Frozen shoulder is a very painful and debilitating condition also known as adhesive capsulitis.  In order to be diagnosed as a ‘true’ case of frozen shoulder, shoulder movement will be limited and painful, and if investigated, inflammation and adhesion formation of the shoulder capsule would be detected.  Frozen shoulder can also mimic conditions such as cervical radiculitis, rotator cuff tendonitis or bursitis, bicipital tendonitis and shoulder impingement syndrome.  

According to the American Academy of Orthopaedic Surgeons, frozen shoulder syndrome is a progressive condition that follows three stages:  freezing, frozen, and then thawing.  Although the cause for frozen shoulder syndrome (FSS) is not clear, patients usually report having injured the involved shoulder at some point in their medical history.  This condition occurs in 10-20 percent of individuals with diabetes. Other medical problems associated with increased risk of frozen shoulder include: hypothyroidism, hyperthyroidism, Parkinson’s disease, and cardiac disease or surgery.¹

The ‘freezing’ stage. 

The onset of shoulder pain is usually insidious (without obvious physical cause), and the pain related to this ‘freezing’ stage gets worse over time, creating progressive limitation to shoulder’s range of motion.  The pain during this stage can be constant, aching and dull, with sharper pains felt at the end-range of motion.  The ‘freezing’ stage can last anywhere from weeks to several months.

The ‘frozen’ stage.

The shoulder can be classified as ‘frozen’ once it has reached its maximum restricted movement pattern.  At this stage, constant pain may have subsided, but pain will often be felt whenever movement is attempted past the restricted range of motion.  Typically, a person experiencing FSS will be unable to reach behind their back, cannot move the arm toward the ‘hitch-hikers’ position, and will be unable to bring the hand/arm above the height of the shoulder.  The ‘frozen’ stage typically lasts for up to nine months.

The ‘thawing’ stage.

After the ‘frozen stage’, the patient will slowly begin to be able to increase their pain-free range of motion.  Without treatment, there is a natural course of healing whereby the ‘frozen shoulder’ typically thaws within 12-18 months.  It is a mystery to most doctors and therapists as to why this syndrome occurs, and the variable response rates to different treatments. 

Can Chiropractic Help?

Since innervation of the shoulder joint and the surrounding musculature is provided by nerves exiting the cervical spine, it is always advisable to have your chiropractor assess your neck for vertebral subluxations in this area.  Restoring proper segmental motion can help facilitate proper nerve function supplying the shoulder, and this is likely to contribute to your recovery.

In one such case, a 53-year old woman reported complete relief following a course of chiropractic treatments aimed at manipulating the ‘frozen’ shoulder joint and the cervicothoracic areas of the spine.  Even more impressive was the fact that chiropractic worked where other treatments had failed, including NSAIDs, analgesics and physical therapy.².

Given the fact that shoulder movement and stabilization requires a great deal of muscular coordination (by the rotator cuff), joint manipulation alone may have limited success in many cases.  According to the American Academy of Orthopaedic Surgeons, exercise and stretching are the most highly recommended forms of complimentary conservative therapies.¹

In the tougher cases where conservative therapies are uneffective, aggressive therapy aimed at removing the capsular adhesions in addition to intra-articular corticosteroid injections are considered the best options for a ‘cure’.³  Surgery should be considered a last resort, however, as the procedures themselves will often require a protocol of post-surgical rehabilitation, they are typically much more expensive than conservative treatment methods, and if general anaesthetic is required, there is a much greater risk of complications from the surgery.

Always keep in mind that if you are receiving treatment for a frozen shoulder, and you notice absolutely no change over a period of 6-10 sessions, the treatment is unlikely to improve your condition.  However, if there are any improvements after the initial course of treatments, be persistent – remember that a ‘frozen shoulder’ can take up to 4 years to heal in some cases.  Any acceleration in your recovery time will be a significant improvement to your quality of life.

Resources:

1.        http://www.aaos.org

2.        J Manipulative Physiol Ther 1995 (Feb); 18(2): 105-115.

3.        J Orthop Surg (Hong Kong) 2008 (Dec); 16(3): 295-299.