Don’t want to be left out in the cold: Non-surgical management of Frozen Shoulder.

Dr Jeremy Lewis PhD FCSP  Professor of Musculoskeletal Research (University of Limerick, Ireland)  Reader in Physiotherapy (University of Hertfordshire, UK)  Consultant Physiotherapist  Independent Prescriber  Sonographer Central London Community Healthcare NHS Trust (www.clch.nhs.uk), London, UK Centre for Health & Human Performance (www.chhp.com), London, UK www.LondonShoulderClinic.com @JeremyLewisPT Lecture title: Don’t Want To Be Left Out In The Cold? Non-surgical Management of Frozen Shoulder. 5th Biennial Emirates Physiotherapy Conference 20th May 2016 (11:30 - 12:00) Learning Objectives This lecture will cover: 1. History and epidemiology of frozen shoulder 2. Diagnosis of frozen shoulder 3. Evidence based management of frozen shoulder 4. Challenges for the future Abstract Background: Frozen shoulder is characterised by (frequently severe) pain and a substantial loss of movement and as such is associated with considerable morbidity and frustration for patients and clinicians. It is considered to be a self-limiting condition of 1 to 3 years duration. However, studies that have purported to follow sufferers, report that loss of movement and pain may still be present at 7 years. Although the term ‘frozen shoulder’ was first coined by Codman in the 1930’s, the research underpinning our understanding of the patho-aetiology and best management remains equivocal. Objectives: The aim of this presentation is to describe an evidence based care pathway for the non-surgical management of Frozen Shoulder. The care pathway was developed after being awarded a competitive grant from Shine - The Health Foundation (www.health.org.uk). The remit was to develop a care pathway that would reduce the need for people with frozen shoulder to be referred to secondary care. In addition to the development and analysis of the clinical pathway, an independent health economist evaluated the cost of the new service in comparison to comparable care pathways being provided in secondary care. A psychologist led focus group reported on the participants’ experiences. Methods: The entire pathway was developed and run by community based specialist physiotherapists, and involved: (i) Diagnosis and health screening (ii) Ultrasound guided intra-articular glenohumeral injections (steroid and lidocaine) performed by physiotherapists (iii) Ultrasound guided intra-articular glenohumeral hydrodistension procedures (lidocaine and NaCl) performed by physiotherapists The injection therapy was embedded within a physiotherapy rehabilitation programme. Findings and Conclusions: All stages of the pathway are supported by research evidence. Clinical outcomes were good to excellent. During the project no patient required a referral to secondary care. An independently run focus group reported that participants were very satisfied with the care received. The health economic analysis demonstrated substantial savings when the care was delivered in the community compared with secondary care. The project has highlighted areas for potential future research. References: Page, M et al (2014) Manual therapy and exercise for adhesive capsulitis (frozen shoulder). Cochrane Database of Systematic Reviews. CD011275 Buchbinder R, et al (2008) Athrographic ditension for adhesive capsulitis (frozen shoulder) (Review). Cochrane Database of Systematic Reviews. CD007005. Maund E, et al (2012) Management of frozen shoulder: a systematic review and cost-effectiveness analysis. Health Technologies Assessment. 16 (11). ISSN 1366-5278 NICE- National Institute for Health and Care Excellence. NICE Pathways -Clinical Knowledge Summaries. http://cks.nice.org.uk/#azTab Lewis JS. (2015) Frozen shoulder contraction syndrome. Grieve's Modern Musculoskeletal Physiotherapy (4th edition). Jull G, Moore A, Falla D, Lewis JS, McCarthy C, Sterling M (eds) Elsevier, London. Lewis J. (2015). Frozen shoulder contracture syndrome - Aetiology, diagnosis and management. Manual Therapy. 20(1), 2-9. doi:10.1016/j.math.2014.07.006 Acknowledgements: The Health Foundation Shine-Inspiring Improvement http://www.health.org.uk http://www.health.org.uk/media_manager/public/75/programme_library_docs/Central%20London%20-%20Frozen%20Shoulder.pdf