Natural history of frozen shoulder.
Authors: Hand & Carr
References: BESS, 2004
This is the largest reported natural history study of frozen shoulder. 500 patients were identified from a specialist shoulder clinic register with a diagnosis of frozen shoulder based on Codman's criteria. 273 patients with primary frozen shoulder replied to a detailed postal questionnaire regarding their condition. The main outcome measure was the Oxford Shoulder Score (OSS). Mean follow up from symptom onset was 52 months (range 12-240 months), with 89% of shoulders followed up for a minimum of 3 years. Mean OSS at follow up was 18/60, with 40% of patients having persistent mild/moderate symptoms. Patients with unbearable symptoms at presentation had the worst outcome. The mean age of onset was 53 years (range 27-85 yrs). The female to male ratio was 1.6:1. The condition was bilateral in 20%, with no incidence of ipsilateral recurrence. 22% of the patients reported a history of minor trauma to the upper limb prior to the onset of symptoms. 16% were diabetic and 4% reported a history of Dupuytren's contracture. Right and left arms were affected equally with no relationship to hand dominance. 61% reported slowly, and 39% reported sudden onset of symptoms. Generally pain and stiffness improved with time. Frozen shoulder affects people mainly in their 6th decade. The natural history is for improvement with time; those with unbearable symptoms at presentation had the worst outcome. Significant numbers of patients had persistent symptoms long term.