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Routine x-rays for suspected Frozen Shoulder offer little over diagnosis based on history and clinical examination alone


Frozen shoulder is a common condition and current guidelines state that it is a diagnosis of exclusion. Along with a history and clinical examination, routine x-ray is mandated to rule out any masquerading pathology such as fracture, dislocation, metastatic lesions or severe osteoarthritis. Despite the certainty of the guidelines there is a lack of evidence to support the use of routine x-rays in this situation.

A retrospective review following SQUIRE Guidelines

A retrospective review was performed of all x-rays obtained in the diagnosis of frozen shoulder between February 2014 and August 2017 in an integrated musculoskeletal interface service. Results were screened and the prevalence of masquerading pathology was determined.

350 shoulder x-rays that were performed with a differential diagnosis of frozen shoulder were reviewed. 213 were from female patients (60.9%), mean age was 57.7 years (SD 10.4). 342 (97.7%) did not have any concerning features. Six (1.7%) had severe osteoarthritis, one (0.3%) had a fracture and one (0.3%) had a lucency. All 8 patients with ‘masquerading’ pathology had findings from the history and clinical examination that would have warranted an x-ray regardless of differential diagnosis of frozen shoulder.

The findings of this retrospective review of a large number of x-rays do not support the requirement of a routine x-ray to rule out masquerading pathology to confirm the diagnosis. The data suggests that it is unnecessary for patients who do not have a relevant clinical history suggesting serious or masquerading pathology to undergo routine imaging.

Acceptance Date Feb 25, 2019
Publication Date Jun 24, 2019
Journal Musculoskeletal Care
Print ISSN 1478-2189
Publisher Wiley
Pages 288-292
Keywords adhesive capsulitis, contracted shoulder, frozen shoulder, serious pathology, x-ray
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