An international consensus on the etiology, risk factors, diagnosis and Management for individuals with Frozen Shoulder: a Delphi study

Paul Salamh¹, Brent Stoner¹, Nathaniel Ruley¹, Huiling Zhu¹, Marcus Bateman², Rachel Chester³, Liesbet Da Baets^{4

5}, Jo Gibson^{6

7}, Luise Hollmann⁸, Martin Kelley^{9

10}, Jeremy Lewis^{11

12

13

14}, Philip McClure¹⁵, Karen McCreesh¹⁶, Michel Gcam Mertens^{17

18

19}, Lori Michener²⁰, Amee L Seitz²¹, Filip Struyf²², Joseph Zuckerman²³, William King²⁴

Affiliations

¹ Krannert School of Physical Therapy, University of Indianapolis, Indianapolis, IN, USA.
² Derby Shoulder Unit, University Hospitals of Derby and Burton, Derby, UK.
³ School of Health Sciences, Faculty of Medicine and Health, University of East Anglia, Norwich, Norfolk, England.
⁴ Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Belgium.
⁵ Department of Physical and Rehabilitation Sciences, University Hospitals Leuven, Belgium.
⁶ School of Health Sciences, Liverpool Hope University, Liverpool England.
⁷ UL Rehabilitation Specialist, Rehab4Performance, Liverpool, England.
⁸ Discipline of Physiotherapy, University of Canberra, Bruce, ACT, Australia.
⁹ Good Shepherd Penn Partners, Philadelphia, PA ,USA.
¹⁰ Perelman School of Medicine, Department of Orthopaedics, University of Pennsylvania, Philadelphia, PA, USA.
¹¹ Therapy Department, Central London Community Healthcare National Health Service Trust, Finchley Memorial Hospital, London, UK.
¹² School of Health Sciences, University of Nottingham, Nottingham, UK.
¹³ School of Life and Health Sciences, University of Nicosia, Republic of Cyprus, Cyprus.
¹⁴ School of Allied Health, University of Limerick, Limerick, Ireland.
¹⁵ Department of Physical Therapy, Arcadia University, Glenside, PA, USA.
¹⁶ School of Allied Health, and Health Research Institute, University of Limerick, Limerick, Ireland.
¹⁷ Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium.
¹⁸ Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands.
¹⁹ Pain in Motion International Research consortium (PiM).
²⁰ Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.
²¹ Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL ,USA.
²² Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium.
²³ Department of Orthopedic Surgery, Department of Orthopedic Surgery at NYU Grossman School of Medicine, New York, NY, USA.
²⁴ Bognor War Memorial Hospital, Sussex Community NHS Foundation Trust, Bogner Regis, UK.

PMID: 40042389
PMCID: PMC12281644 (available on 2026-03-05)
DOI: 10.1080/10669817.2025.2470461

An international consensus on the etiology, risk factors, diagnosis and Management for individuals with Frozen Shoulder: a Delphi study

Paul Salamh et al. J Man Manip Ther. 2025 Aug.

. 2025 Aug;33(4):309-320.

doi: 10.1080/10669817.2025.2470461. Epub 2025 Mar 5.

Authors

Affiliations

¹ Krannert School of Physical Therapy, University of Indianapolis, Indianapolis, IN, USA.
² Derby Shoulder Unit, University Hospitals of Derby and Burton, Derby, UK.
³ School of Health Sciences, Faculty of Medicine and Health, University of East Anglia, Norwich, Norfolk, England.
⁴ Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Belgium.
⁵ Department of Physical and Rehabilitation Sciences, University Hospitals Leuven, Belgium.
⁶ School of Health Sciences, Liverpool Hope University, Liverpool England.
⁷ UL Rehabilitation Specialist, Rehab4Performance, Liverpool, England.
⁸ Discipline of Physiotherapy, University of Canberra, Bruce, ACT, Australia.
⁹ Good Shepherd Penn Partners, Philadelphia, PA ,USA.
¹⁰ Perelman School of Medicine, Department of Orthopaedics, University of Pennsylvania, Philadelphia, PA, USA.
¹¹ Therapy Department, Central London Community Healthcare National Health Service Trust, Finchley Memorial Hospital, London, UK.
¹² School of Health Sciences, University of Nottingham, Nottingham, UK.
¹³ School of Life and Health Sciences, University of Nicosia, Republic of Cyprus, Cyprus.
¹⁴ School of Allied Health, University of Limerick, Limerick, Ireland.
¹⁵ Department of Physical Therapy, Arcadia University, Glenside, PA, USA.
¹⁶ School of Allied Health, and Health Research Institute, University of Limerick, Limerick, Ireland.
¹⁷ Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium.
¹⁸ Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands.
¹⁹ Pain in Motion International Research consortium (PiM).
²⁰ Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.
²¹ Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL ,USA.
²² Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium.
²³ Department of Orthopedic Surgery, Department of Orthopedic Surgery at NYU Grossman School of Medicine, New York, NY, USA.
²⁴ Bognor War Memorial Hospital, Sussex Community NHS Foundation Trust, Bogner Regis, UK.

PMID: 40042389
PMCID: PMC12281644 (available on 2026-03-05)
DOI: 10.1080/10669817.2025.2470461

Abstract

Introduction: There has been an emergence of evidence in the area of frozen shoulder (FS) within the past decade related to risk factors, etiology, diagnosis, and management. It has become increasingly challenging for clinicians and researchers to stay up to date in these areas, particularly with the clinical practice guidelines that are available being few and outdated. To this end, the aim of this study was to produce an international consensus on the risk factors, etiology, diagnosis and management for individuals with FS.

Methods: During phase one a steering committee was formed in order to identify experts in the area of FS, examine the current evidence related to FS and identify key areas lacking consensus. Phase two consisted of inviting experts to participate in a three-round survey with a priori consensus level set at 80%. Descriptive statistics were utilized to determine the characteristics of the expert panel, response rate, and level of consensus.

Results: A total of 14 international experts responded to all three rounds of the Delphi survey with 100% response rate following round one. Consensus was reached for 101 items (57 in the first round, 37 in the second round and 7 in the third and final round). Specific to key topic areas, the following number of items reached consensus; etiology 9 items (diabetes mellitus, trauma, shoulder arthroscopy, thyroid disease, prolonged immobilization, adrenocorticotropic hormone deficiency, metabolic synderome, connective tissue disorders, and hyperlipidemia), risk factors 40 items (including biophysical factors for developing FS and biophysical and psychosocial factors influencing the Management and course of outcomes related to FS), diagnosis 19 items (4 confounding the diagnosis and 15 signs and symptoms associated with FS), Management 33 items overall and categorized into effectiveness for early and later stages of FS).

Conclusion: The results of this international Delphi study help to provide a consensus on key elements to consider in clinical practice related to etiology, risk factors, diagnosis, and management for those with FS.

Keywords: Delphi; Frozen shoulder; glenohumeral joint; orthopedics; range of motion; shoulder; stiffness.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

References

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An international consensus on the etiology, risk factors, diagnosis and Management for individuals with Frozen Shoulder: a Delphi study

Affiliations

An international consensus on the etiology, risk factors, diagnosis and Management for individuals with Frozen Shoulder: a Delphi study

Authors

Affiliations

Abstract

Conflict of interest statement

References

MeSH terms

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous