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Physiotherapy and drugs in frozen shoulder – what is really helping?

Authors: R.L. Diercks

References: SECEC 2005

Abstract
The natural history of idiopathic frozen shoulder syndrome is considered benign, but the long period of pain and disability has been the reason for many interventions. Mobilisations and stretching, intra-articular injections, manipulation under anaesthesia and surgical or arthroscopic release are performed with good results reported by authors. Studies have been performed with physiotherapy, special mobilisation techniques, manipulation under anaesthesia, intra-articular corticosteroids, Japanese herbal medicine, oral corticosteroids, and regional nerve blocks. The most astounding factor in all studies is that all have good outcomes, varying from 78% to 98%! Where, then, do all the patients come from that are treated surgically (open or arthroscopic) because of resistant frozen shoulder? And why are the results of these therapies also good? There are, aside from studies about the etiology, a number of confounding factors which make comparison of different studies difficult, if not impossible: The diagnosis and the definition of the “frozen shoulder syndrome”: is it primary idiopathic frozen shoulder, does diabetes play a role, is it post-surgical, post-trauma or coincident with impingement? The duration of disease before inclusion, before intervention, the timing of the intervention, and the factor “time” in the disease process. The scoring system used and the definition of “good” and “bad” results.

In this course, a straight forward classification of frozen shoulder will be given. All recent studies on non-surgical intervention in frozen shoulder will be analysed and compared with the “natural course of the disease”. The results of “supervised neglect” are comparable, or better, than most intervention studies. Is patience the best therapy for the important patient? Is a disease with a benign course, during more than 9 months, still acceptable in our modern industrial or social society?

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