FROZEN SHOULDER A CONSENSUS AND EVIDENCE-

DERIVED INTEGRATED CARE PATHWAY FOR THE MANAGEMENT OF ‘FROZEN SHOULDER’

‘Frozen’ shoulder is a disabling and painful condition that affects 2-5% of the population, with the peak incidence being in women in the 5th and 6th decades of life (1) Classically there are three stages characterised by pain (freezing), stiffness (frozen)

and recovery (thawing), respectively. Most patients make a satisfactory recovery within two years but sig-

nificant numbers are left with residual symptoms of vary- ing severit (2) There is no clear treatment of choice or nationally agreed pathway identified in the litera- ture. Recent research findings could improve the management of this condition if imple- mented (2,3). The aim of this project is to establish a consensus and evidence- based approach to this condition.

METHOD We propose to combine a series of semi-structured interviews with key professionals involved in the care of patients with frozen shoulder with an online discussion project open to the wider medical and physical ther- apy community (see the next col- umn for details on getting involved), to establish criteria for interventions and develop a patient pathway, using a two-part flowchart design and evidence checking task. Comparison of the results is made with research findings and recommendations in the literature.

GET INVOLVED IN THE ONLINE WORKSHOP sportEX will be hosting our first ever online workshop which will follow the same process outlined below. We will have online a group of 6 specialists including physiother- apists Dr Dylan Morrissey and Jo Gibson accompanied by an orthopaedic consultant, two sports physicians and a general practitioner.

The workshop objectives will include: ■ to discuss and refine a care pathway for frozen shoulder ■ to provide an update about the most recent evidence base for frozen shoulder treatment and rehabilitation

■ a discussion and debate of this evidence base with your own profession as well as with other professions

■ following completion of the session you will receive a document of all the conference discussions and decisions in html format which you are then able to save and/or print out for your future reference or for inclusion in your continuing professional development portfolio.

The workshop will take place on Monday July 31st at 7pm and last for approximately 2 hours during which time you will be able to leave your computer for short periods if you wish to. The cost to participate is £30 if you have an online subscription or £40 for others, numbers are limited. When you book we will post you a booking confirmation followed by an email reminder of the event a week before it takes place. Then 24 hours before the event we will pro- vide you with log in details. To sign up for the workshop telephone sportEX on 020 8287 3312 or visit the Online conferences area in the shopping area of www.sportex.net

By Dr Dylan Morrissey, MCSP, MSc, PhD

INTRODUCTION Frozen shoulder is difficult to define, difficult to diagnose early and certainly difficult to manage. Patients present at a variety of stages with no clear treatment of choice being identifiable from the literature. There is a widely held assumption that all patients make a full recovery in the fullness of time although this has been shown not to be the case (2). Research has shown that there are differences in the patient experience of frozen shoulder depend-

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ing on the nature of management but that no interventions make a clear long term difference. For example, patients who have a combination of physiotherapy and intra-articular cortico-steroid injection (IACI) at an early stage have less pain and better function at an earlier stage of their condition compared to patients who have an IACI or physiotherapy on its own (3). There is a need to manage these patients optimally in order to minimise disability and optimise recovery, which requires inter-disciplinary working. There is therefore a need to define best practice and integrated care pathways.

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