A Natural History of Frozen Shoulder

Natural History of frozen shoulder: fact or fiction? A systematic review
Wong CK et al. Physiotherapy: 2017

  • In the 1970s, Reeves suggested that recovery from frozen shoulder followed a natural history, progressing through what we refer to as the painful, stiff, and recovery phases. This was largely based on the conceptualization of frozen shoulder as an inflammatory disorder.

  • Despite several authors challenging the "natural history" theory of frozen shoulder, documenting long-term residual deficits years later, orthopedic texts and websites have continued to perpetuate the theory of forzen shoulder as a self-limiting condition that resolves over time. 

  • This belief can affect clinical decision making by both patients and healthcare practitioners who may opt out of treatment rather than face the cost, discomfort, or inconvenience of treatment but then can run the risk of facing chronic residual deficits. 

  • None of the studies included in this review demonstrated a recovery pattern consistent with the theoretical stages of pain/stiff/thawing as suggested by Reeves. 

  • While ROM and functional improvements did occur, objectively measured evidence for full recovery was not apparent. 

  • The results of this systematic review did not support the two main tenets of the natural history theory of a progression through the painful, stiff, and recovery phases with full resolution w/o supervised treatment.

  • Furthermore, a conservative estimate by the authors of pts returning to full function w/o supervised treatment is a more modest, 26%

  • With stronger evidence to the contrary, correcting public and professional misconceptions about frozen shoulder may reduce delays in people seeking treatments that demonstrate moderate to strong improvements in pain, ROM, and function.  Delayed treatment may lead to worse outcomes, as evidence suggests that the greatest gain, regardless of treatment approach, occurred early.