Frozen Shoulder

Chinese Medicine window on shoulder Pain- with the aim of managing symptoms.

A very painful Shoulder condition that presents with a lack of shoulder movement and extreme pain. The shoulder joint is highly mobile, To achieve this great range of movement the articulating bone surfaces are very small. For the shoulder to be stable enough there are many Ligaments that wrap around the join and hold the shoulder structure together. There are numerous muscles that pass the shoulder joint to enable the wide range of actions that the shoulder needs to perform. All these muscles attach to the shoulder joint and adjacent bone surfaces via the muscle tendons. A frozen shoulder occurs when the shoulder capsule and all the above-mentioned structures passing through it thicken and tighten. This causes severe restriction of movement in the shoulder.

Immobilizing the shoulder after traumatic injury can lead to inflammation to build up around the joint that may lead to a frozen shoulder. The exact reason for Frozen Shoulder is not known but is often noted with post-surgery immobilization and minor shoulder injuries that may develop into

a Frozen Shoulder.

chinese Medicine pain frozen shoulder chinese medicine pain management
Many types of shoulder injuries, if not addressed properly can lead to atrophy and immobility of the shoulder that can eventuate in a frozen shoulder. Sporting injuries, involving small muscle tears, mild shoulder dislocations, supraspinatus muscle tears, which are commonly seen in individuals over 40’s, or Rotator Cuff injuries where the four muscles around the shoulder joint that control its movement in all directions cease in their ability to govern movement in a synchronous way. The weak muscle will not stabilize the shoulder structure as it moves and the intact muscles will pull the shoulder out of its position ever so slightly causing pain and further damage to intact muscles. Rotator cuff injuries may involve partial or full muscle tears that can appear with minimal or no symptoms in the initial stage, just to progress and cause a deep dull shoulder ache that often disturbs sleep, especially when lying on the unaffected side unless of course, the Supraspinatus muscle is involved. Supraspinatus tears will cause pain when lying on the affected side. Rotator cuff injuries may start the process of loss of shoulder function, and manifest with difficulty in combing your hair or reaching behind your back, and may present with arm weakness. Rotator cuff Injuries, Supraspinatus tears, and other shoulder injuries can at times progress further and become frozen shoulders. The anatomical bone structure of the shoulder is such that its minimal bone articulation (as seen in the image above) enables great shoulder mobility but as a consequence, reduces joint stability, a large number of ligaments and tendons that transverse the joint can damage easily, inflame and adhere to each other under all of the above-mentioned conditions. All the above conditions will greatly benefit from treatment at their onset to reduce the likelihood of progression to further immobility, such as that seen with a Frozen Shoulder.

From a Chinese medical perspective, such adhesion of the joint is viewed as Qi and Blood stasis, with possible dampness accumulation in the joint. When Qi stops moving and becomes static, locally circulating blood also stagnates. Blood stagnation is responsible for the sharp pain that is felt in the shoulder, weakness is to do with the Qi and damp stasis at the joint. Chronic pain and other chronic conditions in the body where stasis and lack of flow ensues tends to slow down recovery time and further complicate conditions and their rates of healing. Just like inflammation, Dampness, as it is termed in Chinese Medicine, can cause local swelling and the heavy type of sensation that often appears with most types of swelling.

There are different stages of a Frozen shoulder. In the initial stage, it may be of easier to manage the pain, as the joint capsule has not yet completely ceased. At a later stage, it becomes progressively more challenging as the range of movement is reduced and as the soft tissues within the shoulder begin to adhere to each other. The muscles around the joint (rotator cuff muscles) begin to atrophy and muscle mass is lost. This becomes an apparent complication no matter what form of medicine you seek in helping shoulder rehabilitation. The earlier you seek treatment, the faster the likely resolution of the condition..

When addressing a Frozen shoulder in the clinic I approach it with Traditional Chinese Acupuncture, where firstly, I access joint mobility and learn which meridian pathways are mostly blocked. The aim is to remove Qi and Blood stasis by stimulating the movement of Qi and Blood across and inside the joint. Often I will use some deep tissue Tui- Na (Chinese Deep Tissue and pressure point therapy) to increase the range of movements. I will most likely dispense herbal medicine in an attempt to soften the adhesions in the joint and attempt to assist the healing process between the Acupuncture sessions. Depending on the seriousness of the condition, its resolution time seems to vary greatly as the healing process is generally better with the young, and will improve more quickly the less chronic the condition is.

At times frozen shoulder may require further Medical intervention especially if the shoulder is completely immobile. The role of Chinese Medicine to manage the pain of frozen shoulder and possibly achieve a greater range of movement. as with most condition, Chinese Medicine treats the underlying causeaccording to TCM theory and aims to restore function.

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References:

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Lee, J. A., Kim, S. Y., Lee, S. H., & Kim, M. R. (2016). Acupuncture for frozen shoulder: systematic review and meta-analysis. Evidence-based complementary and alternative medicine, 2016.

Choi, J. Y., Song, Y. H., & Han, J. H. (2016). Clinical study on effect of electroacupuncture on frozen shoulder patients. Journal of pharmacopuncture, 19(4), 323-327.

He, Y., Zhang, X., Wang, Y., Zhou, M., & Liu, Z. (2019). Acupuncture for frozen shoulder: A systematic review and meta-analysis. Complementary therapies in clinical practice, 34, 181-193.

Zhang, J. H., Wang, D., Liu, M., & Sun, C. (2017). The effectiveness and safety of acupuncture therapy in frozen shoulder: a systematic review and meta-analysis. The American journal of Chinese medicine, 45(3), 485-503.

Liu, C. T., Yu, C. H., Hsieh, Y. L., & Yang, C. C. (2017). Acupuncture stimulation improves balance function in stroke patients: A single-blinded controlled, randomized study. The American journal of Chinese medicine, 45(05), 997-1015.

Xia, T., Wang, Y., Wang, Y., & Song, X. (2019). Acupuncture for frozen shoulder: A meta-analysis of randomized controlled trials. Medicine, 98(18).