Analysis shows that most studies on frozen shoulder report short-term results

Favejee MM. Br J Sports Med. doi:10.1136/bjsm.2010.071431.

Results of a systematic review highlight the dearth of high-quality randomized control trials with long-term results for patients with frozen shoulder.

M.M. Favejee, MD, and colleagues at Erasmus University Medical Center in Rotterdam, The Netherlands, searched the Cochrane Library, PubMed, Embase, Cinahl and Pedro for systematic reviews and randomized clinical trials (RCTs) on frozen shoulder.

Their research included five Cochrane reviews and 18 RCTs, which examined the effectiveness of oral medication, injection therapy, physiotherapy, acupuncture, arthrographic distension and suprascapular nerve block on frozen shoulder.

The investigators found strong evidence for the effectiveness of steroid injections and laser therapy in short-term follow-up and moderate evidence for steroid injections in mid-term follow-up. They found moderate evidence for the following:

in favor of mobilization techniques in the short- and long-term,
for the effectiveness of arthrographic distension alone and as an addition to active physiotherapy in the short-term,
for the effectiveness of oral steroids compared with no treatment or placebo in the short-term, and
for the effectiveness of suprascapular nerve block compared with acupuncture, placebo or steroid injections.

They found no or only limited evidence of effectiveness for other commonly used interventions. Although frozen shoulder symptoms may last up to 4 years, most of the studies in this trial reported only short-term results.

“High-quality RCTs studying long-term results are clearly needed in this field,” the authors wrote in their study.

I congratulate the authors on this well-written article.

While the clinical diagnosis of frozen shoulder is often straightforward, its treatment rarely is. A variety of treatment algorithms have been postulated, and many of these have been substantiated in clinical trials. A thorough review, such as the one presented here, is a valuable addition to the literature and furthers our ability to treat this difficult problem with evidence-based medicine.

Thank you for your contribution; your work is much appreciated.

— Wesley K. Cox, MD
Arnold & Cox Knee and Shoulder Center
Fayetteville, Arkansas