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Frozen shoulder

Abstract

Frozen shoulder is a common debilitating disorder characterized by shoulder pain and progressive loss of shoulder movement. Frozen shoulder is frequently associated with other systemic conditions or occurs following periods of immobilization, and has a protracted clinical course, which can be frustrating for patients as well as health-care professionals. Frozen shoulder is characterized by fibroproliferative tissue fibrosis, whereby fibroblasts, producing predominantly type I and type III collagen, transform into myofibroblasts (a smooth muscle phenotype), which is accompanied by inflammation, neoangiogenesis and neoinnervation, resulting in shoulder capsular fibrotic contractures and the associated clinical stiffness. Diagnosis is heavily based on physical examination and can be difficult depending on the stage of disease or if concomitant shoulder pathology is present. Management consists of physiotherapy, therapeutic modalities such as steroid injections, anti-inflammatory medications, hydrodilation and surgical interventions; however, their effectiveness remains unclear. Facilitating translational science should aid in development of novel therapies to improve outcomes among individuals with this debilitating condition.

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Fig. 1: Structural changes during frozen shoulder.
Fig. 2: The stages of frozen shoulder.
Fig. 3: Molecular pathophysiology of frozen shoulder.
Fig. 4: Proposed algorithm for differential diagnosis of frozen shoulder.
Fig. 5: Key examination techniques for frozen shoulder.

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Introduction (N.L.M., G.A.C.M. and S.A.R.); Epidemiology (N.L.M., E.W., A.L.C. and P.D.K.); Mechanisms/pathophysiology (N.L.M., L.M., S.A.R., M.A., A.L.C. and G.A.C.M); Diagnosis, screening and prevention (A.M., F.S. and E.W.); Management (N.L.M., A.L.C., A.M., F.S., E.W., P.D.K., G.A.C.M., J.C.R. and S.A.R.); Quality of life (N.L.M. and P.D.K.); Outlook (N.L.M., M.A., S.A.R. and A.L.C.); Overview of Primer (N.L.M.).

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Nature Reviews Disease Primers thanks P. J. Millett; C. P. Charalambous; M.-M. Lefevre-Colau, who co-reviewed with A. Roren; and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Millar, N.L., Meakins, A., Struyf, F. et al. Frozen shoulder. Nat Rev Dis Primers 8, 59 (2022). https://doi.org/10.1038/s41572-022-00386-2

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