The Chartered Society of Physiotherapy The Chartered Society of Physiotherapy

What did you come here to do today?

Help us to plan site improvements by sharing the reason for your visit.

A questionnaire survey of UK physiotherapists on the diagnosis and management of contracted (frozen) shoulder

Abstract

Objective

To gain insights into the diagnosis and management of contracted (frozen) shoulder (CFS) in a sample of UK physiotherapists, underpinning the development of evidence-based clinical guidelines.

Methods

An anonymous online questionnaire was developed and distributed via iCSP, targeting physiotherapists who treat CFS. For treatments, respondents were invited to consider ‘pain-predominant’ and ‘stiffness-predominant’ scenarios, choose from listed treatment options, and specify any unlisted conservative options they might consider. Frequency analysis was used for closed-ended questions, and content analysis was used for open-ended questions.

Results

In total, 289 valid responses were received. All respondents thought that movement restriction informed diagnosis. Of those specifying the manner of testing movements, 98% (121/123) included passive testing. Of those describing specific patterns of restriction, 71% (93/131) emphasised external rotation. Fifty-four percent (152/282) of valid respondents would consider suggesting/requesting imaging investigations, usually to exclude bony abnormalities. For treatment, only 46 respondents reported considering any unlisted conservative options, usually liaison regarding medication. For pain-predominant CFS, the preferred physiotherapeutic options were advice/education (96%; 277/288), injection (80%; 230/288), gentle exercise (79%; 228/288), superficial heat/cold (69%; 199/288) and acupuncture (68%; 196/288). For stiffness-predominant CFS, the preferred options were stretching (93%; 268/288), advice/education (88%; 252/288), joint mobilisations (87%; 250/288), function-based exercises (75%; 216/288) and hands-on soft-tissue techniques (59%; 170/288). Some dissociation was noted between clinical practice and research evidence. Eighty-five percent (253/284) of respondents would consider referring for an orthopaedic opinion.

Conclusions

Acknowledging restricted passive external rotation (vs the capsular pattern) as diagnostic of CFS would standardise and might improve the clinical aspect of diagnosis. The value of X-rays in differential diagnosis was under-recognised. Modalities used to treat CFS were dichotomised by pain-predominant and stiffness-predominant classifications, which may be more useful than existing classifications.

Cite this article

A questionnaire survey of UK physiotherapists on the diagnosis and management of contracted (frozen) shoulderNigel C.A. Hanchard, Lorna Goodchild, Jackie Thompson, Tracey O’Brien, Dot Davison, Chris RichardsonPhysiotherapy 1 June 2011 (volume 97 issue 2 Pages 115-125 DOI: 10.1016/j.physio.2010.08.012)

Links