The United Kingdom Frozen Shoulder Trial
A frozen shoulder is when the tissues around the shoulder have become inflamed, painful and feel tight.
A frozen shoulder tends to improve with time, sometimes taking up to three years.
Most people are treated by their family doctor, and some may have physiotherapy. 1 in 10 patients with a frozen shoulder do not improve, and are referred to hospital for further, specialist, treatment. This may involve a structured programme of physiotherapy or surgery.
What we did
Between 1st April 2015 and 31st December 2017 we screened 914 patients, 55% were randomly assigned to one of three commonly provided NHS treatments for frozen shoulder:
1. Early structured physiotherapy with a steroid injection (99 patients).
2. Manipulation under anaesthetic (MUA) with a steroid injection (201 patients).
3. Arthroscopic capsular release (ACR) with MUA (203 patients).
The aim of each treatment is to reduce pain and to improve movement and function.
What we found
This is the largest randomised trial to compare early structured physiotherapy with a steroid injection, manipulation under anaesthesia with a steroid injection, and arthroscopic capsular release with MUA for frozen shoulder.
Early structured physiotherapy with a steroid injection could be accessed earlier in the NHS however, patients were more likely to need further treatment.
Manipulation under anaesthesia with a steroid injection was the most cost-effective option but, patients had to wait longer to receive the treatment.
Arthroscopic capsular release with MUA carried higher risks and costs however, patients were less likely to require further treatment.
Overall, the study found that none of the treatments were superior on patient-reported outcomes for pain and function at 12 months.
Frozen shoulder: which treatment should you choose?
Following the study, the below animation was created to aid healthcare professionals and patients in their evidence based decision making for frozen shoulder treatment.
Professor Amar Rangan
South Tees Hospitals NHS Foundation Trust
NIHR Health Technology Assessment (HTA) Programme
Patients who are at least 18 years old, diagnosed with frozen shoulder and for whom secondary causes for their condition have been ruled out.
Surgical treatments compared with early structured physiotherapy in secondary care for adults with primary frozen shoulder: the UK FROST three-arm RCT
Brealey, et al. (2020)
Health Technology Assessment
Physiotherapy for primary frozen shoulder in secondary care: Developing and implementing stand-alone and post operative protocols for UK FROST and inferences for wider practice.
Hanchard, et al. (2020)
United Kingdom Frozen Shoulder Trial (UK FROST), multi-centre, randomised, 12 month, parallel group, superiority study to compare the clinical and cost-effectiveness of Early Structured Physiotherapy versus manipulation under anaesthesia versus arthroscopic capsular release for patients referred to secondary care with a primary frozen shoulder: study protocol for a randomised controlled trial.
Brealey, et al. (2017)