Analysis of the Epidemiological and Surgical Predictors of Frozen shoulder Observed in a 5-year Pilot at Zhejiang Provincial Hospital of Chinese Medicine

doi:10.21203/rs.3.rs-3865649/v1

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Analysis of the Epidemiological and Surgical Predictors of Frozen shoulder Observed in a 5-year Pilot at Zhejiang Provincial Hospital of Chinese Medicine

https://doi.org/10.21203/rs.3.rs-3865649/v1

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Background

Frozen shoulder constitutes a disease category associated with significant clinical morbidity and complications. However, the precise risk factors contributing to its development remaining unidentified.

In this study, a clinical database was established through the collection of medical records from frozen shoulder patients who were hospitalized in the Department of Tuina at The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine) between 1 January 2017 and 30 December 2022. A randomized case-control design was employed to identify potential risk factors by analyzing the demographic characteristics of the patients. Additionally, logistic regression analysis was conducted to ascertain the prognostic risks associated with frozen shoulder, including factors such as age, gender, and surgical interventions.

Methods

A total of 176 patients with frozen shoulder with a median age of 55.94 years were enrolled in this study. Complicated diabetes (B, 2.517; OR, 12.396; 95% CI, 3.656-42. 028; P=.000), and cervical spondylosis (B, 1.495; OR, 4.459; 95% CI, 1.857-10.709; P=.001) were at higher risk in patients with bursitis compared to controls. In the intention to treat analysis (ITT) population, 125 persons choose surgical treatment and 51 choose conservative treatment, and long duration of illness (B, -0.716; OR, 0.489; 95% CI, 0.260-0.916; P=.026) and long hospital stay (B, 0.46; OR, 1.582; 95% CI, 1.008-2.482; P=.046), accompanied by cervical spondylosis (B, 1.149; OR, 3.155; 95% CI, 1. 335-7.453; P=.009) and hypertension (B, 1.279; OR, 3.593; 95% CI, 1.508-8.556; P=.004) patients were more likely to opt for surgery, and health insurance had little impact on whether patients operated or not (P>0.05).

Results

The study identified various risk factors for frozen shoulder, including obesity, thyroid nodules, diabetes, and cervical spondylosis. Additionally, patients with long-term disease, short hospital stays, and concomitant hypertension or cervical spondylosis demonstrated a higher likelihood of choosing surgical intervention.

Biological sciences/Psychology

Health sciences/Anatomy

Frozen shoulder

Diabetes

Surgical Intervention

Course of Disease

Length of Hospital Stay

frozen shoulder, referred to as periacetabular arthritis in medical terminology, is a persistent periacetabular disorder resulting from aseptic inflammation of the joint capsule. It exhibits a prevalence rate ranging from 2–5%, with a greater occurrence observed among older individuals, those with diabetes, and the female population.

frozen shoulder symptoms encompass peripheral shoulder joint pain, as well as restricted active and passive shoulder range of motion, leading to functional impairment of the joint over a prolonged period and a diminished quality of life.

This condition is characterized by the development of fibroproliferative tissue fibrosis, resulting in the transformation of fibroblasts containing type I and type III collagen into smooth muscle fibroblasts. Additionally, it involves neovascularisation, local inflammation, and ultimately leads to the fibrotic contracture of the shoulder capsule, accompanied by clinical stiffness[14].

The etiology and pathogenesis of frozen shoulder remain uncertain[12], and limited research has been conducted on the epidemiology of frozen shoulder and its associated risk factors in the urban population of China. Consequently, employing logistic regression analysis to identify surgical interventions and risk factors for the development of frozen shoulder is imperative in order to mitigate its occurrence.

The clinical course of frozen shoulder typically spans a minimum of one year, commencing with an initial phase characterized by a "freezing" episode lasting approximately 2–9 months, during which shoulder pain precedes a decline in range of motion. This is followed by a subsequent "stiffening" phase lasting approximately 4–12 months, wherein the patient experiences a reduction in pain but an improvement in range of motion. Ultimately, a "thawing" phase lasting approximately 5–24 months ensues, during which the patient's range of motion gradually improves, leading to an overall enhancement in their quality of life[6, 30].

The current management of frozen shoulder encompasses both surgical and non-surgical approaches.[23] While non-surgical interventions generally yield favorable results for the majority of patients, surgical intervention becomes imperative in cases where non-surgical methods prove ineffective[29, 33]. Non-surgical treatment modalities primarily involve the administration of pharmacological agents and biologics, such as NSAIDs and glucocorticoids, as well as physical therapy techniques like acupuncture, extracorporeal shock wave therapy, early structured physiotherapy (ESP), and range of motion training, among others.[15, 26]

Although surgical treatment options for frozen shoulder, such as manipulative therapy under anesthesia (MUA) and arthroscopic capsular release (ACR), have been utilized, there is currently a lack of established systematic evidence-based management for this condition. Additionally, the associated risk factors for frozen shoulder remain unknown [20, 25]. The United Kingdom Frozen Shoulder Trial (UK FROST, Study ID: ISRCTN48804508) has shed light on the potential complications associated with ACR, highlighting the financial and operational benefits of alternative treatments such as ESP and MUA, with manipulative therapy being the most efficient option.[2, 24]

The aim of our study was to evaluate the risk factors of patients that are significantly associated with the occurrence of frozen shoulder, in comparison to a matched control group without frozen shoulder, with the ultimate goal of identifying and deriving the specific risk factors.

Study design and data source

A retrospective comparative study was conducted to identify all patients who were admitted to the Department of Tuina at The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine) between 1 January 2017 and 30 December 2022, and were diagnosed with frozen shoulder using the diagnosis codes M75.000 (frozen shoulder) or M75.001 (Periarthritis of the shoulder). All patients received information about our study. All experiments were conducted in accordance with relevant guidelines and regulations. The Research Ethics Committee of The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine) approved the study and confirmed that the study did not require written informed consent from patients (2022-KL-022-02).

During the same time frame, we conducted physical examinations on a cohort of healthy individuals in order to establish a control group for our study. This control group was randomly selected from the Electronic Medical Record (EMR) and matched with the case group in terms of sex, age, and absence of frozen shoulder. The age discrepancy between the control and case groups was limited to 5 years, and the number of individuals in the control group was equal to that of the case group, maintaining a 1:1 ratio.

Study sample

The documentation of surgical intervention for frozen shoulder was additionally documented using the Current Procedural Terminology (CPT) codes 29825, 23020, and 23700, which are standardized codes utilized in the medical field to describe medical, surgical, and diagnostic services provided. A control group of patients without frozen shoulder, matched in terms of sex and age, was identified for the purpose of comparing demographic and patient-related factors (see Table I).

Exposure

The primary focus of inquiry pertains to identifying the demographic groups that exhibit heightened vulnerability to frozen shoulder, as opposed to those displaying diminished susceptibility. This determination was made through the analysis of diverse diagnostic findings and surgical pathology, extracted from the medical records of patients who underwent CT or MRI scans for frozen shoulder observation, as well as shoulder arthroscopy for pain management. A comparative examination of these populations was conducted over a span of five years, aiming to ascertain the factors contributing to frozen shoulder susceptibility and the corresponding treatment approaches adopted by individuals.

Outcome of interest

Demographic information including sex (male, female), age (≤ 45, 46 ~ 55, 56 ~ 65, >65), and body mass index(BMI) (< 18, 18 ~ 23.9, 24 ~ 27.4, ≥ 27.5)was collected for all patients. Mortality was obtained from all membership files within the institution, we expanded the mortality endpoint to 5 years for a better follow-up.

Covariates

Additionally, the study recorded the coexistence of various medical comorbidities, such as cervical spondylosis, diabetes mellitus, thyroid nodule, hypertension, hepatitis, gastritis, fatty liver, lumbar disc herniation, contralateral shoulder joint disease, and osteoporosis. Furthermore, data regarding the disease progression, duration of hospitalization, and insurance details were gathered.

Noninferiority

Summary statistics were computed for continuous variables and are presented as means, standard deviations (SD), and ranges. Categorical variables are reported as frequencies and percentages. The t-test was employed to compare measurement values across groups, the χ2 test was utilized to compare rates between groups, and the Mann-Whitney test was applied for rank data.Furthermore, logistic regression analysis was employed to ascertain significant correlations between patient-related variables and the diagnosis of frozen shoulder, as well as to identify significant associations between patient factors and the requirement for surgical intervention in cases of frozen shoulder. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed for the aforementioned associations. All statistical analyses were conducted using SPSS 25.0 software. A P value of less than .05 was considered statistically significant.

Statistical analysis

A total of 176 patients diagnosed with frozen shoulder and an equal number of control patients without frozen shoulder were identified over a span of 5 years. The groups were meticulously matched based on sex and age, with women constituting 56.25% (99 out of 176) of the patients. The average age of patients in the frozen shoulder group was 55.94 years, with a standard deviation of 8.57. Notably, the majority of patients fell within the age range of 40 to 70 years, as indicated in Table 1.

Table 1

Comparison of Demographic Characteristics for Bursitis Patients vs. the Control Group
Patient Factor	n (%)	Bursitis group (n = 176) n (%)	Control group (n = 176) n (%)	P value
Sex				1
Male	154(43.75%)	77 (43.75%)	77(43.75%)
Female	198(56.25%)	99 (56.25%)	99 (56.25%)
Age (\(\stackrel{-}{x}\pm s\))		55.94 ± 8.57	55.74 ± 8.13	0.87
≤ 45	32(9.09%)	15(8.52%)	17(9.66%)
46 ~ 55	163(46.31%)	83(47.16%)	80(45.45%)
56 ~ 65	116(32.95%)	56(31.82%)	60(34.09%)
>65	41 (11.65%)	22(12.50%)	19(10.80%)
Body Mass Index (BMI)				< 0.001
< 18	3 (0.85%)	3(1.70%)	3(1.70%)
18 ~ 23.9	233(66.19%)	106(60.23%)	127(72.16%)
24 ~ 27.4	92 (26.14%)	52(29.55%)	40(22.73%)
≥ 27.5	21 (5.97%)	15(8.52%)	6(3.41%)
Medical comorbidities
Cervical spondylosis	49 (13.92%)	41(23.3%)	8(4.5%)	< 0.001
Diabetes mellitus	38 (10.80%)	34(19.3%)	4(2.27%)	< 0.001
Hypertension	52 (14.77%)	37(21.0%)	15(8.52%)	0.001
Hepatitis	10 (2.84%)	10(5.6%)	0(0.0%)	0.001
Gastritis	29 (8.24%)	23(13.1%)	6(3.41%)	0.001
fatty liver	56 (15.91%)	22(39.3)	34(19.32%)	0.08
Lumbar disc herniation	41 (11.65%)	26(14.8%)	15(8.52%)	0.068
Contralateral shoulder joint disease	3 (0.85%)	3(1.70%)	0(0.00%)	0.082
Osteoporosis	9 (2.56%)	8(4.55%)	1(0.57%)	0.018
thyroid nodule	63 (17.90%)	9(5.11%)	54(30.68%)	0.000

There were no statistically significant differences observed in terms of gender, age, fatty liver, Lumbar disc herniation, and contralateral shoulder joint disease between the two groups (P > 0.05). However, patients with frozen shoulder exhibited a significantly higher rate of obesity compared to the control group (P < 0.01). Furthermore, when compared to the control group, significant differences were observed in BMI, cervical spondylosis, diabetes, hypertension, hepatitis, gastritis, and osteoporosis (P < 0.01 or P < 0.05).

Binary Logistic regression analysis was carried out with the occurrence of frozen shoulder as the dependent variable and the variables with statistical significance in the univariate analysis as independent variables. The results showed that BMI (B, 0.460; OR,1.585; 95% CI, 1.044–2.405; P = .031), Cervical spondylopathy (B, 1.495; OR, 4.459; 95% CI, 1.857–10.709; P = .001), Diabetes (B, 2.517; OR, 12.396; 95% CI, 3.656–42.028; P = .000), Gastritis (B, 1.486; OR, 4.419; 95% CI, 1.403–13.912; P = .011), Thyroid nodule (B,-2.269; OR,1.585; 95% CI, 1.044–2.405; P = .031) were independent risk factors for frozen shoulder (Table 2).

Table 2

Multivariable adjusted OR and 95% CI for Bursitis
Parameter	B	Standard error	Wald chisquare	Pr > chi-square	OR (95% CI)
BMI Cervical spondylopathy	0.460 1.495	0.213 0.447	4.672 11.184	0.031 0.001	1.585(1.044–2.405) 4.459(1.857–10.709)
Diabetes	2.517	0.623	16.330	0.000	12.396(3.656–42.028)
Hypertension	0.763	0.397	3.704	0.054	2.145(0.986–4.668)
Hepatitis Syphilis	21.216	12315	0.000	0.999	-
Gastritis	1.486	0.585	6.448	0.011	4.419(1.403–13.912)
Osteoporosis	1.544	1.146	1.816	0.178	4.682(0.496–44.215)
thyroid nodule	-2.269	0.457	24.658	0.000	0.103(0.042–0.253)

Among the cohort of 176 individuals diagnosed with frozen shoulder, a total of 125 patients opted for surgical intervention. Notably, when compared to the control group, patients who underwent surgery exhibited statistically significant disparities in various aspects, including medical insurance, disease duration, length of hospital stay, as well as comorbidities such as cervical spondylopathy, hypertension, gastritis, and lumbar disc protrusion (P < 0.01 or P < 0.05) (as presented in Table 3).

Table 3

Comparison of Demographic Characteristics for Bursitis Operative Group versus the Nonoperative Grou
Patient factor	n (%)	Surgical treatment(n = 125) n (%)	Conservative treatment(n = 51) n (%)	P value
Sex				0.075
Male, n (%)	77 (43.75%)	60 (48.00%)	17 (33.33%)
Female, n (%)	99 (56.25%)	65 (52.00%)	34 (66.67%)
Age (\(\stackrel{-}{x}\pm s\))		55.44\(\pm\)7.69	57.16\(\pm\)10.39	0.314
≤ 45	15 (8.52%)	8 (6.40%)	7 (13.73%)
46 ~ 55	83 (47.16%)	65 (52.00%)	18 (35.29%)
56 ~ 65	56 (31.82%)	41 (32.80%)	15 (29.41%)
>65	22 (12.50%)	11 (8.80%)	11 (21.57%)
BMI (\(\stackrel{-}{x}\pm s\))		23.32\(\pm\)3.09	23.21\(\pm\)2.92	0.845
< 18	3 (1.70%)	1 (0.80%)	2 (3.92%)
18 ~ 23.9	106 (60.23%)	78 (62.40%)	28 (54.90%)
24 ~ 27.4	52 (29.55%)	35 (28.00%)	17 (33.33%)
≥ 27.5	15 (8.52%)	11 (8.80%)	4 (7.84%)
Medical insurance				0.037
Provincial units	70 (39.77%)	42 (33.60%)	28 (54.90%)
Municipal level unit	75 (42.61%)	60 (48.00%)	15 (29.41%)
Rural areas	7 (3.98%)	4 (3.20%)	3 (5.88%)
No medical insurance	24 (13.64%)	19 (15.20%)	5 (9.80%)
Course of disease				< 0.003
< 2months	20 (11.36%)	6 (4.80%)	14 (27.45%)
2-9months	116 (65.91%)	88 (70.40%)	28 (54.90%)
10-18months	28 (15.91%)	22 (17.60%)	6 (11.76%)
> 18months	12 (6.82%)	9 (7.20%)	3 (5.88%)
Hospital Stay		6.78\(\pm\)4.25	9.22\(\pm\)5.53	< 0.002
0-5days	67 (38.07%)	54 (43.20%)	13 (25.49%)
6-10days	70 (39.77%)	51 (40.80%)	19 (37.25%)
11–15 days	30 (17.05%)	17 (13.60%)	13 (25.49%)
> 15days	9 (5.11%)	3 (2.40%)	6 (11.76%)
Medical Comorbidities
Cervical Spondylopathy	41 (23.30%)	19 (15.20%)	22 (43.14%)	< 0.001
Diabetes	34 (19.32%)	24 (19.20%)	10 (19.61%)	0.95
Hypertension	37 (21.02%)	19 (15.20%)	18 (35.29%)	< 0.003
Hepatitis Syphilis	10 (5.68%)	8 (6.40%)	2 (3.92%)	0.519
Gastritis	23 (13.07%)	11 (8.80%)	12 (23.53%)	< 0.009
Fatty liver	22 (12.50%)	15 (12.00%)	7 (13.73%)	0.754
Lumbar disc protrusion	26 (14.77%)	11 (8.80%)	15 (29.41%)	< 0.001
Osteoporosis	8 (4.55%)	4 (3.20%)	4 (7.84%)	0.18
Thyroid nodule	9 (5.11%)	4 (3.20%)	5 (9.80%)	0.071

Binary Logistic regression analysis was carried out with the occurrence of operative as the dependent variable and the variables with statistical significance in the univariate analysis as independent variables. The results showed that the course of disease (B, -0.716; OR, 0.489; 95% CI, 0.260–0.916; P = .026), hospital stay (B, 0.46; OR, 1.582; 95% CI, 1.008–2.482; P =. 046), hypertension (B, 1.279; OR, 3.593; 95% CI, 1.508–8.556; P = .004), cervical spondylosis (B, 1.495; OR, 4.459; 95% CI, 1.857–10.709; P = .001) were independent risk factors for operative (Table 4).

Table 4

Multivariable Adjusted OR and 95% CI for Bursitis
Parameter	B	Standard error	Wald chisquare	Pr > chi-square	OR (95% CI)
Course of Disease	-0.716	0.321	4.981	0.026	0.489(0.260–0.916)
Hospital Stay	0.459	0.230	3.982	0.046	1.582(1.008–2.482)
Medical Insurance	-0.286	0.248	1.337	0.248	0.751(0.462–1.220)
Hypertension	1.279	0.443	8.343	0.004	3.593(1.508–8.556)
Gastritis	0.670	0.554	1.462	0.227	1.954(0.660–5.785)
Cervical Spondylosis	1.149	0.439	6.861	0.009	3.155(1.335–7.453)
Lumbar Disc Protrusion	0.795	0.523	2.311	0.128	2.215(0.795–6.177)

The examination of risk factors associated with disease aids in the understanding of its frozen shoulder. This examination encompassed a sample of 99 female and 77 male patients admitted to the Department of Tuina at The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), with an average patient age of 56.4 years.

In comparison to the sex- and age-matched control group, multifactorial regression analysis revealed that obesity, cervical spondylosis, diabetes, gastroschisis, and hypothyroidism were identified as significant risk factors for the onset of frozen shoulder. Additionally, thyroid tuberculosis and disability were found to be noteworthy risk factors for the development of frozen shoulder.

In the matched surgical and non-surgical groups of patients, disease duration, duration of hospitalization, hypertension, and gastritis were important correlates of patients' selection of surgical treatment and were independent of the type of medical insurance (provincial, provincial, rural medical, self-pay).

Multiple studies on frozen shoulder have indicated that women aged 40 to 60 constitute the high-prevalence group, primarily due to the age-related degeneration of rotator cuff tendons. The aging process of tendons leads to a reduction in ultimate strain, ultimate load, elasticity, and overall tensile strength. Consequently, this degeneration affects the tendon cells and collagen fibers of the shoulder joint, resulting in the local accumulation of lipids and matrix (glycosaminoglycans). Ultimately, these changes impact the range of motion of the acromioclavicular joint.[19] The highest incidence of capsular adhesions in the acromioclavicular joint (47.2%) was registered in the 46- to 55-year-old group of patients in this research (Table I), with 99 cases (56.3%) of women included in the study, mostly developing between 46 and 65 years of age, which is also consistent with the results of previous epidemiological studies.

The elevated glucose concentration in the bodily fluids of individuals with diabetes mellitus results in an increase in collagen cross-linking,[4, 18] thereby impacting the stability of connective tissue in the shoulder joint. Additionally,[28] genes such as WNT7B, MMP14, and SFRP4 have been identified as potential co-pathogenic factors for both frozen shoulder and diabetes mellitus.[10] The occurrence of frozen shoulder in diabetic patients is estimated to range from 10.8–30%, with a lifetime prevalence of 76% reported by Juel in individuals aged 45 years and older with type 1 diabetes complicated by frozen shoulder, compared to a prevalence of 14% in the nondiabetic group.[9]

Recent epidemiological studies have revealed that China exhibits a substantial surge in the prevalence of diabetes on a global scale, with an estimated 11% of the population being affected [21, 34]. Moreover, the present study demonstrates a prevalence of diabetes of 19.3% within the freezing shoulder case group, thereby further substantiating the significant correlation between diabetes and the onset of frozen shoulder.

The prevalence of overweight and obesity has witnessed a significant surge over the past forty years, emerging as a prominent global public health concern. In China alone, the occurrence of obesity reached 34.3% in 2019. This escalating trend of obesity is linked to various incapacitating musculoskeletal disorders in adulthood, thereby amplifying healthcare expenses and societal burdens. Consequently, it results in diminished quality of life and elevated disability rates.

In this study, 52 (29.6%) of 176 patients with frozen shoulder were overweight and 15 (8.5%) were obese, and elevated BMI was also a risk factor for frozen shoulder (OR, 1.585; 95% CI, 1.044–2.405; P = .031).

The pathogenesis of thyroid disorders (thyroiditis, hypothyroidism, hyperthyroidism, nodules, and cancer) and musculoskeletal disorders, especially shoulder disorders, is a hot topic of current research.[22] Vicenti found that 10.9% of patients with thyroid disorders developed periarteritis, and patients with subclinical thyrotoxicosis had the highest prevalence of adhesive shoulder capsulitis.[31] Schiefer found the prevalence of hypothyroidism in FS patients to be 27.2%.[27]

In the present study, only 9 (5.1%) patients with thyroid nodules among 176 patients with adhesive shoulder capsulitis compared to 54 (30.7%) patients with thyroid nodules in the control group, probably because thyroid ultrasound was included in the health screening program and thyroid ultrasound was not mandatory during hospitalization of frozen shoulder patients, thus the detection rate of thyroid nodules was higher in healthy patients.[7] The results of the current study also suggest that thyroid nodules cannot be considered a risk factor for frozen shoulder, while the relevance of functional thyroid disorders such as hypothyroidism and hyperthyroidism remains to be investigated (B, -2.269; OR,1.585; 95% CI,1.044–2.405; P = .031). In an analysis of other associated risk factors, we found that 23.3% of patients with frozen shoulder were diagnosed with cervical spondylosis and the prevalence in the control group was only 4.5%. This result confirmed a strong association between frozen shoulder and cervical spondylosis (B,1.495; OR,4.459; 95% CI,1.857–10.709; P = .001). In addition, gastroschisis was the most common medical co-morbidity in the population and was more common in the frozen shoulder group (13.1%) compared to the control group, and gastroschisis was also a significant correlate of frozen shoulder (B,1.486; OR,4.419;95% CI,1.403–13.912; P = .011).

In the present study, a total of 176 patients diagnosed with frozen shoulder were included. Among them, 125 patients (71%) opted for surgical intervention, while 51 patients (29%) chose non-surgical treatment. Notably, the duration of disease was found to be significantly longer (P < 0.000) in the surgical group (45.52 ± 1.3 months) compared to the non-surgical group (32.04 ± 1.72 months). Furthermore, a subsequent multifactorial analysis revealed a significant association between the duration of disease and the decision to undergo surgery (B,-0.716; OR,0.489; 95% CI,0.260–0.916; P = .026).

Furthermore, the surgical group exhibited a significantly shorter length of stay (4.88 ± 0.17 days) compared to the nonoperative group (6 ± 0.28 days) (P < 0.000). Subsequent multifactorial analysis revealed a significant association between length of stay and surgery (B,0.46; OR,1.582; 95% CI,1.008–2.482; P = .046). Consequently, patients with frozen shoulder experiencing chronic shoulder pain and limited motion prioritize achieving increased shoulder mobility and reduced pain within a short timeframe [11].

In the current study, it was demonstrated that out of the 176 individuals diagnosed with frozen shoulder, 39.8% were beneficiaries of provincial health insurance, 42.6% were covered by municipal health insurance, 4% were insured under rural health insurance, and 13.6% were self-pay patients. Furthermore, the multifactorial analysis indicated that health insurance status did not significantly influence the likelihood of undergoing surgery among the patients (P = .248).

In addition, we found a significant association between hypertension (B,1.279; OR,3.593; 95% CI,1.508–8.556; P = .004), gastritis (B,1.149; OR,3.155; 95% CI,1.335–7.453; P = .009) and surgery.[13] The radiating pain in the cervical and shoulder region can occur when cervical spine pathology occurs because the nerves that innervate the shoulder joint and upper extremity originate from the brachial plexus, which consists of the cervical spinal nerves, and the blood supply to the shoulder joint also comes from the neck.

It is postulated that there exists a potential association between cervical spondylosis and the exacerbation of shoulder pain in patients diagnosed with frozen shoulder. Nocturnal pain is a characteristic manifestation of frozen shoulder, which may further intensify accompanying symptoms such as heightened blood pressure and cervical spondylosis. Consequently, frozen shoulder patients presenting with hypertension and cervical spondylosis may exhibit a preference for surgical intervention in order to alleviate the adverse repercussions of nocturnal pain.

Nevertheless, our study has certain limitations. Firstly, it only encompasses frozen shoulder patients who were admitted to the Department of Tuina at The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine). Consequently, the findings may not be representative of the entire population of frozen shoulder patients. Additionally, it is possible that some patients may have preferred non-surgical approaches, such as Chinese medicine, acupuncture, physiotherapy, or rehabilitation exercises, for functional recovery. Furthermore, we did not develop a risk prediction model specifically for frozen shoulder, an area that warrants further investigation in our future research endeavors.

The research identified various risk factors for frozen shoulder, including obesity, thyroid nodules, diabetes, and cervical spondylosis. Additionally, patients with long-term disease, short hospital stays, and concomitant hypertension or cervical spondylosis demonstrated a higher likelihood of choosing surgical intervention.

Acknowledgments

This study was supported by the Science and technology project of traditional Chinese medicine in Zhejiang Province (NO. 2022ZA058), Medical Health Science and Technology Project of Zhejiang Provincial Health Commission (NO. 2023KY855), Natural Science Foundation of China (Grant no. 81774447) and Zhejiang Traditional Chinese Medicine Scientific Research Foundation (No. 2020ZB095).

Author contributions

Zukang Qiao and Xi Pang collecting data, Nengyi Jiang , Li Xiang, BS^b, QiuShuang Li, MS^c*, Junlong Xiong, MS^a*

Zukang Qiao: Funding acquisition and Conceptualization, Xi Pang and Li Xiang: Data Curation, Nengyi Jiang: Writing Original Draft and Review, QiuShuang Li and Junlong Xiong: Formal analysis and Writing Review, Zukang Qiao: Project administration.

Data availability statement

All data can be found in the attachment.

Declaration of competing interest

Authors hereby declare that there are no competing interests.

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No competing interests reported.

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Analysis of the Epidemiological and Surgical Predictors of Frozen shoulder Observed in a 5-year Pilot at Zhejiang Provincial Hospital of Chinese Medicine

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Noninferiority

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