Frozen shoulder remains a somewhat mysterious pathology in which we, as empathic physiotherapists, want to take our magic wand and break down the ice cage of stiffness. But is our effort rewarded or do we head for a burnout if we see too much frozen shoulder patients a year? We summarize the results of the recent review from Mine et al. in Journal of Rehabilitation Medicine 2019. Thirty trials were included, with the majority of studies evaluated as being at high risk of potential bias. Only 4 trials were evaluated as being at low risk of bias. We take out the 3 most important conclusions of this review:
1. There is some support for the use of manual therapy and stretching in the more stiff than painful stage of the condition.
- small sample sizes
- no certainty for clinical importance of the differences found
- some but not all outcome measures improved
- cost versus benefit?
2. In the early phase (less than 6 months symptoms) low dose corticosteroids combined with a home exercise program is recommended. (No superior results with high dose and corticosteroids increased outcome compared to only home program)
- short follow up – loss to follow up
- small sample sizes
3. Based on a single study comparing short wave diathermy (SWD) and stretching, heat pack and stretching, and, a home exercise programme, and for some outcomes only, there may be benefit from adding SWD to passive mobilisation and home exercise
- Only one study
- low quality study
The authors state: “In conclusion, there is limited additional guidance available to support clinicians and those seeking care for the non-surgical management of idiopathic FS. “
Up to date it is not possible to be very confident that physiotherapy can increase the speed of recovery. Moreover there is no clear advantage of any conservative strategy and no evidence for often used methods in physiotherapy practice like taping and dry needling.
Minns Lowe C1, Barrett E, McCreesh K, de Búrca N, Lewis J.
J Rehabil Med. 2019 Jun 24. [Epub ahead of print] Clinical effectiveness of non-surgical interventions for primary frozen shoulder: A systematic review.