Frozen Shoulder: A Common Cause of Shoulder Pain
Frozen shoulder, also known as adhesive capsulitis, is a prevalent cause of shoulder pain, especially among middle-aged and elderly individuals. It is a spontaneous, progressive inflammatory condition of the shoulder joint capsule, involving various ligaments and tendons around the shoulder. The exact pathogenesis remains unclear; however, many patients have a history of soft tissue injury or arthritis in the affected area.
Acute and Chronic Phases:
- The acute phase, characterized by intense pain and restrictionof movement (hence, the "freezing phase"), typically involves significant inflammation of the shoulder's soft tissues. Common conditions include subacromial bursitis and rotator cuff tendonitis.
- During the chronic phase, or the "frozen phase", adhesion of the local soft tissues occur, leading to more pronounced movement restrictions and even muscular atrophy.
- Effective treatment during the acute phase can prevent or alleviate the symptoms of freezing. Once frozen shoulder occurs, appropriate treatment can expedite recovery during the "thawing phase."
Acupuncture and Treatment Strategy:
- Acupuncture, particularly electroacupuncture, is highly effective for frozen shoulder.
- During the freezing phase: The focus is on pain relief and inflammation reduction, with shallow acupuncture and heat therapy on tender local points.
- During the frozen phase: Treatment aims to eliminate adhesions and increase shoulder mobility.
- During the thawing phase: Emphasis is placed on the patient's active exercise, supplemented with acupuncture.
- The efficacy of acupuncture for frozen shoulder or periarthritis has been confirmed in randomized controlled studies.
- Exercise itself promotes recovery from frozen shoulder, and combining exercise with acupuncture has been shown to improve recovery outcomes.
Combining Acupuncture with Conventional Treatments:
- Conventional medical treatments for frozen shoulder include local nerve block, physiotherapy, and oral anti-inflammatory pain medications.
- Combining acupuncture with these treatments can enhance effectiveness, providing better pain control, duration, and improved shoulder joint mobility.
Rehabilitation Approach:
- Addressing pain relief and effective shoulder exercise is crucial since pain and mobility issues create a vicious cycle. Local pain leads to movement avoidance, accelerating tissue adhesion and reducing mobility.
- Patients should utilize the hours of pain relief after acupuncture to actively move the affected shoulder.
- Once the shoulder is completely frozen, although pain might decrease, it's generally challenging to move the joint. At this stage, passive shoulder movement is required.
- Regardless of whether the exercises are active or passive, they should encompass various directions, including rotation, elevation, and extension.
- Given that most patients with frozen shoulder experience both pain and mobility impairment, this condition is well-suited for bilateral or symmetrical acupuncture techniques. After stimulating local points on the affected side, contralateral points and corresponding lower limb points, as well as abdominal acupuncture points, can be used while encouraging the patient to move the affected shoulder.
In summary, managing frozen shoulder requires a multifaceted approach, combining pain management through acupuncture with effective shoulder exercises, to break the cycle of pain and immobility.