Frozen Shoulder Syndrome Research Articles

A new perspective of frozen shoulder pathology; the interplay between the brain and the immune system.

Frozen shoulder (FS), also known as adhesive capsulitis of the shoulder (FS), is a fibrotic inflammatory process of unknown etiology whose main symptoms are pain, stiffness and the loss of joint mobility. These symptoms may be associated with pathologies such as diabetes, Dupuytren's syndrome and the prevalence of today's sedentary lifestyle. This literature review provides an overview of the epidemiology and pathogenesis of this pathology, as well as the mechanisms of lowgrade chronic inflammation and infection, insulin resistance, and omics-science associated with it. We also propose a new hypothesis related to the possibility that the GABAergic system could play a decisive role in the development of frozen shoulder and that therefore diabetes type 1, endocrinological autoimmune disorders and frozen shoulder are connected by the same pathophysiological mechanisms. If that is true, the combined presence of psycho-emotional stress factors and pathogenic immune challenges could be the main causes of frozen shoulder syndrome. Finally, we propose a series of possible intervention strategies based on a multifactorial etiological and mechanistic concept.

Clinical evaluation of a patient participation assessment system for upper extremity rehabilitation exercises.

In conventional and robotic rehabilitation, the patient's active participation in exercises is essential for the maximum functional output to be received from therapy. In rehabilitation exercises performed with robotic devices, the difficulty levels of therapy tasks and the device assistance are adjusted based on the patient's therapy performance to improve active participation. However, the existing therapy performance evaluation methods are based on either some specific device designs or certain therapy tasks, which limits their widespread use. In this paper, the effectiveness of a participation assessment system, which can evaluate patients' therapy performance, tiredness, and slacking independent of any device design and therapy exercise, was clinically tested on ten patients diagnosed with frozen shoulder syndrome. The patients performed exercises using the system once a week throughout their 4-week treatment period. Multiple clinical measurements and scales were employed during the clinical study to assess patients' progress and status, such as tiredness throughout the therapy process. The clinical data, along with the patient findings obtained from the participation assessment system, were statistically analyzed and compared. The findings revealed that the patients' improvements and progress during the therapy process clinically coincide with the variations in the performance evaluation results of the system, and the implemented method successfully assesses the patients' participation during the rehabilitation exercises.

Bone and Rheumatic Disorders in Diabetes

Diabetes mellitus, a chronic metabolic ailment characterized by hyperglycemia, affects millions of people worldwide and poses a considerable burden on public health. While the number-one headache of diabetes frequently involves the cardiovascular, renal, and neurological systems, increasing evidence indicates a link between diabetes and bone and rheumatic issues. This abstract explores the complex interplay between diabetes and musculoskeletal conditions, to offer an overview of their pathophysiological mechanisms and medical implications. Bone problems in diabetes are typically characterized by decreased bone mineral density (BMD) and an increased risk of fractures. The imbalance between bone formation and resorption, driven by hyperglycemia-precipitated oxidative stress, advanced glycation stop products (ages), and persistent inflammation, results in decreased osteoblasts interest and more desirable osteoclast features. Furthermore, alterations in the insulin signaling pathway and impaired osteocyte characteristics contribute to compromised bone formation in diabetes. These adjustments together contribute to an extended fracture chance and not on-time fracture recuperation in patients with diabetes. Rheumatic issues in diabetes embody a wide variety of conditions including osteoarthritis, rheumatoid arthritis, and frozen shoulder syndrome. Persistent irritation due to dysregulated immune responses in diabetes can boost joint degeneration, worsen pain, and cause useful impairments. Furthermore, weight problems, regularly linked to type 2 diabetes, place additional mechanical pressure on the weight-bearing joints, exacerbating the progression of osteoarthritis. Rheumatoid arthritis, an autoimmune disease, may have complex interactions with diabetes because of its shared inflammatory pathways. The clinical implications of these interactions are significant. First, healthcare providers should be vigilant in screening and diagnosing bone issues in patients with diabetes, particularly in the elderly population who are at a higher risk of fractures. Second, promoting lifestyle changes, including weight management, normal physical activity, and glycemic manipulation, can mitigate bone and joint-associated complications in diabetes. Additionally, progressive treatment plans focused on the common pathways of inflammation and oxidative stress may hold promise for the treatment of diabetes and its musculoskeletal comorbidities. Bone and rheumatic disorders are increasingly identified as vital comorbidities in diabetes. The tricky pathophysiological mechanisms involved call for similar research to expand patient-centered therapeutic techniques that efficiently manage these musculoskeletal headaches and enhance the overall quality of life of individuals living with diabetes. A complete understanding of these relationships will enable healthcare specialists to enforce timely interventions and customize treatment plans to deal with the specific demanding situations posed by the aid of bone and rheumatic disorders in patients with diabetes.

Association Between Subscapularis Trigger Point and Frozen Shoulder: A Cross Sectional Study

Background: Uncertainty surrounds the relationship between subscapularis trigger sites and the development of frozen shoulder syndrome. Objectives: The purpose of this study was to investigate the relationship between subscapularis trigger points and immobilized shoulder in patients from the Outpatient Physical Therapy Department at NMC Hyderabad. Methods: This cross-sectional study was conducted from September 2022 to February 2023 and included 71 patients diagnosed with grade 1 or 2 frozen shoulder based on Codman's criteria and aged 35 or older. Using an axillary approach, subscapularis trigger points were identified manually, and their presence was evaluated on both the affected and unaffected sides. Using the Chi-square test in SPSS version 22, the relationship between subscapularis trigger points and immobilized shoulder was analyzed. Results: 33 (46.5%) of the 71 participants were male, while 38 (53.5%) were female, with a mean age of 53.32 years. On the affected side, there was a significant association between frozen shoulder and subscapularis trigger points (p =.001). Intriguingly, a statistically significant difference was also observed in the unaffected shoulder joint (p =.001). Practical Implications: It highlighted the importance of diagnosing and treating subscapularis trigger points in patients with frozen shoulder, potentially guiding new therapeutic strategies to improve shoulder mobility and reduce pain in these individuals. Conclusion: Our findings indicate a considerable association between subscapularis triggers points and frozen shoulder, making these trigger points possible therapeutic targets. To investigate the underlying mechanisms and validate these results in larger populationss, additional research is required. Keywords: Frozen shoulder syndrome; Orthopedics; Subscapularis trigger points; Surgery

Effect of Functional Scapular Stabilization Training on Function and Pain in Frozen Shoulder Syndrome: A Randomized Controlled Trial

ObjectiveThe purpose of this study was to determine the effect of functional scapular stabilization training compared with the standard physical therapy on function and pain in people with frozen shoulder syndrome (FSS). MethodsIn a single-blind randomized controlled trial, 86 people with FSS were randomly allocated into the intervention group (functional stabilization training [n = 43]) and control group (standard physical therapy [n = 43]) using block randomization for 12 weeks. The primary outcome measures were the Shoulder Pain and Disability Index and the numeric pain rating scale. The secondary outcome measures were range of motion (ROM), range of passive abduction, and coracoid pain test. All the outcome measures were carried out by an independent blind outcome assessor at baseline and at the end of 12 weeks. ResultsA significant group × time interaction effect was observed for the Shoulder Pain and Disability Index (95% CI, 2.95-16.74; P < .01) and the numeric pain rating scale (95% CI, 0.67-2.07; P < .01) at the end of 12 weeks. The external rotation ROM showed a statistical significance with a mean change of 7.8° and P value of <.01. ConclusionThe present findings show that scapular functional stabilization training resulted in improvement of function, reduction in pain, and greater improvement in external rotation ROM in patients with FSS. Also, our study findings suggest the involvement of rotator interval and inferior soft-tissue structures as indicated by the coracoid pain test and range of passive abduction.

The prevalence of frozen shoulder in patients with limited Dupuytren disease.

Evidence from the literature suggests an association between Dupuytren disease and frozen shoulder syndrome, both clinically and histologically. An increased tendency for fibrotic healing after repetitive microtrauma could be an underlying mechanism. However, it remains unclear how strong this association is and if only mild signs of Dupuytren disease would also increase the risk of frozen shoulder. In 61 patients, we examined the hands for signs of Dupuytren disease and the shoulders for pain and limited motion. We found a 21,7% prevalence of frozen shoulder syndrome in patients with signs of Dupuytren disease versus 13,9% in those without. The other way around, in patients with frozen shoulder syndrome the prevalence of Dupuytren disease was 50% versus 36.7% in those without frozen shoulder syndrome. These differences were not statistically significant, contrary to similar research in the literature. However, methodological issues, especially the choice of control group, may explain the differences between our findings and previous studies. We conclude that the clinical association between Dupuytren disease may not be so strong as previously thought, especially in patients with only limited signs of the disease.

Role of suprascapular nerve block in idiopathic frozen shoulder treatment: a clinical trial survey.

BackgroundSeveral therapeutic methods have been proposed for frozen shoulder syndrome. These include suprascapular nerve block, a simple and cost-effective technique that eliminates the need for nonsteroidal anti-inflammatory drug therapy.MethodsThis was a clinical trial that included patients with unilateral shoulder joint stiffness. Patients were divided into three groups: those treated with isolated physiotherapy for 12 weeks (PT group), those treated with a single dose intra-articular injection of corticosteroid together with physiotherapy (IACI group), and those treated with a suprascapular nerve block performed with a single indirect injection of 8-mL lidocaine HCL 1% and 2 mL (80 mg) methylprednisolone acetate together with physiotherapy (SSNB group). The variables assessed were age, sex, side of involvement, dominant limb, presence of diabetes, physical examination findings including erythema, swelling, and muscle wasting; palpation and movement findings; shoulder pain and disability index (SPADI) score; and the visual analog scale (VAS) score pre-intervention and at 2-, 4-, 6-, and 12-week post-intervention.ResultsNinety-seven patients were included in this survey (34 cases in the PT group, 32 cases in the IACI group, and 31 cases in the SSNB group). Mean age was 48.55±11.06 years. Fifty-seven cases were female (58.8%) and 40 were male (41.2%). Sixty-eight patients had a history of diabetes (70.1%). VAS and SPADI scores and range of mototion degrees dramatically improved in all cases (p<0.001). Results were best in the SSNB group (p<0.001), and the IACI group showed better results than the PT group (p<0.001).ConclusionsSuprascapular nerve block is an effective therapy with long-term pain relief and increased mobility of the shoulder joint in patients with adhesive capsulitis.

POSB332 Comparison of Frozen Shoulder Syndrome Treatment Results Using Traditional and Functional Fasia Training Methods

The aim was to compare the development of the active range of motion, the muscle strength and quality of life linked with frozen shoulder syndrome of patients treated with functional fascia training and conservative methods.

Comparison of the Effect of Codman Exercises and Scapular Rhythm on Pain and External Rotation of Shoulder in Women with Frozen Shoulder Syndrome

Comparison of the Effect of Codman Exercises and Scapular Rhythm on Pain and External Rotation of Shoulder in Women with Frozen Shoulder Syndrome

The epidemiology and etiology of adhesive capsulitis in the U.S. Medicare population

BackgroundAdhesive capsulitis (AC) of the shoulder, also known as frozen shoulder, causes substantial pain and disability. In cases of secondary AC, the inflammation and fibrosis of the synovial joint can be triggered by trauma or surgery to the joint followed by extended immobility. However, for primary AC the inciting trigger is unknown. The burden of the disorder among the elderly is also unknown leading to this age group being left out of therapeutic research studies, potentially receiving delayed diagnoses, and unknown financial costs to the Medicare system. The purpose of this analysis was to describe the epidemiology of AC in individuals over the age of 65, an age group little studied for this disorder. The second purpose was to investigate whether specific medications, co-morbidities, infections, and traumas are risk factors or triggers for primary AC in this population.MethodsWe used Medicare claims data from 2010–2012 to investigate the prevalence of AC and assess comorbid risk factors and seasonality. Selected medications, distal trauma, and classes of infections as potential inflammatory triggers for primary AC were investigated using a case–control study design with patients with rotator cuff tears as the comparison group. Medications were identified from National Drug codes and translated to World Health Organization ATC codes for analysis. Health conditions were identified using ICD9-CM codes.ResultsWe found a one-year prevalence rate of AC of approximately 0.35% among adults aged 65 years and older which translates to approximately 142,000 older adults in the United States having frozen shoulder syndrome. Diabetes and Parkinson’s disease were significantly associated with the diagnosis of AC in the elderly. Cases were somewhat more common from August through December, although a clear seasonal trend was not observed. Medications, traumas, and infections were similar for cases and controls.ConclusionsThis investigation identified the burden of AC in the US elderly population and applied case–control methodology to identify triggers for its onset in this population. Efforts to reduce chronic health conditions such as diabetes may reduce seemingly unrelated conditions such as AC. The inciting trigger for this idiopathic condition remains elusive.

Retrospective study of suprascapular nerve block with closed manipulation and intra articular steroid injection in patients with frozen shoulder

Background: Frozen shoulder syndrome is chronic inflammation of glenohumeral joint capsule commonly known as adhesive capsulitis. This disease characterised by gradually increasing shoulder pain followed by limitation in range of movements. Therapeutic management has no effect on adhesive capsulitis. Recently a combination of suprascapular nerve block (SSNB) with closed manipulation and with intraarticular steroid injection (IA) has shown a best and fruitful treatment which is safe and successful method for the relieving of pain and gain of full range of motion (ROM).Aim: To assess the pain scores and to achieve full range of movements before procedure and after 5 hours, 5 days and 15 days and 1month of the procedure.Study Design: Retrospective study.Methods: Retrospective study of 82 patients (26 male and 56 female) with frozen shoulder, from December 2018 to December 2020. A combination of suprascapular nerve block (SSNB) with closed manipulation and with intra articular steroid injection (IA) were given to the patients. Assessment were done on the severity of pain and range of movements before and after the treatment were noted.Results: All parameters like forward flexion, extension, adduction, abduction, internal rotation, external rotation and circumduction assessed before procedure and after 5 hours, 5 days, 15 days and 1month after procedure were done. Many patients significantly improved. However at 15 days of assessment 8 patients showed mild restriction of all the movements.Conclusion: Combination of suprascapular nerve block with closed manipulation and with intraarticular steroid injection is the best and fruitful treatment for frozen shoulder. Continuous shoulder mobilizing exercise will improve from pain and improve functional outcomes of these patients.

Periarthritis shoulder – Effect of manipulation under general anesthesia on pain and range of movement

Introduction: Periarthritis shoulder is unique condition, in sense that same pathology does not affect any other joints in particular other than shoulder.2 Spontaneous occurrence of pain in shoulder unrelated to injury, but at times associated with injury in 20-30% of cases.2 Main aim of treatment is symptomatic pain relief followed by restoration of normal joint movements. Manipulation under General Anesthesia (MUA) appears to be mainstay of treatment for people who do not benefit by physiotherapy and universal shoulder mobilization exercises.3 Aim of Study: To study effect of manipulation under general anesthesia on Periarthritis shoulder. Objective: To study improvement in Range of Movements, Pain and Short DASH score. Materials and Methods: Study was carried out in Pushpagiri Institute of Medical Sciences and Research Centre during September 2010 to September 2012. 40 patients were selected for the study, underwent MUA with intra-articular steroid injection (40mg/ml methyl prednisolone), 2% Lignocaine (5ml) and Hydrodilation (40ml cold normal saline). They were started physiotherapy immediately and continued. Result: Among the 40 patients 6 patients never returned for follow-up. Data analysis of remaining 34 patients shows improvement in shoulder range of movement. Quick DASH score decreased from 83.72(S.D + 7.1) to 27.66 (S.D + 7.0). VAS score improved from 7.29 (S.D + 1.03) to 1.71 (S.D + 0.84). Conclusion: Periarthritis shoulder, treated with MUA with intra-articular steroid (steroid+Lignocaine) and hydrodilation (with normal saline) result in good immediate pain relief postoperatively and easy breakage of adhesions during the procedure. This followed by immediate physiotherapy decreases pain, adds good functional recovery and early return to daily activities of living. Physiotherapy and universal shoulder mobilization exercises should be continued thereafter to prevent recurrence of symptoms. Keywords: Frozen shoulder syndrome, Adhesive capsulitis, Periarth

PREVALENCE AND MANAGEMENT OF THE DIABETIC FROZEN SHOULDER

The term frozen shoulder was first introduced by Codman in 1934. He described a painful shoulder condition of insidious onset that was associated with stiffness and difficulty sleeping on the affected side. Codman also identified the marked reduction in forward elevation and external rotation that are the hallmarks of the disease. Long before Codman, in 1872, the same condition had already been labelled periarthritis by Duplay. In 1945, Naviesar coined the term adhesive capsulitis. [2] The pathophysiology of idiopathic adhesive capsulitis (frozen shoulder) is poorly understood. Most authors have reported various degrees of inflammatory changes in the synovial membrane. Adhesions between the shoulder capsule and the humeral head have been noted by some, but not all, authors. [4] The aetiology of periarthritis of the shoulder, however, is not clearly understood. Amongst the factors suggested are trauma myocardial infarction hemiplegia, pulmonary tuberculosis, thyrotoxicosis, cerebral tumour, and epilepsy. [7] Subjects with Frozen Shoulder Syndrome group A treated with ERM and MWM and group B treated with MRM. The duration of each treatment was 3 weeks. There was an improvement in mobility and functional ability at 12 weeks in subjects treated with the 3 mobilization techniques. Comparing the effectiveness of the 3 treatment strategies in subjects with unilateral Frozen Shoulder Syndrome, ERM and MWM were more effective than MRM in increasing mobility and functional ability. [22].

Subscapularis Trigger Points as a Predictor for Frozen Shoulder Syndrome: Correlation Study

Trigger points in the shoulder region muscles restrict movement of shoulder and create pain on movement and at rest. The key muscle that must be examined is the subscapularis muscle. The aim of this study is to investigate the relationship between subscapularis trigger with shoulder pain, shoulder abduction and shoulder external rotation. 50 patients diagnosed with frozen shoulder. Data obtained regarding pressure pain threshold (PPT) using pressure algometry, shoulder pain and disability index (SPADI)using questionnaire, shoulder abduction and external rotation ROM using digital inclinometer were statistically analysed and compared. Strong negative significant correlation between PPT with SPADI, strong positive significant correlation between PPT with shoulder abduction and external rotation. Subscapularis trigger points in patients with frozen shoulder affect shoulder pain, shoulder abduction, and external rotation.

A prospective study on role of hydraulic distension along with steroid under local anaesthesia in the management of frozen shoulder

Introduction: Frozen shoulder” is a chronic condition characterized by gradually progressive, painful restriction of all shoulder joint movement, with slow spontaneous recovery of either partial or complete movement over a period of time. Although many treatment options have been proposed for the frozen shoulder syndrome, each has limitations. Hydro dilation technique was developed in order to loosen the reported contraction and adhesion. we evaluated the Range of movement and pain relief of shoulder following “Hydraulic distension under local anaesthesia along with a steroid” pre and post distension. Material and methods: A prospective observational study was conducted in the department of orthopaedics at RLJ hospital attached to Sri Devaraj Urs Medical College between June 2018 to November 2019 for a period of 1.5 year. All the Patients with Peri arthritis shoulder and age above 30 years were included in the study. After obtaining the informed consent from the patients, Demographic data, History, Clinical Examination and details of investigations were recorded in study proforma. The pain and functional scoring used as per “The society of American Shoulder and elbow surgeons” and follow-up was done at 3 weeks, 6 weeks and 12 weeks after procedure. IBM SPSS version 22 was used for statistical analysis. Results: Total 50 patients were included in the study. The average age of the study population was 52.68 ± 9.79. There were no patients with complete disability. Marked pain (grade 1) was observed on presentation in 46(92%) of the subjects. Post distension only 9(18%) had pain. Flexion, abduction, internal rotation, external rotation movements of the shoulder have improved post distention and were statistically significant at 3rd, 6th, 12 th week. The mean ASES was 36.04 ± 5.84 at base line, it was 67.6 ± 7.64 at 6th week and 91.04 ± 8.68 at 12th week. The differences in the ASES score at 6th week and 12th week follow up period with baseline value were statistically significant (P value

The effect of electroacupuncture merged with rehabilitation for frozen shoulder syndrome: A single-blind randomized sham-acupuncture controlled study

Frozen shoulder syndrome (FSS) causes pain and reduces the range of motion in the shoulder joint. To investigate the short and medium-term effects of electroacupuncture in people with FSS, we evaluated the therapeutic effects of true and sham electroacupuncture on pain relief and improvement of shoulder function. In this randomized, single-blind controlled clinical trial, 21 subjects with FSS were randomly assigned to two groups: a true electroacupuncture group (TEAG) and a sham electroacupuncture group (SEAG). The two groups underwent 18 sessions of treatment over approximately 6-9 weeks and were then followed up at 1, 3, and 6 months. Their effectiveness for alleviating the intensity of shoulder pain was evaluated with a visual analog scale (VAS), while improved shoulder mobility was evaluated by the active range of motion (AROM) and passive range of motion (PROM), and shoulder functional ability was evaluated using the Shoulder Pain and Disability Index (SPADI). It demonstrated that the TEAG or SEAG showed lasting effects at 1, 3, and 6 months, although with no significant difference between these two groups in the shoulder functional ability outcomes. However, the decline in the VAS occurred earlier in the TEAG than the SEAG. Also, there was much more improvement in AROM for flexion and abduction in the TEAG than the SEAG. An increase in the abduction angle after electroacupuncture and manual rehabilitation was also apparent. These results suggest that electroacupuncture plus rehabilitation may provide earlier pain relief for patients with FSS and could be applied clinically.

THERAPEUTIC EFFICACY OF CODMANS VERSUS MAITLAND REGIME FOR THE TREATMENT OF FROZEN SHOULDER SYNDROME

Frozen shoulder syndrome is a commonly encountered clinical complaint. It is encountered by clinicians (General Practitioners (GP’s), Rheumatologists, Orthopedic surgeons) and physical therapists (Physiotherapy, Osteopathy, Chiropractic).Shoulder joint is one of the most rewarding and functional joints involved in daily routines including performances, occupational and recreational activities. &#x0D; Aim to Compare the Therapeutic efficacy of codmans and Maitland regime for the treatment of frozen shoulder syndrome &#x0D; Methods Each group consists of fifteen patients and they were equally divided into two groups such as Group A and B. The group include both male and female with the age group of 30-55 years. One group of patients treated with conventional Shoulder exercise regime and other group treated with Maitland manipulation. &#x0D; Study Design Comparative study with pretest and post –test design &#x0D; Results Group A patients which shows significantly 1.46(P0.05) pain reduction. Group B patients which shows significantly 1.40(P0.05).Finally both the groups shows the pain reduction &#x0D; Clinical Implications The notion of the current study which provides evidence that Conventional Shoulder exercises and Maitland mobilization were equally effective for the management of pain in frozen shoulder. &#x0D; Both manual mobilization therapy along with general exercises and exercises alone brought improvements in outcome measure scales for pain, glenohumeral ranges and shoulder pain.

Physiotherapy in frozen shoulder syndrome - literature review

Physiotherapy in frozen shoulder syndrome - literature review

Effectiveness of hydraulic distension of shoulder in the management of frozen shoulder

Frozen shoulder is a chronic fibrosing condition of capsule of shoulder joint. The purpose of this study was to evaluate the efficacy of hydraulic distension in the treatment of frozen shoulder. 50 Patients with 54 shoulders of frozen shoulder syndrome were treated with hydraulic distension and steroid under local anesthesia from July 2014 to August 2016.Various parameters like pain, range of movements (ROM) and function of shoulder were assessed on predistension, post distension and at 6 weeks follow up. Results were graded as excellent, good, fair, and poor based on above parameters. During post distension period, 4% of the patients had excellent results, 44% good results, 46% fair results and 14% had poor results. At follow up, 38% had excellent results, 52% had good results, 16% had fair results and 2% had poor results. Hydraulic distension is a safe, reliable, cost effective procedure without requiring specialized equipments in the management of frozen shoulder.

Comparison of Oral Glucocorticoid and Only Analgesics in the Treatment of Idiopathic Frozen Shoulder

Objectives: This study aims to assess and compare the role of oral glucocorticoids and only analgesics in treating patients with idiopathic frozen shoulder. Patients and Methods: Fifty eight patients having primary idiopathic frozen shoulder syndrome were included in this study. Secondary causes (trauma, infection) and systemic disease related to frozen shoulder were excluded. Patients were randomized into two groups: patients in the first group (18 males, 11 females; mean age 45.3 years; range 32 to 67 years) were given 0.5 mg/kg/day methylprednisolone (32 mg maximum dose) halved each week, ceased at the end of each month and patients in the second group (11 males, 18 females; mean age 46.5 years; range 29 to 73 years) were given only oral analgesics. Physical therapy as a home program was initiated as the pain subsided in both groups. Visual analog scale (VAS), active range of motion (ROM) of the shoulder joint and Disabilities of arm, shoulder and hand (DASH) questionnaire scores were evaluated at baseline every week for one month then at end of third , sixth month and first year. Results: Visual analog scale, DASH and active ROM scores in both groups were significantly improved. Statistically significant difference was detected between steroid and only oral analgesic in terms of post-treatment VAS scores. Conclusion: Glucocorticoids with physiotherapy is an effective treatment for idiopathic frozen shoulder.