Chiropractic Management of Adhesive Capsulitis (Frozen Shoulder): A Retrospective Case-Series of Seven Patients

Abstract

Background: Adhesive capsulitis, or frozen shoulder, is a common musculoskeletal condition characterized by progressive pain and stiffness of the glenohumeral joint. While often self-limiting, its prolonged course prompts exploration of conservative management options. Methods: A retrospective case-series was conducted by reviewing patient files from Pure Wellness Chiropractic in Wilmington, DE. Seven patients (n=7) meeting the inclusion criteria of a chief complaint of frozen shoulder with documented pre-treatment and post-treatment pain scores were included. Data on pain, measured on a 0-10 numeric rating scale, and treatment duration were extracted and analyzed descriptively. Results: The seven patients demonstrated a mean pain reduction of 87% (median 89%). Treatment durations varied from a few weeks to several months. Case vignettes illustrate significant improvements in pain and function, including restored sleep and ability to perform overhead activities. Objective mobility changes were not quantitatively tracked. Conclusions: The findings from this small case-series suggest that a multimodal chiropractic approach may be effective in reducing pain and improving function for patients with adhesive capsulitis. The results support the need for more rigorous prospective research, including randomized controlled trials, to validate these outcomes.

Methods

This study employed a retrospective case-series design to evaluate the outcomes of patients treated for frozen shoulder at a single chiropractic center. All data were extracted from existing patient records at Pure Wellness Chiropractic in Wilmington, DE, with all patient identifiers removed to ensure anonymity. Inclusion criteria for this series required a patient chart to contain a chief complaint or diagnosis consistent with adhesive capsulitis (frozen shoulder) and documented pre- and post-treatment subjective pain ratings.

Seven patient files (n=7) met these criteria and were included in the analysis. The primary outcome measure was the change in self-reported pain intensity, documented using a 0-10 Numeric Rating Scale (NRS), where 0 represents 'no pain' and 10 represents the 'worst pain imaginable'. Data regarding patient demographics (age range, gender), treatment timeframe, and qualitative descriptions of functional improvement were also collected when available.

Patients received a multimodal course of care administered by the Doctors of Chiropractic at the clinic. Treatment protocols were not standardized for the purpose of this retrospective review but were tailored to each patient's clinical presentation. The therapeutic techniques available at the practice include Diversified, Thompson Drop, Gonstead, Sacro Occipital Technique (SOT), Activator Methods, extremity adjustments, Cox Distraction, Webster technique, and myofascial release. The specific combination and frequency of these interventions were determined by the treating provider based on the individual patient's needs and progress. Descriptive statistics, including mean and median, were calculated for the percentage of pain reduction across the cohort.

Discussion

The results of this retrospective case-series suggest that a multimodal chiropractic treatment approach may be a beneficial component of management for patients with adhesive capsulitis. The cohort of seven patients experienced a mean pain reduction of 87%, a clinically significant improvement that surpasses what might be expected from the natural history of the condition alone in the observed timeframes, which ranged from a few weeks to several months. While adhesive capsulitis can resolve spontaneously, the process often takes 1-3 years. The improvements noted in this series appear to represent an accelerated recovery from the painful phase of the condition.

The therapeutic interventions utilized at the clinic, including spinal and extremity adjustments, soft tissue mobilization, and various instrument-assisted techniques, likely contribute to these outcomes through several mechanisms. Chiropractic adjustments may help restore normal arthrokinematics of the glenohumeral and surrounding joints, breaking up minor adhesions and stimulating mechanoreceptors to inhibit nociceptive signals. Soft tissue methods like myofascial release could directly address the capsular and muscular contractures that are hallmarks of the condition. By improving biomechanics and reducing peripheral pain generators, such care may facilitate a more rapid transition through the freezing and frozen stages.

Clinically, these findings highlight the potential role for chiropractic care as a non-invasive option for individuals suffering from frozen shoulder. The reported improvements in pain, sleep quality, and the ability to perform overhead activities (as noted in Case 6 and Case 7) underscore the impact of treatment on quality of life. The success reported by a patient who had 'tried everything else' (Case 4) suggests this approach may also be valuable for those who have not found relief with other conservative measures. However, these are preliminary observations that must be interpreted with caution.

Limitations

This study has several important limitations inherent to its design. As a retrospective case-series, it lacks a control group, making it impossible to definitively attribute patient improvements to the chiropractic interventions versus the natural history of the disease, placebo effects, or other concurrent treatments. The data were collected from a single private practice, which may limit the generalizability of the findings to other clinical settings or provider approaches. The reliance on self-reported pain scores as the primary outcome measure introduces subjectivity, and the absence of objective, quantitative data on range of motion is a significant drawback. Furthermore, the small sample size (n=7) reduces the statistical power of the results. There is also a potential for selection bias, as the cases reviewed may represent patients who experienced particularly favorable outcomes, while those who discontinued care due to a lack of progress would not be captured in the final analysis.