Conservative treatment for idiopathic frozen shoulder: Is supervised neglect the answer? A systematic review

OBJECTIVE: The aim of this study was to assess the most beneficial conservative treatment for idiopathic frozen shoulder. METHODS: A total of 498 frozen shoulder cases (mean age 52.4+3.8 years) from 10 articles consisting of seven level 1B and three level 2B studies were included after searching electronic databases of Pubmed, Embase, and Scopus from 1st January 2000 up to 30th October 2020. Patients were followed up for 7.9+7.7 and 3 (1-24) months on average. The mean duration of symptoms the patient experienced before receiving conservative treatment was 22.5+6.8 weeks. This study measured clinical outcomes using the improvement of active range of motion (ROM) and patient-reported outcome measures (PROMs). Numerical data analyses were calculated based on weighted means according to the number of patients involved in each study. RESULTS: When comparing the ranges of motion of active flexion, abduction, external rotation, and internal rotation it was observed that conservative treatments increased the active ROM of flexion by 57.9o (22.1%), abduction by 62.4o 116 (99.1%), external rotation by 37o (230.4%), and internal rotation by 22.1o 117 (71.2%). From all current included literature on idiopathic frozen shoulder, supervised neglect resulted in the highest percentage of ROM improvement in flexion, abduction, external rotation, and internal rotation. Patients receiving supervised neglected treatment significantly improved their patient-reported outcome measures (PROMs). CONCLUSION: Although according to the present literature supervised neglect is the most beneficial conservative therapy, physiotherapy has been proven to provide adequate range of motion and clinical outcome improvement. LEVEL OF EVIDENCE: Level II, Therapeutic Study