Natural history of frozen shoulder: fact or fiction?

This review found a lack of evidence to support the long-running notion that frozen shoulder is a self-limiting condition with identifiable stages of progression (painful, stiff and recovery phases) and complete resolution of symptoms, even without treatment. The proposed timing of this progression – slower gains in the beginning and faster ones at the end – was also found to be unsupported by evidence.

The longstanding concept that frozen shoulder is a self-limiting condition with a natural progression to full symptom resolution is largely based on two 1970s studies with serious methodological issues and doubtful interpretations. Nevertheless, this notion has been perpetuated ever since by various authors and orthopedic texts.

After a database search, study selection and quality assessment, this review found 7 low- to moderate-quality studies involving subjects with frozen shoulder that underwent no treatment and reported levels of pain, range of motion (ROM) and function.

There was no evidence beyond low-level studies to support the natural history theory of frozen shoulder. Additionally, higher-quality studies provide evidence of the contrary. No longitudinal studies found a progression through painful, stiff and recovery/thawing phases. The best avilable evidence also found the greatest gains in ROM and function occur early in the disease progression, also contradicting the natural history theory classically proposed. Reference to this natural progression by health professionals and giving this information to the public should be discouraged.