Frozen Shoulder and Menopause Case Study

In this Frozen Shoulder and Menopause Case Study we saw a 56-year-old woman dealing with menopausal symptoms – hot flashes, hormonal variations, sleep issues – who developed a frozen shoulder out of the blue.  Frozen Shoulder (Adhesive Capsulitis) is a common condition with a poorly understood, multifactorial basis, which is frequently seen in women ages 40 to 60. While 5% of the world’s population is going to develop Frozen Shoulder, often for no obvious reason, it turns out there is a likely connection between menopause and frozen shoulder that may involve hormone changes. In our case above, both conditions required some attention. Diabetes is also a  consideration which needed to be ruled out. What we did was made sure the patient was adequately addressing her menopause and blood sugar, while we went all-in on the shoulder, with great success. 

How did Frozen Shoulder Present?

Frozen Shoulder, a type of arthrofibrosis,  happens when the connective tissues around the shoulder joint become thickened and stiff, often a result of trauma, extended use, immobilization, surgical procedures, or inflammation. The capsule of the shoulder joint becomes surrounded, essentially, by scar tissue adhesions. In our case the patient suddenly could not raise their arm above 90 degrees out to the side, and could not inwardly rotate the shoulder (think fastening a back-hook bra or scratching the back). Besides there being troubling pain, it felt as though a stiff rubber band was blocking the movement.  What we frequently see is pain reported pulling on an overcoat, and with females it is often the back bra clasp. Often, with the arm out at 90 degrees, elbow bent at 90 degrees (like a politician waving at the crowd), trying to rotate the hand down to the palm being flat out and down in front is painful particularly below the horizon line. Alternatively, with the hand out, elbow bent at 90 like a handshake, rotating the arm and hand outward to the side can also be painful. This particular patient, a sailboat racer, could not pull on her life jacket over her coat. 

The Connection with Estrogen

We can discuss in another blog why men also get Frozen Shoulder, but while we are on the subject – men have estrogen – a lot of estrogen- as well.  First, let’s point out that the estrogen/capsulitis relationship is is a connection, not a causation. But interestingly, post-menopausal women on Hormone Replacement Therapy (HRT) show a lower risk of developing frozen shoulder.  According to Duke University School of Medicine, “Estrogen plays a role in stimulating bone growth, reducing inflammation, and promoting connective tissue integrity…. Not using systemic hormone therapy was associated with a higher risk of adhesive capsulitis”. The conclusion appeared to be that given that older women are most commonly affected by adhesive capsulitis, there may be a connection between the loss of estrogen and menopause and this condition.  In October 2022,  this Duke researcher presented this relatiponship with a retrospective case study at the meeting of the North American Menopause Society meeting in Atlanta. 

Despite this, we still see internet posts suggesting that there is no “solid evidence” linking estrogen to Adhesive Capsulitis – we are not going to link them here; sometimes it’s hard to create a study that can generate “solid evidence”.  In this situation, we can also get into the “Correlation is not Causation” argument – but again – if a “cause” is multifactorial – you may never statistically “nail it down”. So, in the meantime, let’s go with the clinical results, and address both issues without arguing about it. 

Did we need an MRI?

Whether or not an MRI is needed really depends on a lot of factors that we will review during your appointment. In this case, no MRI was required – but we had already scheduled a plain-film x-ray to rule out joint space loss due to shoulder arthritis, or a bone spur at the acromio-clavicular (AC) joint. Keep in mind, you can have all of the above at the same time. In this case, our results turned positive right away and we didn’t need the X-ray.  However, the shoulder MRI is no big deal  – if we need to get one, we are not going to make a patient beg for it. But when a situation is chronically problematic – as in existing for more than six months, or recurrent – we typically want to get a look at what we are working with, rather than shooting in the dark as we see a lot of other providers do.

Vitamins, Supplementation and Medicines

Vitamin C (megadoses – don’t do this yourself) can apparently help to ward off the development of Adhesive Capsulitis. In this case, we brought this into play, along with bioflavonoids. Anti-inflammatory supplements that work on immune-system-mediated inflammation were prescribed and we helped her obtain them. The patient also used some over-the-counter NSAIDs (ibuprofen) – until she did not need them anymore.

Did we Adjust or Manipulate the Shoulder? Other treatments?

Absolutely we adjusted and manipulated the cervical spine, upper thoracic spine and ribcage, as well as the shoulder extremity. If you want to see the move we used, you will simply have to be a patient, since I can’t really adequately describe it here – and – not all moves are for all patients. In our case, we only needed two sessions of shoulder manipulation to get our results, and the range of motion and pain relief was dramatic after the first day. Not all results are going to be like that – but they can be. By the way, there was also some soft tissue massage and electrical stim therapy, which while it added to the success, was really just a part of a regular treatment plan at Blue Heron Chiropractic. At Blue Heron, all our “standard” treatment plans are “customized”.

How did we address the Menopausal Overlay

This patient has a great supplement regime, and so taking some supps to help things out was something that came naturally. She eats a live-food and “Green” diet as often as possible. We provided her a link to a great online supplier to obtain Femmenessence and “Maca”, a promising supplement for this significant issue. While we are not “vending” or “selling” this directly, we make recommendations like this to patients as a part of our balanced, whole-body  plans. Sometimes what we do is make sure the patient is doing it themself, and helpfully advise them.

How does the Mainstream treat frozen shoulder?

PT is often prescribed with a lot of shoulder exercises without first considering the above conditions – and maybe not unless you ask. Sometimes the exercises or stretching worsens the condition, creating a lot of unhappy reactions. If the physiotherapy doesn’t improve the condition, conservative providers may schedule an MRI, while others might jump right into a corticosteroid injection on the first day (we don’t recommend starting that). Some providers will schedule manipulation under anesthesia (read as – painful), which we also don’t recommend up front. Especially if the overlays of menopause or diabetic changes are not considered, the final result is going to be surgery, which might even get mentioned to you on your first session. Surgery or injections are typically never our first course. Typically, we recommend covering all the bases in order to get the best results with the lowest chance of surgery or painful injections. I would prefer to address this chiropractically. Let’s work on this at an appointment at Blue Heron Chiropractic at 1934 NE Broadway, easily accessible in Northeast Portland.

What if treatment so far has failed?

If you have had all or some of the above and it has not yet worked, let’s look at your case from a different perspective. This does not make the other approaches wrong – just different. We will get your medical records and apply another approach. What we will likely be doing is adding to what you have had, rather than subtracting from or taking away. We may change a few things. But often a fresh perspective makes the difference.

Will Frozen Shoulder return?

Recurrence is always a possibility, especially in our case with the menopausal/estrogen overlay. Occasionally – as in maybe 20% – we see it in the opposite shoulder.  We do, however, now have a game plan to treat it. However, we will always re-evaluate when it happens.  Frozen Shoulder that develops in response to an injury has less frequency of recurrence unless there are one of these above overlays as well – or one develops. 

Is Blue Heron Chiropractic masking for the COVID Pandemic at this time?

New variants are showing up are causing a lot of people to get sick. The Doctor is going to mask for your session, while your mask is definitely optional.  Our staff is vaccinated and boosted, so even if we get this, we won’t be gone long and will get back to caring for you. We remain protective for folks who are immune compromised, have “Long Covid”, or need special considerations. A patient can wear their own mask at any time – and If you would like a mask and don’t have one, we can provide it – but again, masking is optional.  If you have flu-like symptoms, are sneezing or coughing or blowing, we may provide you with a mask, so we can continue to serve you better; feel free to mention this to us when you call in to confirm your appointment.  Schedule an appointment today.  You can access Chiropractic safely and securely at Blue Heron Chiropractic & Healing Arts Center, with Dr. Dana Sibilla, DC DABCO FIANM.

Want some more chiropractic reading? Try our prior blog on Go-To 7-Minute Workouts.