Frozen Shoulder - What Are My Options?

If you've dealt with the aching stiffness and severely limited mobility of a frozen shoulder, you know how extremely painful and debilitating this condition can be. The medical term is adhesive capsulitis, which occurs when the connective tissue surrounding the shoulder joint becomes inflamed and tightens over time.

For years, treatment options were limited - either grin and bear it through months of misery as it potentially heals itself, take anti-inflammatory medication, or opt for invasive procedures like manipulation under anesthesia or surgery. But a number of recent studies offer promising, noninvasive alternatives worth exploring.

What is Frozen Shoulder?

Frozen shoulder occurs when the shoulder joint's capsule, the connective tissue surrounding the joint, becomes thickened and inflamed, leading to pain and restricted movement. This condition typically progresses through three distinct phases:

1. Freezing phase: This is the initial stage, where the shoulder gradually becomes more painful and stiff, with a decrease in range of motion.

2. Frozen phase: During this stage, the shoulder becomes increasingly stiff, with significant limitations in movement. Pain may decrease, but the stiffness can be debilitating.

3. Thawing phase: In this final stage, the shoulder slowly regains its range of motion, though it may take several months to years for a full recovery.

What Causes Frozen Shoulder?

The exact cause of frozen shoulder is not fully understood, but research suggests several potential contributing factors:

• Immobilization: Prolonged immobilization of the shoulder, such as after an injury or surgery, can increase the risk of developing frozen shoulder.

• Diabetes: Individuals with diabetes, particularly those with poorly controlled blood sugar levels, are at a higher risk of developing frozen shoulder.

• Hormonal changes: Hormonal fluctuations, such as those experienced during menopause, may be linked to the development of frozen shoulder.

• Autoimmune disorders: Conditions that affect the immune system, such as thyroid disorders, may also increase the risk of frozen shoulder.

Symptoms and Diagnosis

The early symptoms of frozen shoulder include gradual onset of pain and stiffness in the shoulder. Patients may experience difficulty with everyday tasks, such as reaching behind their back or overhead. A healthcare provider, such as an orthopedic specialist or physical therapist, can diagnose frozen shoulder through a physical examination and may order imaging tests, such as X-rays or MRI, to rule out other conditions.

Conservative Care Options for Frozen Shoulder

Therapeutic Exercise / Physical Therapy

A 2019 study found that a regimen of stretching, flexibility exercises, and painless range-of-motion exercises was effective at restoring mobility and function in frozen shoulder patients over 12 weeks. Low-intensity workouts focused on the shoulder joint itself and supporting muscles.

Light Therapy  

Light-based treatments are also showing potential. A 2022 study revealed therapeutic laser therapy helped reduce pain and disability when combined with stretching. The low-level laser works by decreasing inflammation.

Shockwave Therapy  

You may have heard of shockwave therapy for plantar fasciitis or kidney stones. Surprisingly, a 2021 study concluded it was effective for decreasing frozen shoulder pain and improving range of motion too.

Chiropractic Care  

Many frozen shoulder sufferers are considering chiropractic treatment as an alternative therapy as well. Several studies point to chiropractic shoulder adjustments helping reduce inflammation, break up scar tissue, and restore mobility over several months of care.A 2012 study in the Journal of the Canadian Chiropractic Association observed significant improvements in shoulder mobility, pain, and disability after 6 weeks of combination chiropractic treatment including adjustments, manual therapy, and exercise.

Recently, research in the treatment of frozen shoulder has included the use of platelet-rich plasma (PRP) and stem cell therapy, to help reduce inflammation and promote tissue healing (3).

Additionally, some studies have explored the use of novel therapeutic techniques, such as joint mobilization and proprioceptive neuromuscular facilitation, to improve outcomes (4).

Recovery and Prognosis

The recovery time for frozen shoulder can vary greatly, but with appropriate treatment, most patients can expect to regain full range of motion within 12-18 months. However, in some cases, the condition can persist for several years. Factors that may influence the recovery time include the severity of the condition, the patient's age, and the presence of underlying medical conditions, such as diabetes. According to a study published in the Journal of Shoulder and Elbow Surgery, the average duration of symptoms for patients with frozen shoulder treated conservatively is approximately 30 months, with significant improvement typically seen within the first 12-18 months

While more large-scale research is still needed, these noninvasive therapies offer new hope for frozen shoulder relief without surgery. If you're struggling with this frustrating condition, it is important to discuss which treatment methods may be right for you with a qualified healthcare professional.

References:

1. Vastamäki, H., Vastamäki, M. (2013). The natural history of idiopathic frozen shoulder. Journal of Shoulder and Elbow Surgery, 22(4), 556-563.

2. Rill, E. K., Fleck, T. M., Fortner, L. M., Groff, Y. J., Devin, C. J., & O'Hara, N. N. (2014). Predictors of outcome in nonoperative management of adhesive capsulitis. Journal of Shoulder and Elbow Surgery, 23(8), 1165-1171.

3. Randelli, P., Arrigoni, P., Ragone, V., Aliprandi, A., & Cabitza, P. (2011). Platelet rich plasma in arthroscopic rotator cuff repair: a prospective RCT study, 2-year follow-up. Journal of Shoulder and Elbow Surgery, 20(4), 518-528.

4. Kinto, N. A., Snyder, A. R., Hardaker, W. T., & Wainner, R. S. (2013). Effectiveness of joint mobilization on adhesive capsulitis of the shoulder: a systematic review. Journal of Orthopaedic & Sports Physical Therapy, 43(8), 566-573.​​​​​​​​​​​​​​​​