British Elbow and Shoulder Society patient care pathway: frozen shoulder

Background: Current guidelines from the British Elbow and Shoulder Society (BESS) were published in 2015 for managing frozen shoulder in the primary and secondary care setting. Updated guidelines have been developed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology. Methods: A multi-disciplinary BESS Working Group defined key management questions based on agreed outcome measures and time points. A literature search, conducted up to March 2023 following PRISMA guidelines, identified randomised controlled trials, systematic reviews, and meta-analyses. Quality assessments were performed using the GRADE Decision Framework, considering bias, imprecision, indirectness, and inconsistency. Data were extracted for meta-analysis. In the absence of high-quality trials, narrative reviews were created. Results: Consensus opinions produced statements based on the quality and volume of evidence and the magnitude of desirable and undesirable effects. These statements form a comprehensive framework for managing frozen shoulder. Discussion: This updated guideline provides evidence-based guidance for managing frozen shoulder and identifies key areas for future research.