Stiffness and pain developing in the shoulder could be adhesive capsulitis, (frozen shoulder), a condition in the shoulder’s ball-and-socket joint/glenohumeral joint. It usually develops over time and limits the functional use of the arm. The pain and tightness restrict arm movement, and the duration of symptoms can persist for 12-18 months. The cause is often unknown, but it is more common in individuals over 40, individuals with diabetes, thyroid disease, and cardiac conditions have an increased risk of developing the condition, and women tend to develop the condition more than men. Chiropractic treatment can be effective at relieving pain and expediting recovery.

Stiffness and Pain

The shoulder joint allows more movement than any other joint in the body. A frozen shoulder causes the capsule surrounding the shoulder joint to contract and form scar tissue. The capsule contraction and the formation of adhesions cause the shoulder to become stiff, restrict movement, and cause pain and discomfort symptoms.

Stages

The progression is marked by three stages:

Freezing

• Stiffness and pain begin to restrict motion.

Frozen

• Movement and motion are severely restricted.

Thawing

• The shoulder starts to loosen up.
• It can take years to fully resolve symptoms.
• In mild cases, a frozen shoulder can go away on its own but that does not mean that it is truly healed and correctly aligned.
• Even in mild cases seeking treatment is recommended, rather than just waiting for it to go away.

Symptoms

• Limited range of motion.
• Stiffness and tightness.
• Dull or aching pain throughout the shoulder.
• Pain can radiate into the upper arm.
• Pain can be triggered by the smallest movements.
• The symptoms are not always due to weakness or injury, but actual joint stiffness.

Causes

Most frozen shoulders occur with no injury or discernible cause but the condition is often linked to a systemic condition or one that affects the entire body.

Age and Gender

• Frozen shoulder most commonly affects individuals between the ages of 40 to 60, and is more common in women than in men.

Endocrine Disorders

• Individuals with diabetes have an increased risk of developing a frozen shoulder.
• Other endocrine abnormalities like thyroid problems can also lead to the development of this condition.

Shoulder Trauma and/or Surgery

• Individuals who sustain a shoulder injury, or undergo surgery on the shoulder can develop a stiff and painful joint.
• When injury or surgery is followed by prolonged immobilization/resting the arm, the risk of developing a frozen shoulder increases.

Other Systemic Conditions

Several systemic conditions such as heart disease have also been associated with an increased risk of developing the condition and can include:

• High cholesterol
• Adrenal disease
• Heart and lung disease
• Parkinson’s disease

Stiffness and pain can also be associated with damage to the joint from injuries or other shoulder problems that include:

• Muscle or connective tissue injury
• Rotator cuff tendinopathy
• Calcific tendinitis
• Dislocation
• Fracture
• Osteoarthritis
• A frozen shoulder associated with any of these causes is considered secondary.

Treatment

A diagnosis is made by observing the range of motion in the shoulder, considering the two types:

Active Range

• This is how far an individual can move a body part on their own.

Passive Range

• This is how far another person like a therapist or doctor can move the body part.

Therapies

• Chiropractic, massage, and physical therapy involve stretches, realignment, and exercises to relieve pain symptoms and restore mobility and function.
• Usually, strength is not affected by a frozen shoulder but a chiropractor may want to strengthen the surrounding muscles to better support the shoulder and prevent worsening the injury or causing a new injury.
• Anti-inflammatory medications and corticosteroid injections may help manage pain symptoms.
• Getting a diagnosis and treatment during the freezing stage can keep the condition from progressing and expedite recovery time.

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Enhancing Health: Evaluation and Treatment

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References

Brun, Shane. “Idiopathic frozen shoulder.” Australian Journal of general practice vol. 48,11 (2019): 757-761. doi:10.31128/AJGP-07-19-4992

Chan, Hui Bin Yvonne, et al. “Physical therapy in the management of frozen shoulder.” Singapore medical journal vol. 58,12 (2017): 685-689. doi:10.11622/smedj.2017107

Cho, Chul-Hyun, et al. “Treatment Strategy for Frozen Shoulder.” Clinics in orthopedic surgery vol. 11,3 (2019): 249-257. doi:10.4055/cios.2019.11.3.249

Duzgun, Irem, et al. “Which method for frozen shoulder mobilization: manual posterior capsule stretching or scapular mobilization?.” Journal of Musculoskeletal & neuronal interactions vol. 19,3 (2019): 311-316.

Jain, Tarang K, and Neena K Sharma. “The effectiveness of physiotherapeutic interventions in the treatment of frozen shoulder/adhesive capsulitis: a systematic review.” Journal of back and musculoskeletal rehabilitation vol. 27,3 (2014): 247-73. doi:10.3233/BMR-130443

Kim, Min-Su, et al. “Diagnosis and treatment of calcific tendinitis of the shoulder.” Clinics in shoulder and elbow vol. 23,4 210-216. 27 Nov. 2020, doi:10.5397/cise.2020.00318

Millar, Neal L et al. “Frozen shoulder.” Nature reviews. Disease primers vol. 8,1 59. 8 Sep. 2022, doi:10.1038/s41572-022-00386-2