Shoulder
Frozen shoulder: a consensus definition

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Introduction

Frozen shoulder (FS) is a common diagnosis treated by orthopaedic surgeons and other physicians caring for musculoskeletal problems. However, there is no standard definition and classification for this common condition.

Materials and methods

We asked 211 clinician members of the American Shoulder and Elbow Surgeons to review our proposed definition of FS and its classification into primary and secondary types. Secondary FS was further divided into intrinsic, extrinsic, and systemic types. The survey required responses to 5 specific questions via an analog scale (1, strongly disagree; 5, strongly agree). Agreement was defined as a 4 or 5 on the analog scale.

Results

We received 190 responses (90%). Eighty-two percent agreed with the proposed definition of FS. Eighty-five percent agreed that FS should be divided into primary and secondary types. Sixty-six percent agreed with subdivision of secondary FS into intrinsic, extrinsic, and systemic types. Eighty-four percent agreed that there was a clinical entity of primary or idiopathic FS. Eighty-five percent agreed that obtaining a consensus definition and classification of FS was a worthwhile endeavor.

Discussion

Significant benefits can be gained from the development of a standard definition and classification of FS, achieved through a consensus of shoulder specialists, that provides a strong foundation for potential acceptance by all musculoskeletal specialists who treat this condition.

Section snippets

Materials and methods

Surveys were sent by standard mail to 211 clinician members of ASES. Three weeks after the initial mailing, a second survey was sent to those members who had not responded in an effort to maximize the response. A third mailing was sent a further 3 weeks later to all nonresponders for the same reason.

Results

We sent 211 questionnaires to the clinician members of ASES. Those members who were primarily involved in basic science research and were not clinicians were not included in this survey. Of the 211 members who received the survey, 138 responded to the first mailing, 36 responded to the second mailing, and 16 responded to the third mailing, for a total of 190 responses and a response rate of 90%. Not all of the questions had been answered on some of the returned questionnaires. This represented

Discussion

Since Duplay7 described painful stiffening of the shoulder, which he termed “humeroscapular periarthritis,” many articles and chapters have been published that address the definition, etiology, clinical presentation, and treatment of frozen shoulder.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25 The review of a selected number of these articles,1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 15, 16, 17, 18, 19, 20, 21, 22, 24, 25 as well as textbooks,14, 23

Conclusion

The true value of the classification system can only be determined when it is used, and time will tell whether this classification system will be used. However, our goal in using this consensus approach was to obtain the valuable input of shoulder specialists so that the classification proposed would be more readily accepted and used. Time will determine whether we have been successful.

Acknowledgments

We acknowledge the contributions of Arash Araghi, DO, and Frances Cuomo, MD, and the editorial assistance of Jim Madden.

Disclaimer

The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

References (25)

  • J.A. Dickson et al.

    Periarthritis of the shoulder: analysis of 200 cases

    JAMA

    (1932)
  • S. Duplay

    De la péri-arthrite scapulo-humérale et des raideurs de l’épaule qui en sont la consequence

    Arch Gen Med

    (1872)
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