Inflammation and a frozen shoulder

Freezing, frozen, and thawing

Mar 13, 2024

person wearing beaded multicolored necklace in selective focus photography — Photo by Brian McMahon` on Unsplash

Frozen shoulder, or adhesive capsulitis, is a very common problem for people. There’s not a clear reason why someone’s shoulder might get stiff and painful and there is not a clear cause of frozen shoulder. According to M Nagy, 4% of the population experience a frozen shoulder and people who have diabetes are 2-4 times more likely to experience a frozen shoulder.

What is a frozen shoulder? Simply put, it’s when the shoulder stiffens and there is loss of range of motion. There are 3 different phases with adhesive capsulitis.

Freezing phase- this is the initial phase and can be quite painful. More pain is reported at night. Range of motion starts to decrease.
Frozen phase- pain typically decreases at this point, but the shoulder is stiff and loss of motion with all planes of motion has occurred
Thawing phase- the shoulder starts to regain range of motion to more improved mobility with focused care and attempts at regaining motion. What I mean is that motion doesn’t just spontaneously increase on its own.

There’s not a specific timeframe for this whole process and it sometimes can take 1-3 years for the mobility to be restored. Sometimes, even after 1-3 years, people still don’t have full range of motion in that shoulder.

Adhesive capsulitis tends to be “an inflammatory process that eventually leads to fibrotic changes.”1

Risk factors include:

Being born female
Over the age of 40
Recent trauma
Prolonged period of immobilization after shoulder surgery/injury
Being white
Type I or II diabetes
Thyroid dysfunction
Cerebrovascular disease, especially subarachnoid hemorrhage
Menopausal people who are not on hormone replacement therapy2

The connection between hormones, gender, and glucose with adhesive capsulitis is really interesting to me because it seems like our traditional methods of treating the inflammatory response that occurs with frozen shoulders are not always 100% effective, and I think traditional treatments miss this connection. How do hormones and glucose levels affect the shoulder? Decreased estrogen can lead to increased inflammation in the body. This directly affects the collagen in the shoulder joint capsule. Higher levels of glucose molecules in the body increases collagen stiffness. With adhesive capsulitis, there’s a thickening in the joint capsule with a loss of redundant tissue in the inferior capsule. The redundant tissue allows for the arm bone to glide, roll, and spin within the socket while allowing for full mobility of movement for the shoulder. There’s also a thickening of a ligament in the shoulder called the CHL ligament, or coracohumeral ligament, which will limit external rotation of the shoulder. External rotation is rotation of the arm away from the center of the body. External rotation is typically the motion that initially gets most stiff but as the thickening continues, loss of motion in all planes will occur. Monitoring glucose and estrogen levels to reduce collagen changes may be one way to prevent the stiffening of the shoulder seen with adhesive capsulitis.

Typical, traditional treatments include anti-inflammatory medicine, cortisone injections, physical/occupational therapy, manipulation under anesthesia, arthroscopy to “clean up” scar tissue or other surgical procedures.3 These treatments are not 100% effective all of the time on their own. For example, NSAID’s by themselves are not effective, but NSAID’s with therapy has a better outcome. If people are continuing with pain and limited motion after 6 months of treatment, then usually surgery may be offered as an option. While I can’t make nutrition or supplementation recommendations, the only research article I could find that supported the use of food or supplements as prevention of adhesive capsulitis after surgery on the shoulder was one that said Vitamin C was effective in reducing frozen shoulder occurrence after surgery. But, it did not make recommendations for the dosage/frequency.

If we looked more at what’s causing the inflammation or more at what can trigger inflammatory responses in the body and directed our treatment to reducing inflammation, controlling glucose, and improving hormone levels, could we prevent the occurrence of frozen shoulders?

Even if we don’t know the exact cause of adhesive capsulitis or the best treatment solution, I can offer some movement strategies to help with shoulder mobility. Here are 5 simple moves you can do to maintain shoulder health:

Lay on your back and reach overhead. Keep your ribs from flaring out and maintain a neutral position in the lower back, meaning no excessive arch in the lower back as you lift your arms. Try this with the palms facing down, the thumbs pointing upward, and with the palms facing up. Notice how each hand position can alter the movement in the shoulder. Notice how each side feels and moves. Stretch overhead 3-5 times for up to 5 breaths.
Bring one arm across your chest while using the other arm to help stretch across 3-5 times for up to 5 breaths each side.
Stand facing a corner placing your hands and elbows on the walls in a “W” position. Step toward the corner. Try with the elbows above shoulder height, at shoulder height and below shoulder height. Hold each position for up to 5 breaths.
Rotate one arm behind your head and one arm behind your back. Use a towel to grip behind your back holding the towel in each hand to help you stretch. Keep the elbows pulled back, your eyes looking straight ahead, lower back in neutral position without rounding or arching, and ribs not flaring up and out. Try each side and breathe 3-5 breaths.
Lay on your back or stand with your back against a wall with your feet about 12-18” away from the wall. Make snow angels keeping the hands and elbows against the wall as best as you can. Try making 5-10 snow angels slowly and gently.

I would love to know-did you try these? How did they feel for you?

Take good care,

Sharon

Sharon Bullard

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