The management of frozen shoulder

Posted on 12 March 2012

A systematic review and cost effectiveness analysis

Frozen shoulder is a painful condition in which movement of the shoulder can become severely restricted. Frozen shoulder impacts on working life, leisure and general quality of life and can take up to three years to resolve.

It is estimated that frozen shoulder affects between 2% and 5% of the general UK population at some time, most commonly amongst people in their 50s.

There are several treatment options available, however there is no current consensus about the overall management of the condition.

Researchers at the NIHR Centre for Reviews and Dissemination at the University of York, set out to investigate the clinical and cost-effectiveness of treatments for primary frozen shoulder, and identify the most appropriate intervention by stage of condition.

They undertook a systematic review which found limited evidence on the effectiveness of treatments for primary frozen shoulder. Overall the quality of the 32 studies identified for inclusion was poor.

The review found that there may be short-term benefit from adding a single intraarticular steroid injection to home exercise, for patients with primary frozen shoulder of less than six months duration.

There may also be benefit, in the first six months, from adding physiotherapy to a single steroid injection.

Having an intervention may be better than having none but there is insufficient information to make robust conclusions about which is most effective and at what stage of frozen shoulder.

The review identified large gaps in the evidence for the effectiveness and cost-effectiveness of all the interventions investigated, and highlighted where future research efforts should focus.

Dr Catriona McDaid, the Chief Investigator, said “This is the first time that the main treatment options for frozen shoulder have been compared and considered in the context of the stage of the condition. As a result we have a clear picture of the existing evidence and where best to focus future research efforts to inform the management of frozen shoulder.”

Notes to editors:

Maund E, Craig D, Suekarran S, Neilson A, Wright K, et al. Management of frozen shoulder: a systematic review and cost-effectiveness analysis. Health Technol Assess 2012;16(11). (http://www.journalslibrary.nihr.ac.uk/hta/volume-16/issue-11)
The systematic review was conducted by researchers from the Centre for Reviews and Dissemination and commissioned by the NIHR HTA programme (Project ref: 09/13/02). The views expressed in the review are those of the authors and not necessarily those of the Department of Health, NIHR HTA, or the NHS.
The Centre for Reviews and Dissemination is part of the National Institute for Health Research (NIHR) and a department of the University of York. The Centre aims to provide decision makers with research-based information about the effects of interventions used in health and social care. For more information visit: www.york.ac.uk/inst/crd
Further information can be obtained from Alison Booth, Tel: 01904 321040 or Email: alison.booth@york.ac.uk.
The National Institute for Health Research Health Technology Assessment (NIHR HTA) programme funds research about the effectiveness, costs, and broader impact of health technologies for those who use, manage and provide care in the NHS. It is the largest NIHR programme and publishes the results of its research in the Health Technology Assessment journal, with over 600 issues published to date. The journal’s 2010 Impact Factor (4.197) ranked it in the top 10% of medical and health-related journals. All issues are available for download, free of charge, from the website. The HTA programme is funded by the NIHR, with contributions from the Chief Scientist Office (CSO) in Scotland and the National Institute for Social Care and Health Research (NISCHR) in Wales. http://www.nets.nihr.ac.uk/programmes/hta.
The National Institute for Health Research provides the framework through which the research staff and research infrastructure of the NHS in England is positioned, maintained and managed as a national research facility. The NIHR provides the NHS with the support and infrastructure it needs to conduct first-class research funded by the Government and its partners alongside high-quality patient care, education and training. Its aim is to support outstanding individuals (both leaders and collaborators), working in world class facilities (both NHS and university), conducting leading edge research focused on the needs of patients. http://www.nihr.ac.uk/