Frozen Shoulder / Adhesive Capulitis

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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.

5 likes, 8 replies

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8 Replies

  • Posted

    Love your explanation of Frozen Shoulder...it makes a lot of sense. Better than the 'we don't know why it happens...sorry...go take some Advil' that I got from one of my doctors...
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  • Posted

    Awesome explanation Gerry the neck. Sometimes doctors don't really know what the problem is so they use this diagnosis as a catch-all for any pain or restricted movement around the shoulder.

    I would also add that the symptoms of frozen shoulder can also be caused by nothing but bad slouching posture over a long period of time. Sitting at a desk staring into a computer screen causes the head to sit forward and the shoulders to round forward which puts a lot of strain on the upper cervical spine but also on the lower cervical spine. This process stretches and inflames the nerves as they exit the neck spinal joints. This can cause neck pain, arm & hand pain, shoulder pain and headaches amongst many other maladies. This is just the upper body complaints, bad sitting posture is horrible for the middle back and also for the lower back (weakeniing all the core muscles).

    This is such an epidemic now they have named it the "disease of modern man".

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    • Posted

      can anyone comment on laser treatment for FS. it's been suggested to me & am wondering if anyone had successfully (or otherwise tried it)?

      with thanks

      c

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  • Posted

    Finally someone is making some sense of this.  I am at my wits end with orthopedic doctors, chiropractors and physical therapists who only make my pain worse! I heard about trigger point therapy which is supposed to shorten the recovery time for the shoulder....was going to try that but from your explanation, that might only aggravate the nerve.  This whole thing started with numbness and pain down my right arm, then my shoulder froze.  MRI didn't show anything wrong with my neck. What treatment WILL help this nerve get better or untrapped? That's the million dollar question! Is it just a wait and see thing. I want to do something to help this along.  It's completely taken over my once active and full life! 
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  • Posted

    Hi Gerry:

    just read ur explaination of FS. i'd add to that, that the majority of these ''invasive'' (surgical/manipulation etc) have not been properly ''trialed''. many have just fallen into the category of ''lets try this'' and over time have become the default blanket treatment for many conditions. anyhow, do u have any suggestions on how to accelerate the healing of this condition?

    thanks in advance.

    Caitlin

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  • Posted

    I really do believe that this is what happened to me through slouching over a computer, added with depression. I have been trying to reverse my behaviour by severely limiting my computer time, sitting up straight (no more slouching with shoulders hunched forward) getting out side, eating healthy again and doing all the things I used to do when I was happy. It is beginning to make me feel so much better emotionally and I love lide again

    thankyou Gerry.

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  • Posted

    Gerry - can I ask you.  Did you do exercises during the course of your 'FS' episodes?  I am receiving conflicting advice.  Some say you need to keep the muscles working otherwise they'll atrophy.  Others say you won't get full range of movement back unless you keep stretching into the pain to extend ROM.  What has your experience been? I think I read somewhere else that you advocate rest primarily and a gentle approach.

    ps - My FS came after a fracture to the humeros. My shoulder was strapped up and the FS followed....

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