Frozen Shoulder Treatment

What is Frozen Shoulder

Shoulder pain occurs when there are issues with the structures comprising the shoulder joint due to external impact, degenerative changes, and other causes. Especially in middle-aged individuals, if they experience shoulder pain and limited shoulder movement without any significant trauma, adhesive capsulitis (frozen shoulder) can be suspected. Severe shoulder joint pain accompanied by a restricted range of motion in the joint is a characteristic feature.

In medical terminology, it is called adhesive capsulitis. This means that there is inflammation in the joint capsule surrounding the shoulder joint. Adhesive capsulitis, also known as frozen shoulder, results in stiffness and pain in the shoulder, along with a restricted range of motion, making the shoulder feel as if it is frozen stiff. The exact cause of this condition is still not fully understood.

Cause

Frozen shoulder is generally more common in women than in men. This is believed to be due to several factors in women, including lower muscle strength compared to men and hormonal influences, such as those associated with menopause, which can make inflammation in the shoulder joint capsule more likely to occur. Furthermore, frozen shoulder is more likely to develop when the shoulder is unable to move freely. For example, it can occur when arm movement is restricted due to conditions like rotator cuff tears, prolonged immobilization from fractures, or after procedures such as breast surgery that limit normal shoulder motion.

In our clinic, we believe that frozen shoulder, also known as adhesive capsulitis, occurs as a protective mechanism in our body to shield the shoulder from additional damage. This is because when the shoulder joint degenerates, it can lead to microscopic injuries in the surrounding muscles, ligaments, and other structures. With every movement of the shoulder, these injured areas are continuously irritated, potentially leading to conditions like rotator cuff tears. As a result, our body seems to activate a form of protective system, effectively stiffening the shoulder on its own to prevent further movement. It can be likened to the shoulder applying its own cast, so to speak.

Progression

Frozen shoulder can resolve naturally over time, but achieving full recovery can be challenging. Individuals with frozen shoulder often experience intense pain when someone lightly touches or bumps their shoulder, even in the slightest way. Additionally, because the entire shoulder is stiff, raising the arm in any direction can be difficult, and even attempting to forcefully lift the arm may prove unsuccessful. However, these frozen shoulder symptoms typically improve, and the joint’s range of motion naturally recovers after an average period of 1 to 3 years. The problem lies in enduring this prolonged timeframe, particularly during the initial phase when the pain is most severe, and living with reduced arm mobility makes daily activities difficult. The shoulder joint has the widest range of motion and is highly mobile in our body, so when its range of motion becomes limited, basic tasks such as getting dressed, eating, and bathing become challenging. Furthermore, waiting for natural healing while the shoulder remains stiff for an extended period can make it difficult to regain the full range of motion that existed before frozen shoulder developed. Therefore, it is important to actively seek treatment for frozen shoulder early on.

Frozen shoulder progresses through three stages based on the duration and nature of the symptoms: the Painful Stage, Frozen Stage, and Thawing Stage.

The first stage, known as the Painful Stage, occurs in the initial 3 to 6 months after onset. During this period, the range of motion gradually diminishes, and the pain intensifies. Stiffness in the shoulder joint slowly develops, leading to reduced mobility, and severe pain is experienced with every movement of the shoulder. Night pain, known as nocturnal pain, is particularly characteristic during this stage.

The second stage is the Frozen Stage, during which the shoulder becomes virtually immobile, resembling a frozen state. This stage typically lasts for approximately 6 to 12 months after onset. While pain may decrease relative to the Painful Stage, the symptom of shoulder stiffness becomes more pronounced. Both active joint movements, where you try to move the shoulder on your own, and passive joint movements, where someone else assists in moving the shoulder, are restricted. Raising the arm or rotating it backward becomes difficult, and even simple tasks like getting dressed or bathing become challenging.

The final stage, the Thawing Stage, occurs over a period of 12 to 18 months or longer. During this phase, pain diminishes, and the shoulder stiffness gradually resolves. Pain is only experienced when the shoulder is excessively moved during this stage, and there is some restoration of joint movement range. It is typical for frozen shoulder to spontaneously recover within a range of 1 to 3 years. However, the prolonged recovery period may still result in partial joint mobility limitations, and complete functional recovery may not be achieved. Therefore, rather than enduring shoulder pain and joint movement restrictions while waiting for spontaneous recovery, seeking appropriate treatment early on is advisable.

Treatment

Generally, for patients with degenerative musculoskeletal conditions like herniated discs or spinal stenosis, it is recommended to prioritize rest rather than exercise when experiencing pain. Exercising while in pain can potentially worsen damage to already affected discs, so it’s advisable to alleviate the pain through treatment before engaging in exercise, primarily for the purpose of preventing recurrence. However, patients with frozen shoulder (adhesive capsulitis) are different.

Unlike other degenerative musculoskeletal conditions, it is beneficial for frozen shoulder patients to engage in exercise even when they have pain. This is because they need to restore the diminished range of motion. Prolonged maintenance of a stiff shoulder can result in permanent limitations in shoulder joint movement. Therefore, rather than staying inactive and enduring the pain, it’s better to gradually increase the range of motion with appropriate frozen shoulder stretching exercises, as long as it’s done within reasonable limits. When performing frozen shoulder stretches, it’s best to do so during the Frozen Stage when pain is gradually decreasing or after pain reduction through methods like traditional Chinese medicine treatment. However, it’s important to avoid excessive shoulder movement exercises as they can exacerbate pain.

A case of frozen shoulder treatment is written in this post.