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Frozen shoulder bombshell: it ain’t self-limiting

 •  • by Paul Ingraham

Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of PainScience.com: a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

Everyone who knows anything about frozen shoulder knows that it goes through three phases, even without treatment — a painful phase, a stiff phase, and recovery/thawing phase. And then you’re good. It’s “self-limiting.” Right? This is in all the textbooks! Dr. Christopher Kevin Wong found convincing evidence that it’s all wrong:

It turns out … not so much. In fact, while no evidence supported the natural history theory, evidence from multiple randomized control trials with longitudinal data directly contradict the theory of a recovery phase that leads to complete resolution for frozen shoulder. That the findings so starkly contradict the accepted view of frozen shoulder, as reflected by clinical reviews, research article introductions, textbooks, and reputable health websites has prompted reflection on how such an assumption made it into the medical knowledge base.

In other words, how the #%!*& did this happen? Basically it was a mistake that just got repeated until it was entrenched. Once it’s in a few textbooks, it’s game over for the truth.

So frozen shoulder probably does not consistently “thaw.” This is a bombshell, and a credible one, and bad news. I’ve always thought frozen shoulder is an interesting mess of a topic. It just got even more interesting and messy.

And how long will it be until most physiotherapists know about this? Start your timers. Bet it takes 20 years.

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