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Original article

Vol. 150 No. 0708 (2020)

A large-scale assessment of the healthcare burden of adhesive capsulitis of the shoulder joint

  • Samy Bouaicha
  • Karl Wieser
  • Philipp Kriechling
  • Stefan M. Scholz-Odermatt
Cite this as:
Swiss Med Wkly. 2020;150:w20188



Frozen shoulder is a poorly understood pathological entity that is characterised by a painful and stiff shoulder. To analyse the socioeconomic impact of frozen shoulder in terms of cost generation and prolonged absence from work, we conducted a retrospective cohort study based on shoulder injuries through accidents in Switzerland.


Data were obtained from the comprehensive database of the Statistical Service for the Swiss National Accident Insurances (SSUV). Cases with shoulder injuries (ICD-10 codes S4* and M84.3*) and/or an additional code of adhesive capsulitis (M75.0) were extracted. Outcomes were work incapacity, with long-term work incapacity defined as absence from work for >90 days and very-long-term cases with >360 days lost. Healthcare and treatment costs as well as total insurance expenses were measured over a 5-year follow-up. Multivariate statistical analyses were used to quantify the effect of the frozen shoulder complication.


Among all 456,926 patients with a shoulder injury, 5% or a total of 22,228 posttraumatic frozen shoulder cases were observed over the 8-year period. Patients suffering from a frozen shoulder after shoulder injury showed significantly longer sick leave periods with 30.8% long-term and 9.7% very-long-term cases compared with 9.4% and 1.3%, respectively, in the non-frozen shoulder cohort. Overall costs per case for an injured shoulder without developing a frozen shoulder was roughly CHF 8000, whereas expenses for cases with posttraumatic and postoperative frozen shoulder were CHF 34,000 per case.


Developing a frozen shoulder after a shoulder injury is associated with significant longer work incapacities (3.3–7.5 times) and is responsible for costs of CHF 78 million every year. The presented numbers are for cases covered by the compulsory accident insurance only and do not include the even more frequent idiopathic frozen shoulder cases.


  1. Hand C, Clipsham K, Rees JL, Carr AJ. Long-term outcome of frozen shoulder. J Shoulder Elbow Surg. 2008;17(2):231–6. doi:.
  2. Vastamäki H, Kettunen J, Vastamäki M. The natural history of idiopathic frozen shoulder: a 2- to 27-year followup study. Clin Orthop Relat Res. 2012;470(4):1133–43. doi:.
  3. Bridgman JF. Periarthritis of the shoulder and diabetes mellitus. Ann Rheum Dis. 1972;31(1):69–71. doi:.
  4. Cakir M, Samanci N, Balci N, Balci MK. Musculoskeletal manifestations in patients with thyroid disease. Clin Endocrinol (Oxf). 2003;59(2):162–7. doi:.
  5. Lo SF, Chu SW, Muo CH, Meng NH, Chou LW, Huang WC, et al. Diabetes mellitus and accompanying hyperlipidemia are independent risk factors for adhesive capsulitis: a nationwide population-based cohort study (version 2). Rheumatol Int. 2014;34(1):67–74. doi:.
  6. Milgrom C, Novack V, Weil Y, Jaber S, Radeva-Petrova DR, Finestone A. Risk factors for idiopathic frozen shoulder. Isr Med Assoc J. 2008;10(5):361–4.
  7. Hsu JE, Anakwenze OA, Warrender WJ, Abboud JA. Current review of adhesive capsulitis. J Shoulder Elbow Surg. 2011;20(3):502–14. doi:.
  8. van der Windt DA, Koes BW, de Jong BA, Bouter LM. Shoulder disorders in general practice: incidence, patient characteristics, and management. Ann Rheum Dis. 1995;54(12):959–64. doi:.
  9. Huberty DP, Schoolfield JD, Brady PC, Vadala AP, Arrigoni P, Burkhart SS. Incidence and treatment of postoperative stiffness following arthroscopic rotator cuff repair. Arthroscopy. 2009;25(8):880–90. doi:.
  10. Scholz-Odermatt S. Die UVG-Medizinstatistik im Internet. Med Mitt. 2008;79:124–32. Available at:
  11. Scholz-Odermatt SM, Luthi F, Wertli MM, Brunner F. Direct Health Care Cost and Work Incapacity Related to Complex Regional Pain Syndrome in Switzerland: A Retrospective Analysis from 2008 to 2015. Pain Med. 2019;20(8):159–69. doi:.
  12. Fingerhut LA, Warner M. The ICD-10 injury mortality diagnosis matrix. Inj Prev. 2006;12(1):24–9. doi:.
  13. Kobayashi T, Karasuno H, Sano H, Hamada J, Takase K, Tamai K, et al. Representative survey of frozen shoulder questionnaire responses from the Japan Shoulder Society: What are the appropriate diagnostic terms for primary idiopathic frozen shoulder, stiff shoulder or frozen shoulder? J Orthop Sci. 2019;24(4):631–5. doi:.
  14. Duplay S. De la periarthrite scapulohumerale. Rev Frat D Trav De Med. 1896;53:226.