title: Shoulder Stiffness: Current Concepts and Concerns.
abstract: 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 V, evidence-based review.
authors.affiliation: Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan. Electronic address: itoi-eiji@med.tohoku.ac.jp.
authors.forename: Eiji
authors.initials: E
authors.lastname: Itoi
authors.affiliation: Department of Orthopaedic Surgery, Instituto Argentino de Diagnóstico y Tratamiento, Buenos Aires, Argentina.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Arce
authors.affiliation: Department of Orthopedic Surgery, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Gregory I
authors.initials: GI
authors.lastname: Bain
authors.affiliation: Sports Medicine Center, Department of Orthopaedic Surgery, University of Groningen, Groningen, the Netherlands.
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Diercks
authors.affiliation: Taos Orthopaedic Institute, Shoulder and Elbow Service, Taos, New Mexico, U.S.A.
authors.forename: Dan
authors.initials: D
authors.lastname: Guttmann
authors.affiliation: Department of Orthopaedic Sports Medicine, University of Munich (TUM), Hospital Rechts der Isar, Munich, Germany.
authors.forename: Andreas B
authors.initials: AB
authors.lastname: Imhoff
authors.affiliation: Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, Farmington, Connecticut, U.S.A.
authors.forename: Augustus D
authors.initials: AD
authors.lastname: Mazzocca
authors.affiliation: Shoulder & Elbow Center, Funabashi Orthopaedic Hospital, Funabashi, Chiba, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sugaya
authors.affiliation: Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Gyeonggi-Do, Republic of Korea.
authors.forename: Yon-Sik
authors.initials: YS
authors.lastname: Yoo
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002062:Bursitis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D003952:Diagnostic Imaging; D006801:Humans; D007270:Injections, Intra-Articular; D057913:Joint Capsule Release; D008349:Manipulation, Orthopedic; D010808:Physical Examination; D026741:Physical Therapy Modalities; D011183:Postoperative Complications; D009626:Terminology as Topic
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal