Objective
Primary frozen shoulder causes significant pain and progressively restricts shoulder movements. Diagnosis is primarily clinically based on patient history and physical examination. Management is mainly non-invasive owing to its self-limiting clinical course. However, clinical practice guidelines for frozen shoulder have not yet been developed in Korea. The developed guidelines aim to provide evidence-based recommendations for the diagnosis and treatment of frozen shoulder.
Methods
A guideline development committee reviewed the literature from four databases (PubMed, Embase, Cochrane Library, and KMbase). Using the PICO (Population, Intervention, Comparator, and Outcome) framework, the committee formulated two backgrounds and 16 key questions to address common clinical concerns. Recommendations were made using the Grading of Recommendations, Assessment, Development, and Evaluation framework.
Results
Diabetes, thyroid disease, and dyslipidemia significantly increase the risk of developing a frozen shoulder. Although frozen shoulder is often self-limiting, some patients may experience long-term disabilities. Ultrasound and magnetic resonance imaging should be used as adjunctive tools alongside clinical diagnosis, and not as independent diagnostic methods. Noninvasive approaches, such as medications, physical modalities, exercises, electrical stimulation, and manual therapy, may reduce pain and improve shoulder function. Other noninvasive interventions have limited evidence, and their application should be based on clinical judgment. Intra-articular steroid injections are recommended for treatment, and physiotherapy or hydrodilatation with steroid injections can also be beneficial.
Conclusion
These guidelines provide evidence-based recommendations for diagnosing and treating primary frozen shoulder.

Citations

• Comparison of efficacy of intra-articular injection of platelet-rich plasma with bupivacaine and steroid combination in chronic shoulder pain
  Naveen Malhotra, Neha Sinha, Amit Kumar, Ritu, Disha Gupta, Naman Malhotra
  Journal of Anaesthesiology Clinical Pharmacology.2026; 42(1): 120.     CrossRef
• Hyperlipidemia exacerbates frozen shoulder fibrosis by activating the TGF-β/Smad2/3 signaling pathway via the TBX5-TNC-Itgα2 axis
  Fan Jiang, Yi Zhang, Jinlong Ma, Tengbo Yu, Youliang Shen
  iScience.2026; 29(2): 114660.     CrossRef
• Axillary recess capsular edema is associated with heterogeneity in rehabilitation response: Implications for a magnetic resonance imaging-based stratified treatment strategy for adhesive capsulitis
  De-Ting Zhu, Yan-Qi Shan, Yan Wang, ChenChen, Da-Dong Zhang, Xiu-Li Kan, Quan-Bing Zhang, Xue-Ming Li, Yun Zhou
  Archives of Physical Medicine and Rehabilitation.2026;[Epub]     CrossRef
• Clinical efficacy of Mulligan mobilization with movement versus proprioceptive neuromuscular facilitation on pain reduction and shoulder mobility in patients with frozen shoulder
  Sylejman Miftari, Mejdi Aliu
  Health, sport, rehabilitation.2026;[Epub]     CrossRef

Objective
To investigate changes of cardiac and muscle damage markers in exercise-induced hypertension (EIH) runners before running (pre-race), immediately after completing a 100-km ultramarathon race, and during the recovery period (24, 72, and 120 hours post-race).
Methods
In this observational study, volunteers were divided into EIH group (n=11) whose maximum systolic blood pressure was ≥210 mmHg in graded exercise testing and normal exercise blood pressure response (NEBPR) group (n=11). Their blood samples were collected at pre-race, immediately after race, and at 24, 72, and 120 hours post-race.
Results
Creatine kinase (CK) and cardiac troponin I (cTnI) levels were significantly higher in EIH group than those in the NEBPR group immediately after race and at 24 hours post-race (all p<0.05). However, lactate dehydrogenase (LDH), creatine kinase-myocardial band (CKMB), or CKMB/CK levels did not show any significant differences between the two groups in each period. N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were significantly higher in EIH group than those in NEBPR group immediately after race and at 24 and 72 hours postrace (all p<0.05). A high sensitivity C-reactive protein (hs-CRP) level was significantly higher in EIH group than that in NEBPR group at 24 hours post-race (p<0.05).
Conclusion
The phenomenon of higher inflammatory and cardiac marker levels in EIH group may exaggerate cardiac volume pressure and blood flow restrictions which in turn can result in cardiac muscle damage. Further prospective studies are needed to investigate the chronic effect of such phenomenon on the cardiovascular system in EIH runners.

Citations

• Asymptomatic HyperCKemia: A Case Report and Literature Review
  成锋 李
  Advances in Clinical Medicine.2025; 15(07): 408.     CrossRef
• Possible Mechanisms for Adverse Cardiac Events Caused by Exercise-Induced Hypertension in Long-Distance Middle-Aged Runners: A Review
  Young-Joo Kim, Kyoung-Min Park
  Journal of Clinical Medicine.2024; 13(8): 2184.     CrossRef
• Relationship between echocardiographic characteristics and cardiac biomarkers during long-distance trail running
  Romain Jouffroy, Hélène Hergault, Juliana Antero, Antoine Vieillard Baron, Nicolas Mansencal
  Frontiers in Cardiovascular Medicine.2022;[Epub]     CrossRef
• Electrical Cardiometry and Cardiac Biomarkers in 24-h and 48-h Ultramarathoners
  Che-Hung Liu, Li-Hua Li, Ming-Long Chang, Wei-Fong Kao, Chorng-Kuang How, Jiun-I Lai, Yen-Kuang Lin, Yu-Hui Chiu, Wen-Han Chang
  International Journal of Sports Medicine.2021; 42(11): 1035.     CrossRef
• Exercise-Induced Cardiac Troponin Elevations: From Underlying Mechanisms to Clinical Relevance
  Vincent L. Aengevaeren, Aaron L. Baggish, Eugene H. Chung, Keith George, Øyunn Kleiven, Alma M.A. Mingels, Stein Ørn, Rob E. Shave, Paul D. Thompson, Thijs M.H. Eijsvogels
  Circulation.2021; 144(24): 1955.     CrossRef
• Long‐term biological variability and the generation of a new reference interval for plasma N‐terminal pro‐B‐type natriuretic peptide in Labrador retrievers
  S. Gomart, D. Allaway, M. Harrison, D. Dickson, J. Seo, L. Ferasin, J. R. Payne, M. J. Hezzell, K. Borgeat
  Journal of Small Animal Practice.2020; 61(6): 368.     CrossRef
• Acute Responses of Novel Cardiac Biomarkers to a 24-h Ultra-Marathon
  Aleksandra Żebrowska, Zbigniew Waśkiewicz, Pantelis T. Nikolaidis, Rafał Mikołajczyk, Damian Kawecki, Thomas Rosemann, Beat Knechtle
  Journal of Clinical Medicine.2019; 8(1): 57.     CrossRef
• Race duration and blood pressure are major predictors of exercise-induced cardiac troponin elevation
  Øyunn Kleiven, Torbjørn Omland, Øyvind Skadberg, Tor Harald Melberg, Magnus Friestad Bjørkavoll-Bergseth, Bjørn Auestad, Rolf Bergseth, Ole Jakob Greve, Kristin Moberg Aakre, Stein Ørn
  International Journal of Cardiology.2019; 283: 1.     CrossRef