Pandey Vivek, Chidambaram Ram, Modi Amit, Babhulkar Ashish, Pardiwala Dinshaw N, Willems W Jaap, Thilak Jai, Maheshwari Jitender, Narang Kush, Kamat Nilesh, Gupta Prateek, Reddy Raghuveer, Desai Sanjay, Sundararajan S R, Samanta Swarnendu
Investigation performed at Kasturba Medical College-Manipal, Manipal Academy of Higher Education, Manipal, India.
Orthop J Sports Med. 2022 Oct 12;10(10):23259671221118834. doi: 10.1177/23259671221118834. eCollection 2022 Oct.
The management of frozen shoulder (FS) differs depending on experience level and variation between scientific guidelines and actual practice.
To determine the current trends and practices in the management of FS among shoulder specialists and compare them with senior shoulder specialists.
Consensus statement.
A team of 15 senior shoulder specialists (faculty group) prepared a questionnaire comprising 26 questions regarding the definition, terminology, clinical signs, investigations, management, and prognosis of FS. The questionnaire was mailed to all the registered shoulder specialists of Shoulder and Elbow Society, India (SESI) (specialist group; n = 230), as well as to the faculty group (n = 15). The responses of the 2 groups were compared, and levels of consensus were determined: strong (>75%), broad (60%-74.9%), inconclusive (40%-59.9%), or disagreement (<40%).
Overall, 142 of the 230 participants in the specialist group and all 15 participants in the faculty group responded to the survey. Both groups strongly agreed that plain radiographs are required to rule out a secondary cause of FS, routine magnetic resonance imaging is not indicated to confirm FS, nonsteroidal anti-inflammatory drugs should be administered at bedtime, steroid injection (triamcinolone or methylprednisolone) is the next best option if analgesics fail to provide pain relief, passive physical therapy should be avoided in the freezing phase, <10% of patients would require any surgical intervention, and patients with diabetes and thyroid dysfunction tend to fare poorly. There was broad agreement that routine thyroid dysfunction screening is unnecessary for women, a single 40-mg steroid injection via intra-articular route is preferred, and arthroscopic capsular release (ACR) results in a better outcome than manipulation under anesthesia (MUA). Agreement was inconclusive regarding the use of combined random blood sugar (RBS) and glycosylated hemoglobin versus lone RBS to screen for diabetes in patients with FS, preference of ACR versus MUA to treat resistant FS, and the timing of surgical intervention. There was disagreement over the most appropriate term for FS, the preferred physical therapy modality for pain relief, the most important movement restriction for early diagnosis of FS, and complications seen after MUA.
This survey summarized the trend in prevalent practices regarding FS among the shoulder specialists and senior shoulder surgeons of SESI.
肩周炎（FS）的治疗方法因经验水平不同而有所差异，且科学指南与实际临床实践之间也存在差异。
确定肩部疾病专家对FS的当前治疗趋势和实际做法，并与资深肩部疾病专家进行比较。
共识声明。
由15位资深肩部疾病专家组成的团队（教员组）编制了一份包含26个问题的问卷，内容涉及FS的定义、术语、临床体征、检查、治疗及预后。该问卷被邮寄给印度肩肘协会（SESI）所有注册的肩部疾病专家（专家组；n = 230）以及教员组（n = 15）。比较两组的回答，并确定共识水平：高度共识（>75%）、广泛共识（60%-74.9%）、无定论（40%-59.9%）或存在分歧（<40%）。
总体而言，专家组的230名参与者中有142人以及教员组的所有15人回复了调查。两组均高度认同需要进行X线平片检查以排除FS的继发原因，无需常规磁共振成像来确诊FS，非甾体类抗炎药应在睡前服用，如果镇痛药无法缓解疼痛，类固醇注射（曲安奈德或甲泼尼龙）是次优选择，在冻结期应避免被动物理治疗，<10%的患者需要任何手术干预，以及糖尿病和甲状腺功能障碍患者的预后往往较差。广泛认同对于女性无需常规筛查甲状腺功能障碍，关节内单次注射40mg类固醇更佳，关节镜下关节囊松解术（ACR）的效果优于麻醉下手法松解术（MUA）。对于在FS患者中使用随机血糖（RBS）和糖化血红蛋白联合检测与单独使用RBS筛查糖尿病、治疗难治性FS时ACR与MUA的偏好以及手术干预的时机，意见无定论。在FS最合适的术语、缓解疼痛的首选物理治疗方式、FS早期诊断最重要的活动受限以及MUA后出现的并发症方面存在分歧。
本次调查总结了SESI肩部疾病专家和资深肩部外科医生对FS的普遍治疗趋势。
