Frozen shoulder also known as adhesive capsulitis is a condition caused by an unexplained pain, stiffness, limited active and passive range of motion (ROM) in two or more planes which subsequently lead to progressive loss of shoulder function. The shoulder pain is usually greater at night causing poor night sleep. Females will have a greater risk to develop this condition compared to male. Study found that the highest risk factor for frozen shoulder is diabetes mellitus, other risk factors includes any kind of local shoulder trauma or injury, thyroid disease, dyslipidemia and stroke.
The causes of frozen shoulder remained unknown with limited evidence suggests a genetic connection of human leukocyte antigen (HLA) B27 as a risk factor for frozen shoulders. However, strong evidence found that the elevation of inflammatory cytokines levels in the subacromial bursa and anterior capsule area is to be blamed. Arthroscopic observations also found that inflammation often appears in the anterosuperior joint capsule, axillary (armpit) fold of the joint capsule, coracohumeral ligament and in the rotator cuff. These inflammation leaded to adhesion and fibrosis (thickening of the tissue) of the structures involved. From freezing phase, frozen phase to the thawing phase, frozen shoulder can take at least 1.5 to 4 years to get better. Until today, there is still disagreement inside the medical community upon which treatment is the most effective in reducing pain and restoring range of motion for frozen shoulder which varies from laser therapy and steroid injections to arthroscopic capsular release.
Acupuncture has been reported to be effective for the treatment of frozen shoulder. Clinical trial studies also shows that acupuncture helps with shoulder pain reduction, restoring shoulder function, and restoring range of motion. In my clinic, I have seen quite a lot cases of shoulder problems, the modalities such as electroacupuncture, fire cupping, gua sha, moxibustion, heat lamp and herbal liniments are often used in conjunction with acupuncture treatment. A systematic review also found that electroacupuncture is particularly good to relieve the pain of frozen shoulder. Hereby, I summarise the benefit and mechanism of acupuncture for frozen shoulder:
1. Reduce inflammation – acupuncture stimulates the release of noninflammatory and vascular factors, these are neuropeptides (small proteins produced by nerve cells) that help regulate inflammation, blood flow and blood vessel control in the body.
2. Pain relief and modify the way the body responds to pain – specific acupuncture points on the body trigger the release of hormone serotonin and natural pain-killing chemicals called endorphins. These chemical also known as neurotransmitter who deliver and convey the message to promote relaxation and alter the way that our body processes pain in the brain and spinal cord. Studies also found that electroacupuncture at 2Hz and 100Hz produces release of Enkephalin and Dynorphin respectively which helps to ease the pain!
3. Decreased shoulder stiffness, improved range of motion and should mobility – acupuncture enhances blood flow and increases micro-circulation to the area which helps with the healing process by dilating and increase blood flow velocity of the veins and arteries that supply the shoulder area. Stronger circulation of blood in the shoulder area means faster nutrient delivery and therefore, reduce pain sensation, enabling the shoulder movement without feeling the pain.
How many acupuncture sessions are needed for frozen shoulder?
For frozen shoulder, I usually recommend having acupuncture treatment once or twice per week for 4 weeks as a starting point. However, it all depends on the severity of your frozen shoulder, a thorough assessment is required at your first session.
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