”Frozen shoulder” is more specifically known as frozen shoulder, also known as adhesive capsulitis. Primary frozen shoulder is caused by an unexplained inflammation of the shoulder capsule and further thickening and contracture, resulting in pain and limited movement of the shoulder joint. This is shown in the figure below. Patients often come to the hospital for treatment of shoulder pain and limited motion. Frozen shoulder often causes difficulties in dressing, personal hygiene, bathing and other daily activities, which seriously affects the quality of life. Note: The left side shows the joint capsule of a normal shoulder joint, while the right side shows an inflamed, thickened, contracted joint capsule. Patients with frozen shoulder often first consult orthopedics and TCM acupuncture/orthopedic injury. Orthopedics will usually give oral anti-inflammatory and pain medication and joint cavity closure injections. These treatments can be effective in improving the patient’s pain symptoms, and Chinese acupuncture will also be useful for analgesia. However, the limited movement of the shoulder joint is not improved because it is not caused by pain alone, but more by the thickening and contracture of the joint capsule. Therefore, as you can imagine, there is no way to improve the mobility of the joint without treatment for the contracture of the joint capsule, and the patient needs the shoulder joint to have the range of motion needed for daily living. Rehabilitation of frozen shoulder is a long term process and will be done at different stages to address pain and limitation of motion. In the early stages of pain, the rehabilitation department will give the patient oral anti-inflammatory and pain relieving medications, as well as some analgesic treatments, such as laser and interferential electricity, which are unique to the rehabilitation department. In the middle stage, we focus on joint loosening treatment for patients with limited mobility. In addition to coming to the rehabilitation department 2-3 times a week to receive professional rehabilitation treatment, home treatment is also important. In addition to coming to the rehabilitation department three times a week for professional rehabilitation, home treatment is also important. We will instruct patients to perform various self-relaxation, self-distraction and muscle training at home in the outpatient clinic. The vast majority of patients have self-healing characteristics of frozen shoulder, but the process is a long one, with an average duration of 2 years. The significance of rehabilitation is to help patients get through the most painful phase by reducing pain and improving function at the most difficult time (nighttime pain and severely limited movement), and to improve the quality of life of the patient. The Department of Rehabilitation Medicine has unique exercise therapies and techniques that distinguish it from other disciplines such as orthopedics and Chinese medicine. Exercise therapy includes joint exercises and tension exercises. Manipulation is also different from Tui Na or massage in Chinese medicine, and is a Nordic manual therapy technique that uses the principles of mechanics – joint release. The most important aspect of increasing joint mobility is the use of appropriate joint movements, distraction and joint release to open up the sticky joint capsule to improve joint mobility and function. Heat, short wave, ultrasound, and interferential electricity can be used prior to exercise therapy to improve the extension of the joint capsule, muscles, tendons, and ligaments. In addition, short-acting anti-inflammatory pain relievers can also be taken prior to exercise therapy. If your shoulder is sore after exercise, you can also apply local ice or take anti-inflammatory pain relievers. It is also worth mentioning the different levels of intensity of joint release techniques, which not only improve joint mobility but also provide pain relief. Pain-free treatment is the treatment philosophy followed by the Department of Rehabilitation Medicine. Joint release is a hands-on treatment technique performed by a rehabilitation physician or a rehabilitation therapist. Traction is applied to the shoulder joint in all directions to distract the contracted capsule, and the patient is encouraged to move the joint actively while the traction is applied to increase the active mobility of the joint. The effect of this treatment is immediate. Patients often experience varying degrees of improvement in shoulder mobility in all directions after treatment. The patient is often delighted with the improvement. The figure below shows a comparison of upper extremity anterior flexion before and after a single arthroplasty treatment in a patient with frozen shoulder. The following group of pictures shows the joint capsule distraction and narrowing in all directions with arthrodesis.