By Dr. Yoon Jeon. MChiro, MB, BSc, Dip.TCM, PGCert.
Case Presentation
A 55-year-old office worker presented with persistent right shoulder pain and stiffness consistent with frozen shoulder (adhesive capsulitis).
The condition had been ongoing for more than one year and was progressively worsening. The patient reported significant restriction in shoulder movement, particularly in elevation, external rotation, and reaching behind the back.
Pain was described as constant and dull, with intermittent sharp exacerbations during movement. Night pain was also present, significantly affecting sleep quality.
The patient had previously undergone multiple treatments including NHS physiotherapy, prescribed analgesics, and private care interventions. Despite these approaches, symptoms remained persistent with minimal functional improvement.
Clinical Examination
Findings included:
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Marked restriction of glenohumeral joint range of motion (capsular pattern)
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Pain and stiffness in all shoulder planes of movement
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Reduced functional use of the affected arm
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Compensatory overactivity of surrounding shoulder girdle and thoracic musculature
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Associated upper thoracic stiffness contributing to altered shoulder mechanics
Clinical Impression
The presentation was consistent with:
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Adhesive capsulitis (frozen shoulder)
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Secondary thoracic spine and scapulothoracic dysfunction
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Associated myofascial pain patterns
Frozen shoulder is characterised by progressive capsular fibrosis and synovial inflammation, often resulting in long-term functional limitation if not effectively managed.
Treatment
A structured multimodal treatment programme was implemented:
Chiropractic Spinal Manipulation
Applied to the upper thoracic spine to improve regional mobility and reduce compensatory strain on the shoulder complex.
Glenohumeral Joint Mobilisation & Traction
Progressive mobilisation techniques were used to restore joint capsule mobility and improve range of motion.
Electro-Acupuncture
Applied to peri-articular and myofascial trigger points.
- Low/High-frequency EA used to modulate pain pathways
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Assisted in reducing muscular guarding and improving tolerance to movement
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Supported neuromuscular relaxation during rehabilitation phase
Rehabilitation Programme
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Gradual capsular stretching exercises
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Shoulder mobility restoration exercises
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Functional movement retraining
Postural & Ergonomic Advice
To reduce repetitive strain and prevent compensatory dysfunction during office work.
Clinical Outcome
After 2 weeks:
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Noticeable reduction in pain intensity
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Improved tolerance to shoulder movement
After 4 weeks:
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Significant improvement in range of motion
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Reduced night pain
After 6 weeks:
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Full restoration of shoulder function
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Patient reported complete resolution of symptoms
At follow-up:
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No recurrence of symptoms reported
Discussion
Adhesive capsulitis is a self-limiting but often prolonged condition characterised by progressive pain and restricted shoulder movement.
It is commonly associated with:
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Prolonged immobilisation or repetitive strain
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Metabolic and musculoskeletal dysfunction
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Poor scapulothoracic mechanics and thoracic stiffness
Manual therapy combined with exercise-based rehabilitation is widely recommended in conservative management.
Evidence supports the use of joint mobilisation techniques in improving pain and function in frozen shoulder (Ann Cools).
Thoracic spine dysfunction has also been identified as a contributing factor to shoulder impairment due to regional interdependence (Chad E Cook).
Electro-acupuncture has been studied as an adjunct therapy for chronic musculoskeletal shoulder pain, with evidence suggesting modulation of pain pathways and improvement in functional outcomes (Ji-Sheng Han).
Systematic reviews also support acupuncture as a useful adjunct in chronic shoulder conditions, particularly when combined with rehabilitation-based approaches (Caroline A Smith).
Conclusion
This case demonstrates that even long-standing frozen shoulder unresponsive to conventional physiotherapy and pharmacological treatment can respond well to a structured multimodal conservative approach.
The combination of spinal manipulation, shoulder mobilisation, electro-acupuncture, and progressive rehabilitation resulted in full functional recovery within six weeks.
References
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Ann Cools et al. (2015). Rehabilitation of the shoulder: evidence-based approaches.
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Chad E Cook (2013). Regional interdependence in musculoskeletal pain.
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Ji-Sheng Han (2003). Frequency-dependent effects of electro-acupuncture on pain modulation.
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Caroline A Smith et al. Acupuncture for shoulder pain: systematic review evidence.
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National Institute for Health and Care Excellence. Musculoskeletal pain management guidelines.
