Long-term outcome of frozen shoulder

Campbell Hand,
Kim Clipsham,
Jonathan L. Rees,
Andrew J. Carr

Oxford, United Kingdom

J Shoulder Elbow Surg. 2008 Mar-Apr;17(2):231-6. Epub 2007 Nov 12.

Two-hundred and sixty-nine shoulders in 223 patients with a diagnosis of primary frozen shoulder were studied. The main outcome measure was the Oxford shoulder score. The mean follow-up from symptom onset was 4.4 years (range, 2-20 years). The mean age at symptom onset was 53.4 years; with women affected more commonly than men (1.6:1.0).Twenty percent of patients reported bilateral symptoms, but there were no recurrent cases. In the long term, 59% of patients had normal or near normal shoulders and 41% reported some ongoing symptoms. The majority of these persistent symptoms were mild (94%), with pain being the most common complaint. Only 6% had severe symptoms with pain and functional loss.Those with the most severe symptoms at condition onset had the worst long-term prognosis, P <.001. (J Shoulder Elbow Surg 2008;17:231-236.)

Primary frozen shoulder is a common, severely debilitating condition that is frequently difficult to manage. Its prevalence is reported as 2-5%.4,10,20 The diagnosis of frozen shoulder is made on clinical grounds utilizing a set of criteria described by Codman.15 Shoulder stiffness may also occur after fracture or in association with joint diseases, such as osteoarthritis; this is commonly referred to as a secondary frozen shoulder.

There are few studies on the outcome of frozen shoulder, and these reports often involve small numbers of patients (range, 21-62 patients).1,17,18,28,34,37 Interpretation is difficult if patients studied are in the nontreatment arm of a clinical study. Our understanding of the natural history of the condition is, therefore, based on limited information. This evidence suggests that this is a condition that affects more women than men; is most common in the 40–60-year-old age group; is characterized by pain and stiffness in the shoulder passing through three phases: pain, stiffness, and resolution; and invariably leads to full functional recovery.1,17,28,34,37

Frozen shoulder has been reported to be associated with a number of conditions: Dupuytren’s disease, 8,23,38 thyroid disease,2,44 Parkinson’s disease,35 osteoporosis and osteopaenia,26,30 cardiorespiratory disease,3,42 stroke,22 hyperlipidaemia,9 ACTH deficiency, 13 upper limb minor trauma,39 cardiac33,40 and neuro-surgery,5 and diabetes, where the condition is often longer lastingandmoredifficult totreat.4,24,27,32. A genetic basis has also been suggested.19

The pathology of frozen shoulder remains unclear; however, there is evidence to suggest that there is an initial inflammatory process7,29,36,41,43 leading to fibrosis.8,20,25,29

The aims of this study are to describe the medium and long-term outcome of primary frozen shoulder using a validated patient based questionnaire in a large clinic-based population of patients, and to identify any prognostic factors.