Clinical Orthopaedics and Related Research®

, Volume 470, Issue 4, pp 1133–1143 | Cite as

The Natural History of Idiopathic Frozen Shoulder: A 2- to 27-year Followup Study

  • Heidi Vastamäki
  • Jyrki Kettunen
  • Martti Vastamäki
Clinical Research

Abstract

Background

The natural history of spontaneous idiopathic frozen shoulder is controversial. Many studies claim that complete resolution is not inevitable. Based on the 40-year clinical experience of the senior author, we believed most patients with idiopathic frozen shoulder might have a higher rate of resolution than earlier thought.

Questions/purposes

We determined the length of symptoms, whether spontaneous frozen shoulder recovered without any treatment, and whether restored ROM, pain relief, and function persisted over the long term.

Methods

We retrospectively reviewed 83 patients treated for frozen shoulder (84 shoulders; 56 women) 2 to 27 years (mean, 9 years) after initial consultation. The mean age at onset of symptoms was 53 years. Fifty-one of the 83 patients (52 shoulders) were treated with observation or benign neglect only (untreated group), and 32 had received some kind of nonoperative treatment before the first consultation with the senior author (nonoperative group). We also evaluated all 20 patients (22 shoulders; 13 women) with spontaneous frozen shoulder who underwent manipulation under anesthesia during the same time (manipulation group). The mean age of these patients was 49 years. The minimum followup was 2 years (mean, 14 years; range, 2–24 years). We determined duration of the disease, pain levels, ROM, and Constant-Murley scores.

Results

The duration of the disease averaged 15 months (range, 4–36 months) in the untreated group, and 20 months (range, 6–60 months) in the nonoperative group. At last followup the ROM had improved to the contralateral level in 94% in the untreated group, in 91% in the nonoperative group, and in 91% in the manipulation group. Fifty-one percent of patients in the untreated group, 44% in the nonoperative group, and 30% in the manipulation group were totally pain free at rest, during the night, and with exertion. Pain at rest was less than 3 on the VAS in 94% of patients in the untreated group, 91% in the nonoperative group, and 90% of the manipulation group. The Constant-Murley scores averaged 83 (86%) in the untreated group, 81 (77%) in the nonoperative group, and 82 (71%) in the manipulation group, reaching the normal age- and gender-related Constant-Murley score.

Conclusions

We found 94% of patients with spontaneous frozen shoulder recovered to normal levels of function and motion without treatment.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

References

  1. 1.
    Binder AI, Bulgen DY, Hazleman BL, Roberts S. Frozen shoulder: a long-term prospective study. Ann Rheum Dis. 1984;43:361–364.PubMedCrossRefGoogle Scholar
  2. 2.
    Bulgen DY, Binder AI, Hazleman BL, Dutton J, Roberts S. Frozen shoulder: prospective clinical study with an evaluation of three treatment regimens. Ann Rheum Dis. 1984;43:353–360.PubMedCrossRefGoogle Scholar
  3. 3.
    Codman RA. The Shoulder. Boston, MA: Thomas Todd Co; 1934:216–224.Google Scholar
  4. 4.
    Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;214:160–164.PubMedGoogle Scholar
  5. 5.
    Diercks RL, Stevens M. Gentle thawing of the frozen shoulder: a prospective study of supervised neglect versus intensive physical therapy in seventy-seven patients with frozen shoulder syndrome followed up for two years. J Shoulder Elbow Surg. 2004;13:499–502.PubMedCrossRefGoogle Scholar
  6. 6.
    Dudkiewicz I, Oran A, Salal M, Palti R, Pritsch M. Idiopathic adhesive capsulitis: long-term results of conservative treatment. Israel Med Assoc J. 2004;6:524–526.Google Scholar
  7. 7.
    Griggs SM, Ahn A, Green A. Idiopathic adhesive capsulitis: a prospective functional outcome study of nonoperative treatment. J Bone Joint Surg Am. 2000;82:1398–1407.PubMedGoogle Scholar
  8. 8.
    Hand C, Clipsham K, Rees JL, Carr AJ. Long-term outcome of frozen shoulder. J Shoulder Elbow Surg. 2008;17:231–236.PubMedCrossRefGoogle Scholar
  9. 9.
    Hirschmann MT, Wind B, Amsler F, Gross T. Reliability of shoulder abduction strength measure for the Constant-Murley score. Clin Orthop Relat Res. 2010;468:1565–1571.PubMedCrossRefGoogle Scholar
  10. 10.
    Hsu JE, Anakwenze OA, Warrender WJ, Abboud JA. Current review of adhesive capsulitis. J Shoulder Elbow Surg. 2011;20:502–514.PubMedCrossRefGoogle Scholar
  11. 11.
    Katolik LI, Romeo AA, Cole BJ, Verma NN, Hayden JK, Bach BR. Normalization of the Constant score. J Shoulder Elbow Surg. 2005;14:279–285.PubMedCrossRefGoogle Scholar
  12. 12.
    Levine WN, Kashyap CP, Bak SF, Ahmad CS, Blaine TA, Bigliani LU. Nonoperative management of idiopathic adhesive capsulitis. J Shoulder Elbow Surg. 2007;16:569–573.PubMedCrossRefGoogle Scholar
  13. 13.
    Melzer C, Wallny T, Wirth CJ, Hoffmann S. Frozen shoulder: treatment and results. Arch Orthop Trauma Surg. 1995;114:87–91.PubMedCrossRefGoogle Scholar
  14. 14.
    Meulengracht E, Schwartz M. The course and prognosis of periarthritis humeroscapularis with special regard to cases with general symptoms. Acta Med Scand. 1952;118:350–360.Google Scholar
  15. 15.
    Miller M, Wirth M, Rockwood C Jr. Thawing the frozen shoulder: the “patient” patient. Orthopedics. 1996;19:849–853.PubMedGoogle Scholar
  16. 16.
    Othman A, Taylor G. Is the Constant scale reliable in assessing patients with frozen shoulder? 60 shoulders scored 3 years after manipulation under anaesthesia. Acta Orthop Scand. 2004;75:114–116.PubMedCrossRefGoogle Scholar
  17. 17.
    Reeves B. The natural history of the frozen shoulder syndrome. Scand J Rheum. 1975;4:193–196.PubMedCrossRefGoogle Scholar
  18. 18.
    Shaffer B, Tibone J, Kerlan R. Frozen shoulder: a long-term follow-up. J Bone Joint Surg Am. 1992;74:738–746.PubMedGoogle Scholar
  19. 19.
    Simmonds FA. Shoulder pain: with particular reference to the “frozen” shoulder. J Bone Joint Surg Br. 1949;31:426–432.Google Scholar
  20. 20.
    Simple Shoulder Test. Available at: www.orthop.washington.edu/…/OurServices/ShoulderElbow/Articles/SimpleShoulderTest.aspx. Accessed October 18, 2011.

Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  • Heidi Vastamäki
    • 1
  • Jyrki Kettunen
    • 2
  • Martti Vastamäki
    • 3
  1. 1.ORTON Research Institute, Invalid FoundationHelsinkiFinland
  2. 2.Arcada University of Applied SciencesHelsinkiFinland
  3. 3.Department of Hand and Shoulder SurgeryORTON Orthopaedic HospitalHelsinkiFinland

Personalised recommendations