Shoulder Stiffness: Current Concepts and Concerns

Eiji Itoi, Guillermo Arce, Gregory I. Bain, Ronald L. Diercks, Dan Guttmann, Andreas B. Imhoff, Augustus D. Mazzocca, Hiroyuki Sugaya, Yon Sik Yoo

Research output: Contribution to journalReview articlepeer-review

167 Scopus citations


Shoulder stiffness can be caused by various etiologies such as immobilization, trauma, or surgical interventions. The Upper Extremity Committee of ISAKOS defined the term “frozen shoulder” as idiopathic stiff shoulder, that is, without a known cause. Secondary stiff shoulder is a term that should be used to describe shoulder stiffness with a known cause. The pathophysiology of frozen shoulder is capsular fibrosis and inflammation with chondrogenesis, but the cause is still unknown. Conservative treatment is the primary choice. Pain control by oral medication, intra-articular injections with or without joint distension, and physical therapy are commonly used. In cases with refractory stiffness, manipulation under anesthesia or arthroscopic capsular release may be indicated. Because of various potential risks of complications with manipulations, arthroscopic capsular release is preferred. After the capsular release, stepwise rehabilitation is mandatory to achieve satisfactory outcome. Level of Evidence Level V, evidence-based review.

Original languageEnglish
Pages (from-to)1402-1414
Number of pages13
JournalArthroscopy - Journal of Arthroscopic and Related Surgery
Issue number7
StatePublished - 1 Jul 2016
Externally publishedYes


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