New fast track guidelines to defrost frozen shoulders

Clinical guidelines and a new quick reference summary for the diagnosis, assessment and physiotherapy management of frozen shoulders developed at Teesside University have been downloaded over 10,000 times.

Frozen shoulder is both extremely painful and common with 9% of the UK working age population affected (1 in 10). The condition costs the NHS at least £13.5 million annually. *

The guidelines and summary are aimed not just at physiotherapists but to a broad base of health workers including GPs and patients themselves to help make it easier to diagnose the problem and then treat it.

Teesside University’s Dr Nigel Hanchard, lead author of the evidence-based Clinical Guidelines for the Diagnosis, Assessment and Physiotherapy Management of Frozen Shoulder on behalf of the Chartered Society of Physiotherapy, has himself suffered a frozen shoulder during his research.

'It is one of those conditions which is often dismissed as minor because it will eventually go away by itself usually within two to three years. But it is extremely painful. My own experience and my research shows people equate the level of pain with having a serious, life threatening disease such as cancer.

'As part of the research we did a qualitative study with sufferers and it is very much a hidden suffering because there is no physical sign of it; yet it impacts greatly on their lives, particularly in sleep disturbance. Some people cannot even lie down to sleep. They have to sleep sitting up. So there is a knock on effect for all aspects of everyday life. And two to three years with severe pain is a very long time.

'Research we carried out to inform the guidelines’ development suggested certain treatments can accelerate the resolution but that the condition was not diagnosed very reliably. Traditionally, the mainstay of diagnosing frozen shoulder was identifying a proportional restriction of three different movements. But in practice this caused confusion.'

The guidelines have addressed this fundamental problem by recommending a diagnostic approach which relies on identifying involvement of a single movement. This is simpler but at the same more evidence-based. A clear diagnosis gives reassurance to people who are very worried and anxious that their pain is the symptom of a life threatening disease, and it underpins appropriate treatment.

Also included in the guidelines, which are free to download from Teesside University’s online research repository, is a short summary of most possible interventions for a frozen shoulder from the least invasive through to surgery, which gives the theoretical aims of the different interventions and their relative popularity in a sample of UK physiotherapists.

A frozen shoulder can be caused by a sudden wrenching of the arm or shoulder joint or the cause may be unknown. It is most prevalent in people in their fifties and in the early stages is characterised by constant and extensive pain, then a second stage of residual stiffness.

Notes *References: 1. Walker-Bone K et al (2004) Arthritis and Rheumatism 51, 4, 642-51. 2. Bunker T (2009) Shoulder & Elbow 1, 1, 4-9. 3. Maund E et al (2012) HTA, 16, 11.

The guidelines can be downloaded from Teesside University’s research repository TeesRep Download the guidelines from TeesRep

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