We know that the expression “giving someone the cold shoulder” signifies being mean and indifferent to someone on purpose. This is also the name of a song by British pop music queen Adele, but we should not confuse this expression with adhesive capsulitis, a musculoskeletal condition often referred to as frozen or locked shoulder.
Adhesive capsulitis was the diagnosis that a Pennsylvania orthopedic surgeon concluded was behind a medical mystery involving a 51-year-old female patient, who also happens to be a physician, and who was puzzled by the persistent pain and stiffness that impacted her left arm for more than a year. These symptoms appeared to be related to a bulging cervical disc revealed by magnetic resonance imaging. The patient even went through spinal decompression surgery, which provided relief for her back pain, but it did nothing for her arm.
Here’s how the orthopedic doctor arrived at the right diagnosis for this patient: Pain, numbness, and tingling in just one arm and without an obvious explanation such as musculoskeletal injury is often associated with frozen shoulder, but the patient also had a prior history of thyroid dysfunction, which is an autonomous disease affecting the immune system. The age and gender of the patient were also taken into consideration in order to solve the medical mystery.
Frozen shoulder is not a well-known condition because it is estimated to only affect 2% of the global population. Adhesive capsulitis is incorrectly associated with shoulder dislocation. It may even be more common than we know because the pain and discomfort can be mild in some patients who simply get used to it. There is also the tendency of frozen shoulder to go away on its own after about a year and a half. For some reason, it rarely affects both shoulders at once, but it does switch from one arm to the other.
Understanding Frozen Shoulder Syndrome
Adhesive capsulitis is a condition that should be easy to recognize, although it may be hard to diagnose with certainty, and may be misdiagnosed as a frozen shoulder caused by a muscular sprain or dislocation. For some patients, this condition will feel like a very serious disease because it makes their arm motion difficult and painful.
This condition develops gradually and can start to show up months or even years after you have sustained a trauma to the shoulder; this does not mean that the injury caused your shoulder to lock up, it just made you aware of the underlying issue. In most cases, the cause of adhesive capsulitis is not clear. It may develop because of muscle weakness caused by other health conditions, especially in older adults. It may also develop because of an injury to the shoulder joint that damages the glenohumeral joint, which is the ball and socket joint that connects the upper arm bone (humerus) to the shoulder blade (scapula). It is important to emphasize that in all these cases, the shoulder is not really frozen.
A shoulder injury that leads to the onset of adhesive capsulitis may also be caused by an injury in the bursa, which is a fluid-filled sack inside the shoulder that helps lubricate and cushion the joint and may, in some cases, have a protective function.
When this condition starts to develop, it will typically affect the rotator cuff. The rotator cuff consists of several muscles, including the muscles that help to raise and lower the arm and the muscles that stabilize the shoulder joint. There will be a decrease in the use of the rotator cuff, and this can cause your shoulder muscles to become tight and stiff. These are the muscles that will need to do most of the work to stabilize the shoulder joint when the glenohumeral joint is under pressure, which is when you are sleeping or carrying a heavy object or when you play an instrument.
Symptoms of Frozen Shoulder
This condition can cause many symptoms such as:
- Upper arm pain.
- Insomnia caused by not being able to sleep in the fetal position of the affected side.
- An overall feeling of stiffness.
- Pain diffusion.
Frozen shoulder may seem and feel like a chronic condition, but it is not. From onset to recovery, there are four gradual stages of adhesive capsulitis:
- In the freezing stage, patients mostly feel pain and discomfort, and it is this pain that starts to limit the range of motion.
- In the frozen stage, some patients will find the pain to be excruciating, but many others will actually get used to the mild discomfort. What does not vary is the sharply reduced range of motion along with numbness and tingling.
- In the thawing stage, most patients will not feel pain any more, and they will start regaining movement.
- In the recovery stage, patients are happy to learn that they have regained range of motion, but they will be aware of how weakened their shoulders have become.
As previously mentioned, the average time that will pass from the freezing stage to full recovery is 18 months, but it can be as long as three years unless treatment is sought.
Chiropractic Therapy for Frozen Shoulder
Not every patient with frozen shoulder complaints will receive the same kind of treatment. During the assessment stage, we will look at overall spinal health, particularly as it relates to the thoracic and cervical sections. Proper body mechanics cause shoulder motion to initiate at the cervical section, which is also where nerve clusters that communicate with the shoulder initiate.
In the treatment of frozen shoulder, it is vital to address the nerves going to the shoulder. The majority of these go through the neck, but in other places, the nerves run directly into the shoulder joint. Improving the function of these nerves can dramatically improve the healing process. In many cases, the ability to improve their function is directly related to a decrease in inflammation.
The chiropractic process of healing from a frozen shoulder involves much more than the shoulder. The first step involves taking a baseline history. This helps in determining if there are any underlying problems in the person’s history that might be contributing to the condition. When treating a patient who has a frozen shoulder, there are a number of things to address. There are factors that can help improve their shoulder range of motion, help with pain relief, and help with healing, and the first of these is the spinal column.
Patients with frozen shoulders will need to increase their joint motion in the cervical spine. This includes stretching out the ligaments and tendons of the neck. There are also exercises that are used to help with these, but the process often starts with a spinal adjustment. If we notice spinal subluxation, this will be the initial focus of therapeutic sessions. This does not mean that a healthy spine will cure or preclude adhesive capsulitis; what we seek to accomplish is to make the healing process easier and more efficient.
Along with adjusting the spine to improve overall health, we also work on improving the function of the shoulder. This means improving the ligaments and tendons in the shoulder joint. It also helps to work on the nerves, helping them to communicate with the shoulder and provide relief.
There are various ways to make adjustments not only to the main shoulder joint but also to the others we previously mentioned. The adjustments need to be made with the help of patients because they need to stimulate both muscle tissue and nerve function. The physical therapy exercises applied to treat frozen shoulder are different from calisthenics; in the beginning, they are guided by the chiropractor until the patient is comfortable doing them at home. Many of these therapeutic exercises involve stretching that may initially seem unrelated to the affected shoulder.
If you are suffering from frozen shoulder symptoms, we urge you to contact our office today to discuss your options. Not everyone can wait between one and three years for this issue to go away on its own; moreover, the limited range of motion related to frozen shoulder can negatively impact the quality of life for years to come.