Bilateral refractory frozen shoulders treated with conservative and surgical treatments—a case report of long-term follow-up

Abstract

Keywords Frozenshoulder.Physiotherapy.Arthroscopiccapsularrelease.Casereport.Long-termfollow-upIntroductionShoulder stiffness is a major cause of shoulder disability andpain. It was first described in the late 19th century [1, 2].The term frozen shoulder was first described by Codman in1934, who stated the common features of slow onset painnear the insertion of the deltoid, inability to sleep on theaffected side, painful and restricted elevation and externalrotation, and a normal radiological appearance [3]. Clinicalfeatures of idiopathic frozen shoulder are classically charac-terized by three stages: freezing, frozen, and thawing phases[4]. Their characteristic clinical feature is decreasing motionwith pain, severely restricted motion, and recovering fromstiffness, respectively. The estimated prevalence of frozenshoulder is 2–5% in the general population [5, 6]. Patientswith frozen shoulder are observed commonly in their 40s to70s and predominately in females [7, 8]. In addition,20–30% of patients develop stiffness in the contralateralshoulders [7]. Though the natural history of frozen shoulderis not well understood, idiopathic frozen shoulder is consid-ered to be a self-limited disease [3, 9]. Normally, quite a fewpatients respond well with conservative treatments such assteroid injections and physiotherapy [10]. However, somepatients demonstrate little or no improvement or mildimprovement with various degrees of limited range ofmotion. In the recalcitrant cases, surgical intervention, suchas arthroscopic pan-capsular release [11], is indicated.We have experienced a case of bilateral idiopathic frozenshoulders which underwent arthroscopic pan-capsular releaseon one side and conservative treatment, which is mostlyperiodical physiotherapy, on the other side for 5 years. Thepurpose of this study is to report range of motion (ROM)recovery over time of this long-term follow-up case and toprovide guidelines for surgeon’s decision making.Case reportHistory A 56-year-old woman in good general health suf-fered from severe left shoulder pain, which was her