Intended for healthcare professionals

Practice Clinical Update

Frozen shoulder

BMJ 2022; 377 doi: (Published 21 April 2022) Cite this as: BMJ 2022;377:e068547
  1. Marta Karbowiak, trauma and orthopaedics core trainee1,
  2. Thomas Holme, trauma and orthopaedics registrar2,
  3. Maisum Mirza, general practitioner3,
  4. Nashat Siddiqui, consultant orthopaedic and upper limb surgeon2
  1. 1Royal Hampshire County Hospital, Winchester, UK
  2. 2Kingston Hospital NHS Foundation Trust, Kingston upon Thames, UK
  3. 3Warlingham Green Medical Practice, Warlingham, UK
  1. Correspondence to M Karbowiak mkarbowiak{at}

What you need to know

  • Patients with diabetes are at higher risk of developing frozen shoulder and having bilateral symptoms than the general population

  • Recovery times vary, but can be years, and some patients are left with residual pain or functional impairment

  • Physiotherapy is the most commonly used intervention and can be supplemented by intra-articular steroid injections

  • Treatments offered in secondary care include joint manipulation under anaesthesia, arthroscopic capsular release, and hydrodilatation

  • The UK FROST trial compared manipulation under anaesthetic, arthroscopic capsular release, and early structured physiotherapy with intra-articular corticosteroid injections, and found that none of the interventions were clinically superior

Frozen shoulder is a common and often debilitating condition that lacks a clear consensus on management, partly owing to a lack of high quality evidence on the various treatments options. In this clinical update, we offer an overview of the latest evidence on management of frozen shoulder, incorporating the clinical implications of recently published research, including the UK FROST study—the largest randomised controlled trial in this field to date, which compares surgical treatments with early structured physiotherapy and intra-articular corticosteroid injections.

What is frozen shoulder?

Frozen shoulder is a condition that results in development of thickened, fibrosed joint capsule, contraction of the joint, and reduced intra-articular volume.1 The exact cause of these changes is unknown, with several possible processes suggested in the literature.1 Over the years, uncertainty has surrounded the definition and classification of this condition, leading to inconsistencies in both clinical practice and scientific studies.2 This is partially owing to the wide spectrum of clinical presentations, with patients experiencing different levels and combinations of symptoms. This also means their lives can be affected in many different ways, depending on the severity of the condition and their daily activities.

Who gets it?

The age of onset is usually in the fifth decade of life, with peak incidence between …

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