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The Natural History of Idiopathic Frozen Shoulder: A 2- to 27-year Followup Study

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

The natural history of spontaneous idiopathic frozen shoulder is controversial. Many studies claim that complete resolution is not inevitable. Based on the 40-year clinical experience of the senior author, we believed most patients with idiopathic frozen shoulder might have a higher rate of resolution than earlier thought.

Questions/purposes

We determined the length of symptoms, whether spontaneous frozen shoulder recovered without any treatment, and whether restored ROM, pain relief, and function persisted over the long term.

Methods

We retrospectively reviewed 83 patients treated for frozen shoulder (84 shoulders; 56 women) 2 to 27 years (mean, 9 years) after initial consultation. The mean age at onset of symptoms was 53 years. Fifty-one of the 83 patients (52 shoulders) were treated with observation or benign neglect only (untreated group), and 32 had received some kind of nonoperative treatment before the first consultation with the senior author (nonoperative group). We also evaluated all 20 patients (22 shoulders; 13 women) with spontaneous frozen shoulder who underwent manipulation under anesthesia during the same time (manipulation group). The mean age of these patients was 49 years. The minimum followup was 2 years (mean, 14 years; range, 2–24 years). We determined duration of the disease, pain levels, ROM, and Constant-Murley scores.

Results

The duration of the disease averaged 15 months (range, 4–36 months) in the untreated group, and 20 months (range, 6–60 months) in the nonoperative group. At last followup the ROM had improved to the contralateral level in 94% in the untreated group, in 91% in the nonoperative group, and in 91% in the manipulation group. Fifty-one percent of patients in the untreated group, 44% in the nonoperative group, and 30% in the manipulation group were totally pain free at rest, during the night, and with exertion. Pain at rest was less than 3 on the VAS in 94% of patients in the untreated group, 91% in the nonoperative group, and 90% of the manipulation group. The Constant-Murley scores averaged 83 (86%) in the untreated group, 81 (77%) in the nonoperative group, and 82 (71%) in the manipulation group, reaching the normal age- and gender-related Constant-Murley score.

Conclusions

We found 94% of patients with spontaneous frozen shoulder recovered to normal levels of function and motion without treatment.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Carol Norris PhD, for language revision.

Author information

Authors and Affiliations

  1. ORTON Research Institute, Invalid Foundation, Tenholantie 10, FIN-00280, Helsinki, Finland

    Heidi Vastamäki MD

  2. Arcada University of Applied Sciences, Helsinki, Finland

    Jyrki Kettunen PT, PhD

  3. Department of Hand and Shoulder Surgery, ORTON Orthopaedic Hospital, Helsinki, Finland

    Martti Vastamäki MD, PhD

Authors
  1. Heidi Vastamäki MD
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  2. Jyrki Kettunen PT, PhD
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  3. Martti Vastamäki MD, PhD
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Corresponding author

Correspondence to Heidi Vastamäki MD.

Additional information

One of the authors (HV) has received funding from the Finnish Society for Surgery of the Hand.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for his investigation, that all investigations were concluded in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at ORTON Orthopaedic Hospital.

Appendix 1

Appendix 1

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Vastamäki, H., Kettunen, J. & Vastamäki, M. The Natural History of Idiopathic Frozen Shoulder: A 2- to 27-year Followup Study . Clin Orthop Relat Res 470, 1133–1143 (2012). https://doi.org/10.1007/s11999-011-2176-4

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  • DOI: https://doi.org/10.1007/s11999-011-2176-4

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