Frozen shoulder and the Big Five personality traits

doi:10.1016/j.jse.2013.07.049

Journal of Shoulder and Elbow Surgery

Volume 23, Issue 2, February 2014, Pages 221-226

https://doi.org/10.1016/j.jse.2013.07.049 Get rights and content

Background

In the past, several studies have suggested the existence of a “periarthritic personality” in patients with frozen shoulder. We conducted a study to determine differences in personality traits in patients with primary and secondary frozen shoulders.

Materials and methods

We prospectively evaluated 118 patients (84 women and 34 men; mean age, 53.8 years; SD 7.56) with a frozen shoulder. Of these patients, 48 had an idiopathic frozen shoulder and 70 had a secondary frozen shoulder. Personality traits were determined by the NEO Five-Factor Inventory (NEO-FFI) scale. This questionnaire measures the 5 major personality traits and is based on the norms determined in a neutral test situation for 2415 controls.

Results

Compared with healthy controls, no differences in personality traits were found in patients with primary and secondary frozen shoulder, except for Conscientiousness and Extraversion, for which patients with secondary frozen shoulder scored significantly higher than healthy controls. Patients with primary frozen shoulder scored significantly higher on Openness to Experience than did patients with secondary frozen shoulder; on the other 4 Big Five personality traits, no significant differences were found between patients with primary and secondary frozen shoulder. More specifically, patients with idiopathic frozen shoulder did not score higher on the trait Neuroticism as would be expected from previous publications.

Conclusions

Our study results do not indicate that patients with an idiopathic frozen shoulder have a specific personality compared with healthy controls. Only a few differences were found in personality traits when the entire frozen shoulder group was compared with healthy controls and between patients with primary and secondary frozen shoulders. The results of this study suggest that these differences are not sufficient to speak about a specific “frozen shoulder personality.”

Section snippets

Methods

We recruited 118 consecutive patients, 84 women and 34 men with a mean age of 53.88 years (SD = 7.56; range, 28 to 74 years), who presented to our Orthopaedic Upper Limb Clinic with a frozen shoulder for more than 6 months between December 2009 and May 2012. Participants provided written informed consent before inclusion in our study.

Results

A total of 48 patients were identified with an idiopathic frozen shoulder. The remaining 70 had a secondary frozen shoulder, and of these 40 were systemic and 30 were nonsystemic frozen shoulders (Fig. 1). Nine patients had thyroid disease, 17 had hypercholesterolemia, 6 had isolated diabetes and 7 had a combination of the above. Five patients had type 1 diabetes and 5 patients had type 2 diabetes. One patient had Dupuytren's disease. Postoperative frozen shoulders were diagnosed after rotator

Discussion

This study is the first to analyze personality traits of a selected group of patients with a frozen shoulder by widely accepted diagnostic criteria.¹⁶ Within a contemporary biopsychosocial view, it is commonly accepted that musculoskeletal disorders are multifactorial and multidimensional in origin.¹ Possible risk factors are of a physical, psychosocial, or personal origin. In treating patients with a frozen shoulder, the clinical impression often arises that this condition is more often seen

Conclusion

This study does not confirm that persons with an idiopathic frozen shoulder have a specific personality compared with healthy controls. Only a few differences in personality traits were observed when the entire frozen shoulder group was compared with healthy controls and between patients with primary and secondary frozen shoulders with use of the NEO-FFI. In our opinion, these differences are not sufficient to state that a specific "frozen shoulder personality" exists.

Disclaimer

The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

References (16)

A.R. Jensen
The Maudsley Personality Inventory
Acta Psychologica
(1958)
S.P. Smith et al.
The association between frozen shoulder and Dupuytren's disease
J Shoulder Elbow Surg
(2001)
J.D. Zuckerman et al.
Frozen shoulder: a consensus definition
J Shoulder Elbow Surg
(2011)
P.M. Bongers et al.
Epidemiology of work related neck and upper limb problems: psychosocial and personal risk factors (part I) and effective interventions from a bio behavioural perspective (part II)
J Occup Rehabil
(2006)
F.E. Bruckner et al.
A prospective study of adhesive capsulitis of the shoulder ("frozen shoulder") in a high risk population
Q J Med
(1981)
T.D. Bunker et al.
Frozen shoulder and lipids
J Bone Joint Surg Br
(1995)
EA Codman
The shoulder: rupture of the supraspinatus tendon and other lesions in or about the subacromial bursa
(1934)
P.T. Costa et al.
Revised NEO Personality Inventory (NEO-PI-R) and the Five Factor Inventory (NEO-FFI): professional manual
(1992)

There are more references available in the full text version of this article.

Cited by (26)

Depression and Anxiety Are Associated With Worse Subjective and Functional Baseline Scores in Patients With Frozen Shoulder Contracture Syndrome: A Systematic Review
2022, Arthroscopy, Sports Medicine, and Rehabilitation
Citation Excerpt :
In other words, this systematic review cannot answer the question of whether individuals who are depressed and anxious are more prone to develop FSCS. The existence of personality traits that facilitate the onset of FSCS was a theme discussed in the included literature,28-31 but the results were variable; accordingly, the hypothesis of a specific “frozen shoulder personality” was not substantiated. Moreover, authors in this article believe that the intrinsic characters of the FSCS (i.e., subdoluous and criptogenetic onset, and high pain, high disability in middle-aged working subjects) could be factors that increase the probability to develop psychological complaints as a consequence of pathology.
To investigate whether psychological factors, such as avoidance behavior, fear, pain catastrophization, kinesiophobia, anxiety, depression, optimism, and expectation are associated with different subjective and functional baseline scores in patients with frozen shoulder contracture syndrome (FSCS).
Searches were conducted in MEDLINE, Cochrane Library (CENTRAL Database), PEDro, Pubpsych, and PsychNET.APA without restrictions applied to language, date, or status of publication. Two authors reviewed study titles, abstract, and full text based on the following inclusion criteria: adult population (≥ 30 < 70 years old) with FSCS.
Seven hundred and seventy-six records were included by the search strategies. After title final screening, 6 studies were included for the qualitative synthesis. Psychological features investigated were anxiety, depression, pain-related fear, pain catastrophizing, and pain self-efficacy; reported outcomes included pain, function, disability, quality of life, and range of motion. Data suggest that anxiety and depression impact self-assessed function, pain, and quality of life. There is no consensus on the correlation between psychological variables and range of motion. Associations were suggested between pain-related fear, pain-related beliefs, and pain-related behavior and perceived arm function; pain-related conditions showed no significant correlation with range of motion and with perceived stiffness at baseline.
Scores traditionally thought to assess physical dimensions like shoulder pain, disability, and function seem to be influenced by psychological variables. In FSCS patients, depression and anxiety were associated with increased pain perception and decreased function and quality of life at baseline. Moreover, pain-related fear and catastrophizing seem to be associated with perceived arm function.
Psychological risk factors for the occurrence of frozen shoulder after rotator cuff repair
2022, Revue de Chirurgie Orthopedique et Traumatologique
L’épaule gelée est une complication redoutée après réparation de la coiffe des rotateurs.
Il existe des terrains psychologiques prédisposants à la survenue de cette complication.
Nous avons inclus prospectivement 77 patients opérés consécutivement d’une réparation de coiffe sous arthroscopie entre mai 2018 et avril 2019. Nous avons associé à l’évaluation fonctionnelle via un score de Constant, une évaluation psychologique de l’anxiété et de la dépression via l’HADS et de kinésiophobie via le Tampa Scale, en préopératoire et 6 mois après l’intervention.
Au suivi à 6 mois, 8 patients présentaient un diagnostic d’épaule gelée (groupe A), 65 avaient des amplitudes articulaires satisfaisantes (groupe B), 4 patients ont été perdus de vue. Dans le groupe épaule gelée, le taux d’anxiété préopératoire était significativement plus important que dans le groupe B (50 % versus 17 %, p = 0,04). Par ailleurs, on retrouvait significativement plus de femmes (p = 0,028), et plus de patients en maladie professionnelle dans le groupe A (75 % versus 18,5 %, p = 0,027). À 6 mois postopératoire, le score de Constant était de 55 dans le groupe épaule gelée versus 72 dans le groupe B (p = 0,004). La dépression et la kinésiophobie n’ont pas été identifiées comme des facteurs de risque de survenue d’une épaule gelée après réparation de la coiffe des rotateurs.
L’anxiété préopératoire, mais aussi le genre féminin et le statut de maladie professionnelle sont des facteurs de risque de survenue d’épaule gelée après réparation de coiffe des rotateurs. La connaissance de ces facteurs prédisposants permet de mieux cibler les patients à risque.
III ; étude prospective.
Psychological risk factors for the occurrence of frozen shoulder after rotator cuff repair
2022, Orthopaedics and Traumatology: Surgery and Research
Citation Excerpt :
In 1953, Coventry et al. mentioned a “capsulitis personality” combining apathy, muscle contractures, and lower pain threshold [22]. In 2014, Debeer et al. investigated which personality traits may contribute to the occurrence of primary or secondary adhesive capsulitis but could not draw any clear conclusions [23]. Kinesiophobia and avoidance behaviors are known factors for chronic pain and functional limitations.
Frozen shoulder is a dreaded complication after rotator cuff repair.
There are psychological determinants for this complication.
We prospectively included 77 consecutive patients who underwent arthroscopic rotator cuff repair between May 2018 and April 2019. Along with a functional evaluation, we determined the Constant score, anxiety and depression levels based on the HADS, and kinesiophobia based on the Tampa Scale preoperatively and 6 months after the surgery.
At the 6-month follow-up, 8 patients had been diagnosed with frozen shoulder (group A), 65 patients had satisfactory joint range of motion (group B) and 4 were lost to follow-up. In the frozen shoulder group, the preoperative anxiety rate was significantly higher than in group B (50% versus 17%, p = 0.04). Furthermore, there were significantly more women (p = 0.028) and more patients with an occupational disease in group A (75% versus 18%, p = 0.027). At 6 months postoperative, the Constant score was 55 in the group with a frozen shoulder versus 72 in group B (p = 0.004). Neither depression nor kinesiophobia were risk factors for the development of frozen shoulder after rotator cuff repair.
Preoperative anxiety, the female sex and occupational disease are all risk factors for the occurrence of frozen shoulder after rotator cuff repair. Knowing these predisposing factors will help us better manage at-risk patients.
III, prospective study.
Shoulder Stiffness: Current Concepts and Concerns
2016, Arthroscopy - Journal of Arthroscopic and Related Surgery
Citation Excerpt :
Other recognized predisposing factors for shoulder stiffness are immobilization, thyroid disorders, cardiac diseases (e.g., myocardial infarction), pulmonary disorders (e.g., tuberculosis, emphysema), neoplastic disorders, neurologic conditions (e.g., Parkinson disease, cerebral hemorrhage), medications (e.g., treatment with protease inhibitors for HIV), smoking, and Dupuytren contracture.18,22-32 Psychological factors may also play a role.33 Intercellular adhesion molecule-1 (ICAM-1) plays a crucial role in synovial inflammation.
Shoulder stiffness can be caused by various etiologies such as immobilization, trauma, or surgical interventions. The Upper Extremity Committee of ISAKOS defined the term “frozen shoulder” as idiopathic stiff shoulder, that is, without a known cause. Secondary stiff shoulder is a term that should be used to describe shoulder stiffness with a known cause. The pathophysiology of frozen shoulder is capsular fibrosis and inflammation with chondrogenesis, but the cause is still unknown. Conservative treatment is the primary choice. Pain control by oral medication, intra-articular injections with or without joint distension, and physical therapy are commonly used. In cases with refractory stiffness, manipulation under anesthesia or arthroscopic capsular release may be indicated. Because of various potential risks of complications with manipulations, arthroscopic capsular release is preferred. After the capsular release, stepwise rehabilitation is mandatory to achieve satisfactory outcome.
Level V, evidence-based review.
The Stiff Shoulder
2016, Rockwood and Matsen’s The Shoulder
Asian ethnicity: a risk factor for adhesive capsulitis?
2018, Revista Brasileira de Ortopedia
Avaliar se a etnia asiática é um fator de risco no desenvolvimento da capsulite adesiva. Os objetivos secundários foram descrever a prevalência da capsulite adesiva no ambulatório especializado em ombro e a dispersão dos casos de capsulite por faixa etária.
Estudo transversal que comparou a taxa de capsulite adesiva na etnia asiática (casos) com outras etnias (controles). Excluímos pacientes com fraturas e sintomatologia que não envolviam o ombro. O risco relativo foi exposto em razão de chance, ajustado para fatores confundidores por uma regressão logística binária.
Foram avaliados os prontuários de 1.331 pacientes. Após aplicação dos critérios de seleção, restaram 814. Observamos 134 casos de capsulite adesiva (15,6%). O pico de incidência foi aos 60‐64 anos na etnia asiática e 55‐59 anos nas demais. A razão de chance não ajustada foi de 4,2 (IC 95%, 2,4 a 7,4), enquanto a ajustada para sexo e diabetes mellitus foi de 3,6 (IC 95%, 2,0 a 6,5).
A etnia asiática se mostrou um fator de risco independente para o desenvolvimento da capsulite adesiva, com uma razão de chance ajustada de 3,6. O diagnóstico de capsulite adesiva esteve presente em 15,6% da amostra, com pico entre 55 e 64 anos.
The aim of this study was to evaluate whether Asian ethnicity is a risk factor for the development of adhesive capsulitis. The secondary aim was to describe the distribution of cases of capsulitis by age group.
A cross‐sectional study comparing the rate of adhesive capsulitis in individuals of Asian ethnicity with that of other ethnicities. We excluded patients with fractures and those with symptoms not involving the shoulder. The odds ratio was adjusted for confounding factors by binary logistic regression.
A total of 1331 patient records were evaluated and after applying the selection criteria, 814 patients remained. We found 134 cases of adhesive capsulitis (15.6%). The peak of incidence was at 60‐64 years in the patients of Asian ethnicity and at 55‐59 years in the other patients. The unadjusted odds ratio was 4.2 (CI 95%, 2.4 to 7.4), while the odds ratio adjusted for sex and diabetes mellitus was 3.6 (CI 95%, 2.0 to 6.5).
Patients of Asian ethnicity showed an independent risk factor for the development of adhesive capsulitis, with an adjusted odds ratio of 3.6. Adhesive capsulitis was more common between 55 and 64 years.

View all citing articles on Scopus

: This study was approved by the Full Local Research and Ethical Committee of the University Hospital Leuven (B32220097078 S51884).

View full text

ShoulderFrozen shoulder and the Big Five personality traits

Background

Materials and methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Conclusion

Disclaimer

Acta Psychologica

J Shoulder Elbow Surg

J Shoulder Elbow Surg

Epidemiology of work related neck and upper limb problems: psychosocial and personal risk factors (part I) and effective interventions from a bio behavioural perspective (part II)

J Occup Rehabil

A prospective study of adhesive capsulitis of the shoulder ("frozen shoulder") in a high risk population

Q J Med

Frozen shoulder and lipids

J Bone Joint Surg Br

The shoulder: rupture of the supraspinatus tendon and other lesions in or about the subacromial bursa

Revised NEO Personality Inventory (NEO-PI-R) and the Five Factor Inventory (NEO-FFI): professional manual

Shoulder
Frozen shoulder and the Big Five personality traits