Capsulitis Adhesiva

J Shoulder Elbow Surg (2011) 20, 322-325

www.elsevier.com/locate/ymse

Frozen shoulder: a consensus definition
Joseph D. Zuckerman, MD*, Andrew Rokito, MD
Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
Introduction: Frozen shoulder (FS) is a common diagnosis treated by orthopaedic surgeons and other physicians caring for musculoskeletal problems.However, there is no standard definition and classification for this common condition. Materials and methods: We asked 211 clinician members of the American Shoulder and Elbow Surgeons to review our proposed definition of FS and its classification into primary and secondary types. Secondary FS was further divided into intrinsic, extrinsic, and systemic types. The survey required responses to 5 specificquestions via an analog scale (1, strongly disagree; 5, strongly agree). Agreement was defined as a 4 or 5 on the analog scale. Results: We received 190 responses (90%). Eighty-two percent agreed with the proposed definition of FS. Eighty-five percent agreed that FS should be divided into primary and secondary types. Sixty-six percent agreed with subdivision of secondary FS into intrinsic, extrinsic,and systemic types. Eighty-four percent agreed that there was a clinical entity of primary or idiopathic FS. Eighty-five percent agreed that obtaining a consensus definition and classification of FS was a worthwhile endeavor. Discussion: Significant benefits can be gained from the development of a standard definition and classification of FS, achieved through a consensus of shoulder specialists, thatprovides a strong foundation for potential acceptance by all musculoskeletal specialists who treat this condition. Level of evidence: Basic Science Survey Study. Ó 2011 Journal of Shoulder and Elbow Surgery Board of Trustees. Keywords: Frozen shoulder; intrinsic, extrinsic and systematic types; primary or idiopathic FS

Frozen shoulder is a common condition affecting the shoulder that is treated by avariety of medical specialists including orthopaedic surgeons, rheumatologists, and physiatrists. However, it is also one of the most poorly understood shoulder conditions. A Medline search of the National Library of Medicine Citations from 1966-2008 shows 3,586 references when the search terms ‘‘frozen shoulder’’ were used. Further review of the literature indicates that there is an absence of aspecific definition of frozen shoulder, and as such, it has not been classified into
*Reprint requests: Joseph D. Zuckerman, MD, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 E 17th St, 14th Floor, New York, NY 10003. E-mail address: joseph.zuckerman@med.nyu.edu (J.D. Zuckerman).

different subtypes. The absence of a specific definition of this condition makes it difficultto compare the results of different studies that describe either diagnostic or treatment modalities for this condition. We performed an extensive literature review of frozen shoulder in an effort to determine the specific definitions that have been used by different authors. On the basis of this review, we developed a preliminary classification and definition of frozen shoulder. We previously surveyedthe membership of the American Shoulder and Elbow Surgeons (ASES). At that time, there were 128 members of the organization and 112 responded to our survey. Many members provided additional comments to the questions that were asked. At that time, we elected to consider this feedback and to repeat the survey at a later time, after the

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Frozen shoulder
Classification: Frozen Shoulder

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chest wall tumor, previous cerebrovascular accident, or more local extrinsic problems, including previous humeral shaft fracture, scapulothoracic abnormalities, acromioclavicular arthritis, or clavicle fracture. 3. Systemic: These cases occur in association with systemic...