Chronic Frozen Shoulder: Long-Term Impacts and How to Manage It

Chronic Frozen Shoulder: Long-Term Impacts and How to Manage It

Many of you may have experienced these symptoms to some degree—perhaps you’ve started finding it difficult to reach behind your back, or you feel a "catch" or restriction when raising your arms. These are often the first signs of significant muscle tension.

If left unaddressed, these minor aches can evolve into chronic issues, much like the case studies we frequently treat at gwellness clinic. Today, we would like to present a case study on Frozen Shoulder to walk you through our specialized care and treatment approach. Stick around until the end, as we’ve also included some simple exercise recommendations you can do yourself!

(Photo by https://www.sanook.com/health/5513/)

Case Study: Frozen Shoulder (Adhesive Capsulitis) in Traditional Thai Medicine

Patient Information

• Male patient, 50 years old 

• Presents with chronic left shoulder pain for more than 1 year 

Symptoms

• Tight, aching pain with sharp pain when raising the arm 

• Initial pain level: 8/10 

• Pain worsens with activity (e.g., lifting heavy objects or exercising) 

• Previously received physical therapy with temporary improvement 

• Pain relieved by medication 

• Patient seeks treatment through Traditional Thai Medicine 

Physical Examination and Follow-Up

Session 1

Before treatment

• Pain during flexion and extension 

• Pain at the posterior shoulder 

• Radiating pain when twisting the torso (knee rotation causing shoulder pain) 

After treatment

• Improved range of motion 

• Pain reduced to 6/10 

Session 2

Before treatment

• Symptoms improved, no soreness 

• Range of motion improved 

• Pain level: 6/10 

After treatment

• Improved range of motion 

• Pain reduced to 5/10 

• Persistent radiating pain when twisting the torso 

Session 3

Before treatment

• Continued improvement, no soreness 

• Range of motion improved 

• Pain level: 5/10 

After treatment

• Improved range of motion 

• Pain remained at 5/10 

Session 4

Before treatment

• Symptoms similar to previous session 

After treatment

• Significantly improved range of motion 

• Pain reduced to 3/10 

• Mild radiating pain when twisting the torso 

After the 4th session, the patient reported being unable to continue treatment due to personal obligations. Therefore, home exercises were recommended:

1. Wall Crawl Exercise
   Stand sideways facing a wall. Place the affected hand on the wall and slowly “walk” the fingers upward as far as possible. Hold for 10–15 seconds, then walk back down. Repeat 10–15 times. 

2. Pendulum Exercise
   Lean slightly forward, support the body with the unaffected arm, and let the affected arm hang freely. Gently swing it in small circles or forward and backward to reduce pressure on the shoulder joint. 

Treatment Approach

Each session involved assessment through history-taking and physical examination. Treatment methods included:

• Therapeutic Thai Massage 

• Oil Retention Therapy 

Academic Overview of Frozen Shoulder

Frozen Shoulder (Adhesive Capsulitis) is a condition characterized by inflammation and fibrosis of the shoulder joint capsule, resulting in restricted movement and pain.

Key Symptoms

• Shoulder pain, especially when lifting or rotating the arm 

• Stiffness and limited mobility 

• Night pain 

Stages of the Condition

1. Freezing Phase
   Severe pain and increasing stiffness (2–9 months) 

2. Frozen Phase
   Markedly reduced range of motion (2 months to 1.5 years) 

3. Thawing Phase
   Gradual recovery (1–3 years) 

Case Analysis

This case is consistent with:
 Frozen Phase

Reasoning:

• Chronic condition (> 1 year) 

• Clearly restricted range of motion 

• Pain has decreased but stiffness persists 

Additional Recommendations

• Combine stretching exercises with massage to enhance outcomes 

• Avoid excessive or heavy use of the shoulder 

• Long-term follow-up is recommended, as recovery can take considerable time

*The results may vary from person to person, depending on various factors, including behavioral modifications in conjunction with treatment.

For more information, please contact any branch of Gwellness clinic

References

1. Faculty of Medicine Ramathibodi Hospital, Mahidol University. Frozen shoulder: Treatable with proper management. Rama Channel; 2018. Available from: https://www.rama.mahidol.ac.th/ramachannel/article/%E0%B8%82%E0%B9%89%E0%B8%AD%E0%B9%84%E0%B8%AB%E0%B8%A5%E0%B9%88%E0%B8%95%E0%B8%B4%E0%B8%94-%E0%B8%A3%E0%B8%B1%E0%B8%81%E0%B8%A9%E0%B8%B2%E0%B8%AB%E0%B8%B2%E0%B8%A2%E0%B9%84%E0%B8%94%E0%B9%89-%E0%B8%95/ 

2. Tankitjanon P. A comparative study of the effectiveness of royal Thai massage and topical diclofenac in the treatment of frozen shoulder. Bangkok: Chulalongkorn University; 2017. Available from: https://digital.car.chula.ac.th/cgi/viewcontent.cgi?article=2005&context=chulaetd