Natural history of frozen shoulder: fact or fiction? A systematic review

updated Aug 7, 2019

Tags: etiology, counter-intuitive, pro

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Evidence from seven reviewed studies suggests that frozen shoulder does not resolve on its own without treatment, contrary to the entrenched conventional wisdom (which isn’t supported by any evidence). On the contrary, what the evidence supports is that frozen shoulder prognosis is highly unpredictable, and may resolve much sooner than average… or not at all.

original abstract†Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

BACKGROUND: In 1940s, it was proposed that frozen shoulder progresses through a self-limiting natural history of painful, stiff and recovery phases, leading to full recovery without treatment. However, clinical evidence of persistent limitations lasting for years contradicts this assumption.

OBJECTIVES: To assess evidence for the natural history theory of frozen shoulder by examining: (1) progression through recovery phases, and (2) full resolution without treatment.

DATA SOURCES: MEDLINE, PubMed, EBSCO CINAHL and PEDro database searches augmented by hand searching.

STUDY SELECTION: Cohort or randomised controlled trials with no-treatment comparison groups including adults with frozen shoulder who received no treatment and reporting range of motion, pain or function for ≥6 months.

DATA EXTRACTION: Reviewers assessed study eligibility and quality, and extracted data before reaching consensus. Limited early range-of-motion improvements and greater late improvements defined progression through recovery phases. Restoration of normal range of motion and previous function defined full resolution.

RESULTS: Of 508 citations, 13 articles were reviewed and seven were included in this review. Low-quality evidence suggested that no treatment yielded some, but not complete, improvement in range of motion after 1 to 4 years of follow-up. No evidence supported the theory of progression through recovery phases to full resolution without treatment. On the contrary, moderate-quality evidence from three randomised controlled trials with longitudinal data demonstrated that most improvement occurred early, not late.

LIMITATIONS: Low-quality evidence revealed the weakness of longstanding assumptions about frozen shoulder.

CONCLUSION: Contradictory evidence and a lack of supporting evidence shows that the theory of recovery phases leading to complete resolution without treatment for frozen shoulder is unfounded.

original abstract†Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

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