Adhesive capsulitis (Frozen Shoulder) Understanding a sticky issue

By Chan Yin Keen, DC | B.HSci (Chiro), M.Clin.Chiro | One Spine Chiropractic
 

Adhesive capsulitis (frozen shoulder) is a condition where the shoulder gets quite stiff, and potentially painful too. It classically presents as a marked reduction inability to move your shoulder whether under your own volition or assisted. It is an issue I commonly see come through my doors, occurring to mostly women. Typically it occurs on one shoulder only, rarely both, and even then, rarely at the same time. In most cases, it is a gradual build-up rather than a sudden inability to raise their arm. It can be debilitating, making everyday activities like washing one’s hair or putting on a bra quite difficult.

The cause of frozen shoulder is poorly understood. Current literature suggests it can be triggered by trauma, surgery or long periods of immobilization. It is also usually tied to other diseases that one may suffer from, such as diabetes or cardiovascular disease. Previously held beliefs were that it is a self-limiting condition, gradually resolving itself over time. However, current evidence runs counter to that, with many people experiencing some form of continued stiffness or inability to move their arm for years.

To get into a bit more detail with a frozen shoulder, we are looking at a condition that occurs due to the tightening and hardening of the tendons and joint capsule of the shoulder. Adhesions form along the joint capsule make it difficult for the movement to occur in the joint. Notably, these adhesions and hardening of the soft tissue structures around the joint capsule are not a result of repetitive strain. As such, most cases will be treated with some form of repetition exercise or rehabilitative work.

There are three phases to a frozen shoulder. The “freezing” phase, the “frozen” phase, and the “thawing” phase.

During the freezing phase, pain is a symptom of a frozen shoulder. It can feel like an ache in the shoulder when trying to push it to the full range of motion. The pain intensity typically correlates with the eventual amount of reduction in joint range of motion. This early stage of pain can last months before the pain slowly goes away and we are left with a shoulder that still refuses to move. The pain is due to the inflammatory process going on in the joint capsule.

In this phase, the goal should be the reduction of pain while trying to maintain as much mobility as possible. Since the pain is from inflammation, using a cold process like an ice pack or cold compress can ease the discomfort. Alternatively, NSAIDs or a corticosteroid injection prescribed by a medical doctor may help too. Dealing with the eventual reduction in motion, however, requires gentle manual therapy like joint mobilization. Aggressive work can be counter-productive, hastening the “freezing” process.

In the frozen phase, the pain has since dissipated, but the stiffness is still present. This phase may remain for several months too, limiting one’s ability to go about their activities of daily living. Pain may no longer be an issue, but something still needs to be done about the ongoing stiffness. Typically, gentle manual therapy is still indicated, along with stretches and exercises.

In the final thawing phase of frozen shoulder, we can expect a slow return to normal shoulder range of motion. Even then though, without any form of care, some degree of “freezing” may remain for years after the initial occurrence. As with the previous stages, manual therapy and exercise are likely the best way to return to the full range of motion.

I should note, my recommendations for frozen shoulder are almost always non-surgical. That isn’t to say there are no surgical options, for there are such options. Two that I am aware of are manipulation under anesthesia, and shoulder arthroscopy. The former would involve the patient being put under general anesthesia, and the shoulder forcefully moved to cause stretching and tearing of the hardened scar tissue around the shoulder joint. Having seen patients go through such a procedure, the results were generally satisfactory even if the process may sound scary. A shoulder arthroscopy would involve cutting through the hardened tissue using thin instruments inserted into the shoulder via small incisions to the skin. Both surgical options will still require some form of physical therapy to help with recovery for the shoulder, as well as maintain the newly released range of motion. That said, surgical options for adhesive capsulitis generally have good outcomes.

For those less inclined to have surgery, a combination of manual therapy and exercise will be your best bet to recovering from what can be a long term loss of shoulder motion. In light of the recent Movement Control Order due to the COVID-19 pandemic, here are a few easy exercises to attempt at home if you are experiencing a frozen shoulder.

Wall Walking
 
  1. Stand about two foot lengths away from a wall, facing said wall.

  2. Raise arm to about shoulder height, shaping your hand into a V sign (fist closed except for index and middle finger sticking out)

  3. Have your two fingers against the wall, gently “walk” your hand up the wall until you feel a stretch in your shoulder

  4. Hold it for 5 to 10 seconds, then slowly “walk” your hand back down

  5. Repeat 3 times, standing just a bit closer with each repetition.

  Towel Stretch
 
  1. Holding a rolled up towel with one hand, drape it behind your back

  2. With the affected arm, grab hold of the lower end of the towel

  3. Gently pull the towel up with using the good arm, while the affected arm is still holding the lower end of the towel

  4. Hold stretch for 10-15 seconds, then release

  5. Repeat 3-5 times

 Pendulum exercise

  1. Stand beside a table, feet shoulder width apart.

  2. Place hand of unaffected shoulder on table for support

  3. Bend forward at the hip, allowing for your affected arm to hang downwards

  4. Gently shift your weight from side to side and front to back, allowing your arm to swing with the momentum

  5. Once accustomed to the motion, trying shifting your weight to swing your arm in a rotational movement without using your shoulder muscles

  6. Perform motion for 30 seconds to a minute, rest, and repeat 3-5 times a day

So there you have it, several easy to perform exercises that can be done at home for frozen shoulder. If you happen to be reading this during the nationwide movement control order or experiencing some form of lockdown due to the Covid-19 pandemic, stay home and stay safe.

One Spine Chiropractic offers chiropractic solutions for people with musculoskeletal problems. For more information, please contact One Spine Chiropractic at 0 13-810 0373. Find them at D27, 3rd Floor, Center Point Sabah, Jalan Centre Point, Kota Kinabalu, Sabah. 

 

Disclaimer: This article is not intended to diagnose, treat, cure, or prevent any diseases. At Parents Avenue, we strongly recommend all our readers to seek medical advise from your local hospital or clinic. Thank you. 

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