1) Brilliant Frozen Shoulder presentation from @FilipStruyf at #ISERS21 yesterday with a nice balance of the underlying science and clinical implications. Thanks Filip for speaking at our @ISERS2 conference!

2) This is perhaps my favourite slide from the day. In the early painful stage of Frozen Shoulder provocative stretching may increase myofibroblasts thus INCREASING restriction.

3) In the later stages of FS, stretch may increase MMPs and decrease the TIMPs and thus restore balance between MMPs / TIMPs. Perhaps this is why stretching helps in the later stages?

4) When protein joins with glucose in the blood, glycated haemoglobin (Haemoglobin A1c) is formed. Haemoglobin A1c in diabetics risk of development of Frozen Shoulder. Glycated protein is thought to play a role in collagen cross linking & development of restriction

5) Advanced Glycation End Products (AGEs) are proteins or lipids that become glycated as result of exposure to sugar. incidence of AGEs in patients with Frozen Shoulder.

6) IMO when we diagnose somebody with Frozen Shoulder, irrespective of whether they have a Dx of Diabetes, we can assume that all is not well in their metabolism and it is an opportunity for us to start a conversation about lifestyle factors such as nutrition and exercise.