Watchful Waiting Shows Value as Treatment Option for Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by pain and stiffness in the shoulder, resulting in difficulty of movement in the shoulder. It affects 2-5% of the population, typically those between 40 and 60 years old, with an increased risk for people with diabetes and hypothyroidism. Even without treatment, frozen shoulder can get better with time but recovery may take up to three years. Pain medications and physical therapy (PT) are typically used as the main treatments, but there is little evidence showing PT is effective.
 
Study Comparing Frozen Shoulder Treatments
A single-provider, randomized controlled trial (RCT) study used patient-reported outcome measures (PROMs) and health care costs to compare watchful waiting (WW) versus PT for the treatment and management of frozen shoulder. The study, “Watchful Waiting Achieves Higher Value Than Physical Therapy for the Treatment of Idiopathic Frozen Shoulder: A Prospective Randomized Controlled Trial,” randomized 61 patients to either WW (31 patients) or PT (30 patients) and assessed outcomes at six weeks, three months, six months and 12 months.
 
The study is the first RCT to compare PT versus WW for frozen shoulder treatment using a value-based health care framework. The primary outcome was the American Shoulder and Elbow Surgeons Score (ASES), and secondary outcomes included the patient value (12-month ASES score divided by health care costs). The outcomes of the study include:

• WW and PT patients improved significantly at each time point for all PROMs (p<0.05 for all).
• There were no significant differences between WW and PT treatments at any point in time (p>0.05 for all).
• PT patients incurred 10 times higher costs than WW patients (normalized mean difference: 1,635.67; 95% CI: 967.19, 2,304.15; p<0.001) and achieved only 16.9% of the patient value (normalized mean difference: -146.97; 95%CI: -207.47, -86.47; p<0.001). 

Based on the study findings, physicians should inform their patients with adhesive capsulitis of the treatment options. These include non-operative management with medications, physical therapy, watchful waiting and surgery when indicated. Physicians may then decide on the most appropriate treatment plan for their patient which may include the patient’s preferences and needs.
 
With more than 39,000 members, the American Academy of Orthopaedic Surgeons is the world’s largest medical association of musculoskeletal specialists. The AAOS advances musculoskeletal health by providing comprehensive education to help orthopedic surgeons and allied health professionals best treat patients. The AAOS is the source for information on bone and joint conditions, treatments and related musculoskeletal healthcare issues; and it leads the healthcare discussion on advancing quality.