Frozen Shoulder
_{(Adhesive Capsulitis)}

Even without any memory of shoulder injury, you start to feel shoulder pain. Thinking it will pass, you ignore it, but over time, the pain intensifies. Soon, raising your arm becomes difficult, making everyday activities like washing your face, eating with a spoon, and using the bathroom challenging. When you finally visit the doctor, you’re told it’s "frozen shoulder." Commonly affecting people in their 50s, this condition involves restricted movement and pain in the shoulder joint. Inflammation (capsulitis) and adhesions form in the tissues surrounding the shoulder joint, making movement difficult and painful. Medically, this condition is known as adhesive capsulitis and is often referred to as "frozen shoulder."Due to the unique structure of the shoulder joint, frozen shoulder causes pain that limits daily activities like styling hair, fastening belts, and raising arms (anterior elevation: flexion, posterior elevation: extension). Inability to style hair or fasten a belt is due to limitations in shoulder abduction, external rotation, adduction, and internal rotation. In conclusion, frozen shoulder is a relatively benign pain syndrome characterized by painful shoulder hypomobility.

Pathological Changes in Frozen Shoulder includes, but is not limited to, the following anatomical conditions:

• Disuse contracture from prolonged immobilization
• Supraspinatus tendon tear, calcification within the tendon, and impingement syndrome
• Bursitis
• Periosteal pain from biceps shortening at the coracoid attachment, pulled by the coracobrachialis
• Tendinitis of the long head of the biceps
• Acromioclavicular joint degeneration

Symptoms include pain and restricted motion, along with significant proximal muscle atrophy around the shoulder joint, especially in the supraspinatus and infraspinatus muscles, as well as some atrophy in the trapezius and deltoid muscles.

Treatment Approaches
For acute pain, localized stabilization, cold compresses, steroid hormone and local anesthetic injections, or anti-inflammatory painkillers are used. These treatments temporarily alleviate pain but do not address the root cause. Traditional Korean medicine treatments include acupuncture and herbal remedies. Acupuncture relaxes overly tense muscle fibers, offering fundamental relief from pain. Herbal medicine addresses the internal factors contributing to frozen shoulder, aiming for a root-cause approach to treatment. Physical therapy and active range-of-motion exercises are also beneficial for improving mobility and reducing discomfort. Early intervention during the “freezing” stage of the disease enhances treatment effectiveness, whereas treatment during the “frozen” stage will be more difficult, focusing on pain management and gradual recovery of range of motion.

Treatment Case: 64 years old male

   This patient presented with adhesive capsulitis roughly 6 weeks after the initial onset of symptoms. He noticed all of a sudden that he could not raise his left arm to dry his hair one morning. He could not elevate his shoulder beyond 100 degrees, and any elevation past 80 degrees was accompanied with significant pain and discomfort. The patient complained that it felt like “there was a rock lodged between his shoulders”.
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   As the patient was considered to be past the freezing stage already, treatment was mostly conservative and focused on lessening the discomfort experienced as well as slowly gaining mobility of the affected shoulder. The patient was treated with local shoulder point acupuncture according to the IMEAST (Intramuscular Electro Acupuncture Stimulation Treatment) protocol for five sessions. After these sessions, the patient reported that there was a considerable decrease in the local pain experienced, even though the range of motion only increased by 15 or so degrees. After five more sessions, the patient reported that their range of motion increased another 20 or so degrees. While many motions were still somewhat difficult, the patient was able to get through their daily activities relatively well with some adjustments.