Management of frozen shoulder – conservative vs surgical?

Management of frozen shoulder remains controversial.Codman, when he coined the term 'frozen shoulder', claimed that this disorder is 'difficult to define, difficult to treat, and difficult to explain from the point of view of pathology'; 1 almost 80 years later, we are still not much farther.Both conservative and surgical treatment may result in equal outcome two to three years from the onset.However, this is at the expense of pain, stiffness and disability for this length of time.Surgical treatment with manipulation under anaesthetic or arthroscopic release shortens this to several weeks.The authors of these two excellent papers acknowledge the differences in approach in different stages of the disorder.In early stage there is a place for conservative treatment and one may try intra-articular steroid injections.One should bear in mind that manipulation should be performed in a particular way using a short lever arm, stabilising the scapula and utilising 'Codman's paradox' to avoid torque on the arm bone and avoid complications.Physiotherapy is a crucial part of success.