Frozen Shoulder / Adhesive Capulitis

Frozen Shoulder.

Because there seems to be many contradictory opinions on what causes ‘Frozen Shoulder’, I’m going to add my opinion to further confuse, or resolve, our understandings. Firstly, I believe the terms ‘Frozen Shoulder’ and ‘Adhesive Capulitis’ are misleading, and only help to add to the confusion by directing attention to the fallacy that it is solely a shoulder problem. In my opinion, it’s not, and here’s why…….

The most common vulnerability to the nervous system, and how it distributes itself throughout the body, occurs where the nerves exit the cervical spine, between the C1 and C7 vertebrae. Because of possible degeneration or regeneration, whether due to an underlying arthritic condition (such as Osteoarthritis) or an injury based condition (such as whiplash), and because of the full range of flexibility allowed to the neck structure, the risk of a compressed nerve, or even the ‘threat’ of such a risk, becomes a greater possibility than would normally be the case.

Where an actual compression has occurred, there would be obvious indicating symptoms manifested in the hand, at the extremity of that particular nerve’s field of influence. These symptoms are usually self explanatory and point to a direct cause i.e. trapped nerve in neck area. Where there is just a ‘threat’ of nerve compression, the nervous system is capable of reading this vulnerability, and, in order to protect from such an event, it can instigate certain muscular reactions to help protect itself. So, the shoulder (which is the next flexible joint along the nerve route) muscles are instructed to restrict the arm’s movement. This is achieved simply by introducing pain for any arm movements which might refer their effects back to the neck, and thus increase the threat to the nerve.

Unfortunately, this process can enter a cycle, perhaps due to ‘muscle memory’ issues, and can take many months to resolve itself. The actual initial threat to the nerve may have already resolved itself, but the shoulder effects carry on regardless. If that initial threat didn’t resolve for any reason, then the frozen shoulder would keep repeating itself endlessly. This doesn’t happen normally…it does resolve with no obvious lingering damage. In fact, there was never any tissue or structural damage in the shoulder, and it returns to normal painfree flexibility in time, usually about 10 to 12 months. It can be very painfull for first 3 to 4 months, and then gradually reduces in pain intensity until eventually it disappears.

So, to summarise, the painful shoulder is just the nervous system’s way of restricting arm movement so that it can better protect a vulnerability to itself as it exits the cervical spine. Any manipulations of the shoulder, especially painful manipulations, are likely to increase that vulnerability in the neck, and thus lengthen any recovery timespan. Any surgical intervention in the shoulder, where no obvious damage is apparent, is even more questionable. Frozen Shoulder is caused by protective nerve behaviour, and it only resolves itself when the threat to the nerve eases off by itself..

I believe that a lot of confusion, particularly regarding a patient’s understanding, is caused by the use of the terms ‘Frozen Shoulder’ and ‘Adhesive Capulitis’. Perhaps it should just be renamed ‘Referred Shoulder Spasm’ to ease patient anxiety.

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