Frozen Shoulder: Symptoms, Causes & Treatment

 

 What Is A Frozen Shoulder?

 

Adhesive Capsulitis is the medical term for what is more commonly known as Frozen Shoulder (1).Like most other mobile synovial joints in our body, our shoulder joint is covered by a capsule. This capsule, in essence, is composed of two layers, an outer fibrous layer and an inner layer of a synovial membrane. The function of this synovial membrane is to secrete synovial fluid that provides lubrication against friction and freedom of movement to the bone surfaces in contact with the joint. It is richly supplied with blood vessels and provides nutrition to the bones. Thus, the joint capsule is a covering that not only protects the joint from wear and tear but is essential for the nutrition, mobility, and range of movement that is a prominent feature of these joints (1).

The normal range of motion of the shoulder joint includes abduction, adduction, flexion, extension, internal rotation, and external rotation. As the name suggests, Adhesive Capsulitis is an inflammation of the joint capsule that causes the capsule to thicken and develop scar tissue. As a result of this, the capsule shrinks and produces limitations in the range of movement. Therefore, a frozen shoulder causes your shoulder to “freeze,” implying that it is unable to move freely without causing extreme discomfort.(1)

 

What Are The Causes and Risk Factors of Frozen Shoulders?

 

The factors that increase the risk for the development of frozen shoulder include:

 

    Age over 40

    Female

    Immobility: Immobility which may be due to injury of the shoulder joint, fracture, a recent surgery, paralysis, or plegia due to stroke, causes thickening of the joint capsule, thereby predisposing to frozen shoulder. For an immobile shoulder joint to turn to a frozen shoulder, it typically takes several weeks.(2)

    Diabetes: Diabetic population is at an increased risk for developing frozen shoulder because uncontrolled blood glucose levels interfere with the healing properties of our immune system and decrease the production of collagen, an essential component of connective tissue of the joint capsule.(3)

    Thyroid Hormone Imbalance: Thyroid hormone imbalance, whether it is hyperthyroidism or hypothyroidism, can predispose to frozen shoulder because of the release of inflammatory mediators such as cytokines that cause Adhesive Capsulitis.(4)

    Nutritional Deficiency: Vitamins and minerals are essential to the healing process of the body. A deficiency can result in defective or incomplete healing, which may end up as a frozen shoulder.(5)

    Parkinson’s Disease: The akinesia associated with Parkinson’s disease causes immobility, making musculoskeletal diseases such as frozen shoulder very common.(6)

 

How To Treat Frozen Shoulder?

 

To understand how to heal a frozen shoulder, we need to first understand how to address the root cause of the problem, that is, Inflammation. The normal healing process occurs. It has the following steps:

 

  1. Inflammation: The first step of healing from an injury involves Inflammation. This comprises swelling, redness, increase in temperature, and increased blood flow to the injured area. This leads to the sensation of pain and loss of function because of the inflammatory mediators produced by our immune system.
  2. Proliferation: This is the stage in which fibrosis or the development of scar tissue starts. In case of excessive growth of scar tissue, the capsule shrinks, leading to a frozen shoulder. This is also why instead of exercises, we need to focus on targeting the process of fibrosis. The other processes involved in this stage are muscle spasms, trigger points, and fascia restriction, which further potentiate the immobility of the joint.
  3. Maturation: This stage involves the degradation of excessive tissue formed in the stage of proliferation, which remodels the injury site. This can take anywhere from several days to weeks or even months. This is why timely intervention is necessary to halt the processes leading to frozen shoulder.

The pathogenesis of the frozen shoulder involves back and forth movement of the healing process through the two stages of Inflammation and proliferation. It never progresses to the maturation of scar tissue. This is why common and popular treatment modalities such as heat and ice pads, shoulder massage, etc., may only be suitable for providing temporary relief to the pain but not useful in healing and long-term management of frozen shoulder.(7)

To treat frozen shoulder, we need to target the individual processes involved in its pathogenesis.

 

How to target Inflammation:

 

    MagnaHeal: This tool has a magnetic field that exerts a magnetic field penetrating 3 inches deep into the joint, thereby specifically targeting the process of Inflammation occurring in the shoulder joint.

    Anti-inflammatory diet: Diet rich in carbohydrates can worsen the healing process by potentiating the Inflammation 5 hours after their intake. This is why a diet containing anti-inflammatory agents, for example, ginger, turmeric, etc., may be more suitable.(8)

    Nutrient deficiency: Nutrients and minerals, primary antioxidants such as Vitamin C, Vitamin D, are essential to the healing process as they are required as cofactors in the synthesis of collagen, which is a vital component of connective tissues. Their antioxidant properties prevent further damage by the production of reactive oxygen species. By only taking out a few minutes, you can go to the askASTR website, which includes a database comprising nine different healthcare professionals and evaluate your nutritional and mental health. By taking charge of your own health, you can identify which nutritional deficiencies you need to target and how to overcome them.(8)

How to target fibrosis?

 

To break adhesions that have formed in the joint capsule, using A3 and A5 tools by a professional can be very helpful. The A3 device targets superficial scar tissue while the A5 tool goes over the deeper scar tissue in the joint capsule and breaks the fibrous adhesions formed. Similarly, adhesions between the layers of fascia can be broken using the A1 and A5 tools.(9)

 

 Bottomline

It is imperative to target individual processes involved in forming frozen shoulders, step by step, to break the vicious cycle. Only after the pathogenetic processes have been overcome can we progress to the introduction of exercises to improve joint mobility. 

 

References

[1]   Mezian K, Coffey R, Chang K-V. Frozen Shoulder. StatPearls [Internet], StatPearls Publishing; 2021.

[2]   Jansen T, Thorns C, Oestern HJ. [Anatomy of the shoulder joint]. Zentralbl Chir 2001;126. https://doi.org/10.1055/s-2001-12501.

[3]   Akshay Date LR. Frozen shoulder: overview of clinical presentation and review of the current evidence base for management strategies. Future Science OA 2020;6. https://doi.org/10.2144/fsoa-2020-0145.

[4]   Whelton C, Peach CA. Review of diabetic frozen shoulder. Eur J Orthop Surg Traumatol 2018;28. https://doi.org/10.1007/s00590-017-2068-8.

[5]   Cohen C, Tortato S, Silva OBS, Leal MF, Ejnisman B, Faloppa F. Association between Frozen Shoulder and Thyroid Diseases: Strengthening the Evidences. Revista Brasileira de Ortopedia 2020;55. https://doi.org/10.1055/s-0039-3402476.

[6]   Papalia R, Torre G, Papalia G, Baums MH, Narbona P, Di Lazzaro V, et al. Frozen shoulder or shoulder stiffness from Parkinson disease? Musculoskelet Surg 2019;103. https://doi.org/10.1007/s12306-018-0567-3

[7]   Cho C-H, Bae K-C, Kim D-H. Treatment Strategy for Frozen Shoulder. Clin Orthop Surg 2019;11:249.

[8]   Frozen shoulder: What can help? InformedHealth.org [Internet], Institute for Quality and Efficiency in Health Care (IQWiG); 2018.

[9]   Chan HBY, Pua PY, How CH. Physical therapy in the management of frozen shoulder. Singapore Med J 2017;58:685.