{"id":10579,"date":"2023-05-26T06:00:24","date_gmt":"2023-05-26T05:00:24","guid":{"rendered":"https:\/\/blogs.bmj.com\/bjsm\/?p=10579"},"modified":"2023-05-25T07:59:49","modified_gmt":"2023-05-25T06:59:49","slug":"the-msk-playbook-frozen-shoulder","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bjsm\/2023\/05\/26\/the-msk-playbook-frozen-shoulder\/","title":{"rendered":"The MSK Playbook: Frozen Shoulder"},"content":{"rendered":"

Key words:\u00a0<\/b>#MSKplaybook #Mindthesofttissuegap #frozenshoulder #MSKultrasound #SEM #Hydroditension<\/span><\/p>\n

Introduction<\/b><\/p>\n

Frozen shoulder (adhesive capsulitis) is a common condition within community musculoskeletal (MSK) interface services, which presents insidiously and significantly impacts patients\u2019 quality of life and function.<\/span><\/p>\n

In this blog, we discuss how a community-based pathway can permit early diagnosis through prompt referral to rehabilitation, alongside access to injection treatment and MSK ultrasound when there is diagnostic uncertainty. Close links with the shoulder\u00a0<\/span>orthopaedics team can also facilitate early escalation of patients with significant cuff tear or post-trauma.\u00a0<\/span><\/p>\n

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Figure 1: The MSK playbook: frozen shoulder<\/b><\/p>\n

Bringing a one stop shop model to the diagnosis of frozen shoulder<\/b><\/p>\n

Frozen shoulder is associated with significant disability during the acute and post-acute phases. Patients can often present to various primary care clinicians \u2013 general practitioners, first contact practitioners, or practice-based physiotherapists, depending on local staffing and resources. This is a challenge for the early diagnosis and management of frozen shoulder, as not all primary care services have the capacity to offer regular reviews and continuous rehabilitation alongside potential injection therapies.<\/span><\/p>\n

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Figure 2: Natural history of frozen shoulder(1)<\/b><\/p>\n

A \u2013 Short episode of frozen shoulder with full resolution of symptoms\u00a0<\/span><\/p>\n

B \u2013 Frozen shoulder with resolution of symptoms<\/span><\/p>\n

C \u2013 Prolonged episode of frozen shoulder with chronic long-term deficit\u00a0<\/span><\/p>\n

Frozen shoulder has a natural timeline for improvement; however, early diagnoses can assist patients to navigate treatment options. In short lived episodes or mild symptoms, this may mean a full resolution of symptoms with rehabilitation +\/- injection therapy. In cases where the symptoms are more significant, prolonged or chronic, clear referral links for hydrodistension, and early treatment is key for accelerated recovery. Suprascapular nerve blocks can also be considered if there is appropriate expertise available.\u00a0\u00a0<\/span><\/p>\n

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Figure 3: Summary of the initial phase of the community based MSK pathway for frozen shoulder<\/b><\/p>\n

A focussed clinical history, examination, and X-ray (two views) can be used to rule out osteoarthritis; in most cases, this will confirm the diagnosis. However, if there is a suspicion of a significant rotator cuff tear (trauma) or tendinopathy, MSK ultrasound can help to rule in or rule out this diagnosis.<\/span><\/p>\n

Background<\/b><\/p>\n