule of the glenohumeral joint thickens and progressively contracts, causing pain and limited passive range of motion. Onset can be idiopathic (also referred to as primary) or triggered by any of a number of conditions (also referred to as secondary adhesive capsulitis). It has such a strong association with diabetes that some authors recommend screening patients with frozen shoulder for diabetes.2

Frozen shoulder can also be triggered by thyroid disease, hypoadrenalism, hypertriglyceridemia, cardiopulmonary dysfunctions, Parkinson’s, stroke, drugs, acromioclavicular arthritis, humeral fractures, or cervical spondylosis. The literature commonly refers to frozen shoulder as having a favourable prognosis with high spontaneous remission. However, a closer read reveals that spontaneous remission most commonly occurs between 18 and 36 months.3 Longer persistence has been documented in 40% of patients, with long-term disability in 15% of patients, and permanent functional loss in 7 - 15% of patients.4,5

The latest systematic review of conservative treatment in frozen shoulder, published last January, shows that better patient protection and faster relief is available by a number of approaches.6 The authors of the current review and a previous review write that there is no consensus on the single best treatment for frozen shoulder.7 A number of treatments have been shown to decrease pain, increase range of motion, and improve functional status - compared to controls.

The current review found 1,269 peerreviewed articles on frozen shoulder, but narrowed their references to 30 randomized controlled trials, two cohort studies, and one cross-sectional exploratory study. With that data, Piumi Nakandala and colleagues were able to make the following recommendations:

Individual Therapies Strongly Recommended for Frozen Shoulder:

• Physiotherapy techniques & modalities

• Stretching plus corticosteroid injections

• Extra corporeal shock wave therapy Treatments Shown Effective by Moderate Evidence:

• Conventional physiotherapy techniques

• Strengthening exercises

• Mobilisation

• Therapeutic ultrasound

• Proprioceptive neuromuscular facilitation

• Continuous passive motion

• Whole-body cryotherapy

• Specialized acupuncture

Each of these treatments were studied alone; the authors are not recommending them as a group. With a referral to Advanced Physiotherapy, you can give patients access to individualised programs of mobilisation, stretching, strengthening, home exercise plans, and patient education.


1. Hsu JE, Anakwenze OA, Warrender WJ, Abboud JA. Current review of adhesive capsulitis. Journal of Shoulder and Elbow Surgery. 2011 Apr 1;20(3):502-14.

2. St Angelo JM, Fabiano SE. Adhesive Capsulitis. In: StatPearls. StatPearls Publishing, Treasure Island (FL); 2020. PMID: 30422550.

3. Wong CK, Levine WN, Deo K, Kesting RS, Mercer EA, Schram GA, Strang BL. Natural history of frozen shoulder: fact or fiction? A systematic review. Physiotherapy. 2017 Mar 1;103(1):40-7.

4. Koh KH. Corticosteroid injection for adhesive capsulitis in primary care: a systematic review of randomised clinical trials. Singapore Medical Journal. 2016 Dec;57(12):646.

5. Hand C, Clipsham K, Rees JL, Carr AJ. Long-term outcome of frozen shoulder. Journal of Shoulder and Elbow Surgery. 2008 Mar 1;17(2):231-6.

6. Nakandala P, Nanayakkara I, Wadugodapitiya S, Gawarammana I. The efficacy of physiotherapy interventions in the treatment of adhesive capsulitis: A systematic review. Journal of Back and Musculoskeletal Rehabilitation. 2021 Jan 1;34(2):195-205.

7. Page MJ, Green S, Kramer S, Johnston RV, McBain B, Buchbinder R. Electrotherapy modalities for adhesive capsulitis (frozen shoulder). Cochrane Database of Systematic Reviews. 2014(10)

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