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The effectiveness of nonoperative treatment modalities in the management of frozen shoulder: a systematic review of randomized controlled trials
Albishi W, Murad K, Alaseem A, Awwad W, Alsanawi H
Muscles, Ligaments and Tendons Journal 2022 Mar;12(2):104-114
systematic review

BACKGROUND: Frozen shoulder is a widespread concern having an unknown etiology. Management mainly aims at restoring function and treating symptoms. The choice of treatment may differ based on patient variables, stage of presentation, priorities of clinicians, and funding. No robust evidence exists to endorse one treatment modality over another in a conclusive way. Therefore, we performed a systematic review of the conservative therapeutic options for the frozen shoulder. MATERIALS AND METHODS: A wide range of electronic bibliographic databases such as PubMed, Embase, and ERIC was searched. Based on the eligibility criteria, all randomized controlled trials that compared the efficacy of any type of non-surgical or conservative management from 2010 to 2020 are incorporated in the review. Following screening and assessing the abstracts, we ended up reviewing 12 full-text articles and data extracted on essential parameters such as sample size, type of non-surgical treatment, time of follow-up, and primary outcomes. RESULTS: Overall, the systematic review results seem promising for the efficacy of different non-surgical modalities. They improve multiple outcomes such a pain, range of motion, Constant-Murley score, Simple Shoulder Test, shoulder pain, Disability Index, and patient satisfaction. Nonsurgical management is the preferred initial care option, with most patients typically improving within 6 to 18 months. Steroids, physiotherapies, hydrodilatation with hypertonic saline, suprascapular nerve block (SNB), Extracorporeal shockwave therapy, and intra-articular steroid or sodium hyaluronate injections are conservative treatment choices. CONCLUSIONS: Treatment of frozen shoulder remains a challenge, and high-level conclusive evidence is needed to recommend one treatment method over another. The results of this systematic review showed that nonsurgical management, regardless of the preferred treatment option, is beneficial and effective in the treatment of frozen shoulder, and that can guide clinicians in making evidence-based decisions when managing this condition conservatively. This will avoid unnecessary burdens on the healthcare system and patients, as they might be treated effectively without undergoing surgery.

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