Relationship between pain and range of motion in frozen shoulder

Wataru Kurashina; Hideyuki Sasanuma; Yuki Iijima; Tomohiro Saito; Akihiro Saitsu; Sueo Nakama; Katsushi Takeshita

doi:10.1016/j.jseint.2023.05.014

Relationship between pain and range of motion in frozen shoulder

JSES Int. 2023 Jun 5;7(5):774-779. doi: 10.1016/j.jseint.2023.05.014. eCollection 2023 Sep.

Authors

Wataru Kurashina^{1

2}, Hideyuki Sasanuma³, Yuki Iijima³, Tomohiro Saito³, Akihiro Saitsu³, Sueo Nakama⁴, Katsushi Takeshita³

Affiliations

¹ Rehabilitation Center, Tochigi Medical Center Shimotsuga, 420-1 Kawatsure, Ohira, Tochigi 3294498, Japan.
² Graduate School of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 3290498, Japan.
³ Department of Orthopedics Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 3290498, Japan.
⁴ Department of Orthopedics Surgery, Tochigi Medical Center Shimotsuga, 420-1 Kawatsure, Ohira, Tochigi 3294498, Japan.

Abstract

Background: A frozen shoulder (FS) is characterized by pain and limited range of motion (ROM). Although physical assessment of ROM is important for diagnosing and staging FS, ROM cannot be accurately assessed in clinical practice because of pain and muscle contraction. This study aimed to measure changes in shoulder joint ROM before and after anesthesia (ΔROM) in patients with FS and investigate the factors affecting these changes.

Methods: This study included 54 patients (age, 55.6 ± 9.4 years; 17 males; disease duration, 6.6 ± 3.4 months) with FS before manipulation under transmission anesthesia. FS was defined as having a ROM in external rotation (ER) that was less than 50% of that in the unaffected shoulder. Pain at night and during motion was assessed using a numerical rating scale. Before anesthesia, the passive ROM of forward flexion (FF), abduction (AD), and ER were measured in the supine position. After confirming that the anesthesia was effective, passive ROM was measured again.

Results: The ROM in the FF, AD, and ER after anesthesia was significantly higher than that before anesthesia (P < .001). ΔROM in the FF, AD, and ER was significantly correlated with pain at night (r = 0.51, P < .001; r = 0.45, P < .001; and r = 0.39, P = .004, respectively). Furthermore, ΔROM in the ER was significantly correlated with pain during motion (r = 0.31, P = .023) and disease duration (r = -0.31, P = .021).

Conclusion: The ROM of the FS is susceptible to pain and muscle contraction. Interventions, such as physical therapy, may be recommended after pain relief.

Keywords: Anesthesia; Assessment; Frozen shoulder; Pain; Range of motion; Relationship.