Frozen Shoulder - Supervised Exercise Therapy Found Most Effective

While frozen shoulder often proves debilitating, 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.2 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.3,4 Fortunately, systematic reviews and meta-analyses show us that better patient protection and faster relief are available through conservative treatment.5-7.

In frozen shoulder/adhesive capsulitis, 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.8 There is limited evidence and no consensus on the single best treatment for frozen shoulder.6,7 Studies have demonstrated the effectiveness of various approaches including physiotherapy techniques and modalities, stretching plus corticosteroid injections, extra corporeal shock wave, strengthening, mobilisation, ultrasound, acupuncture, etc. But what is most effective? To answer this question, researchers from the University of Antwerp structured the latest systematic review and meta-analysis on frozen shoulder. The Archives of Physical Medicine and Rehabilitation published their results in May.

With 33 studies meeting their inclusion criteria, Mertens et al. conclude that the most effective conservative treatment for frozen shoulder is supervised exercise therapy. Supervised exercise therapy tended to be more effective than home exercise. While modalities can be independently effective, adding modalities did not significantly improve the results of supervised exercise therapy. Several treatment programs are shown to be effective, but stand-alone, supervised exercise therapy proves to be the most effective.

References

1. Walker‐Bone K, Palmer KT, Reading I, Coggon D, Cooper C. Prevalence and impact of musculoskeletal disorders of the upper limb in the general population. Arthritis Care & Research. 2004 Aug 15;51(4):642- 51.

2. 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.

3. 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.

4. 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.

5. Mertens MG, Meert L, Struyf F, Schwank A, Meeus M. Exercise therapy is effective for improvement in range of motion, function, and pain in patients with frozen shoulder: A systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation. 2022 May 1;103(5):998-1012.

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).

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