Strategies for conservative management of the frozen shoulder

다국어 초록 (Multilingual Abstract)

Frozen shoulder is characterized by severe restriction of both active and passive shoulder motions in the absence of an identifiable intrinsic shoulder disorder. A gradual and painful loss in glenohumeral motion results from progressive fibrosis and from contracture of the glenohumeral joint capsule. Effective treatment for frozen shoulder should address the underlying pathology. The first line of treatment of frozen shoulder is usually that of conservative measures and only when frozen shoulder persists more invasive procedures are opted for. Conservative interventions address both the pharmacological and the physical aspects of treatment. For example, synovitis and inflammatory mediators are pharmacologically managed and capsular contracture is treated through physical therapy. Common conservative interventions for the treatment of frozen shoulder are nonsteroidal anti-inflammatory drugs, corticosteroid injections, physiotherapy, manipulation under anesthesia, and hydrodilation. Major gaps in the literature and knowledge exist such as the paucity of randomized controlled trials, a lack of studies that differentiated patients by their stage of adhesive capsulitis, and an incomplete understanding of the disease’s natural course. Recognizing that progression of clinical stages reflects progression in the underlying pathological changes should guide development of treatments. The purpose of the present review is to evaluate the existing evidence regarding the effectiveness of conservative management for the treatment of primary frozen shoulder.