Adhesive Capsulitis (Frozen Shoulder): Stage One

When a patient presents with limited range of motion in the shoulder, it is important to properly diagnose the injury and differentiate adhesive capsulitis from other shoulder injuries that can look similar to this condition such as shoulder impingement syndrome, bursitis, rotator cuff tenosynovitis and cervical radicular pain. Differentiating physical exams will be demonstrated and practiced.

Once the diagnosis is made, the practitioner will need to decide which stage the patient with adhesive capsulitis is in. Each stage will designate various acupuncture and motor points, myofascial mobilizations, therapeutic modalities and Chinese herbal medications that are best suited to the adhesive tissue and sequential myofascial and channel imbalances.

Freezing: Painful Stage 

• This painful stage lasts between 3 and 9 months.

Frozen: Transitional Stage

• This transitional stage can last between 4 to 12 months

Thawing Stage

• This thawing stage lasts anywhere from 12 to 42 months.

This blog will present a few important and effective acupuncture points and a Chinese herbal formula for the Freezing Stage of adhesive capsulitis. Below is information from the upcoming seminar Adhesive Capsulitis: An Acupuncturist’s Guide in Assessment and Treatment in Chicago, IL. Oct. 5-6, 2024. Instructor: Matt Callison L.Ac.

A key finding with frozen shoulder is the occurrence of angiogenesis in the capsular tissue beginning in stage one. The hypervascularity from angiogenesis releases fibroblasts and cytokines (cell mediators) which produces collagen fiber proliferation and granulation. As the disease progresses into the stiff and contracted second phase, angiogenesis declines and is replaced with a thick adhesions of dense collagen fibers primarily in the superior joint capsule (coracohumeral ligament), rotator cuff interval and the subscapularis tendon. (Bunker T. 2009), (Robinson C. M. 2012), (Lewis J. 2015). (Handa A, 2003).

In the first stage, because angiogeneisis is an important event in the etiology of this condition, the author has found good success with treating this initial phase as Blood Stagnation with Cold.

Local points (see PowerPoint images below):

• Extra point Dai Jian Zhen affects the rotator cuff interval and coracohumeral ligament. Moxibustion is applicable.
• Coracoclavicular and coracoacromial ligaments. Moxibustion is applicable.
• Extra point taijian: affects the subscapularis tendon insertion.

Other local, adjacent and distal acupuncture and motor points are used and based on the specific muscle and channel imbalances involved and in regard to the patient’s constitution.

This classic TCM formula is a good working formula and can be modified based on the stage of adhesive capsulitis.

Remove Painful Obstruction Decoction (Juan Bi Tang)

• Radix et Rhizoma Notopterygii (qiang huo) 9g
• Radix Angelicae Pubescentis (du huo) 9g
• Radix Gentianae Macrophylla (qin jiao) 9g
• Caulis Piperis Futokadsurae (hai feng teng) 12g
• Ramulus Mori Albae (sang zhi) 12g
• Radix Angelicae Sinensis (dang gui) 12g
• Radix Ligustici Wallichii (chuan xiong) 6g
• Radix Aucklandiae Lappae (mu xiang) 6g
• Gummi Olibanum (ru xiang) 6g
• Ramulus Cinnamomi Cassiae (gui zhi) 6g
• Radix Aconite Carmichaeli Praeparata (zhi fu zi) 3g
• Radix Glycyrrhizae Uralensis Praeparata (zhi gan cao) 3g

Modification: Add Fructus Chaenomeles (mu gua) 6 g and Radix Paeoniae Lactiflorae (bai shao) 6g for pain in the shoulder.

The following are a few power point slides for this upcoming course, Adhesive Capsulitis: An Acupuncturist’s Guide in Assessment and Treatment in Chicago, IL .Oct. 5-6, 2024. Instructor: Matt Callison L.Ac.