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The condition known as frozen shoulder (also called adhesive capsulitis) is a condition that causes severe pain and progresses through three stages (freezing stage, frozen stage & thawing stage) and worsens over time, restricting shoulder movement (both active range and passive range of motion) and making daily activities extremely challenging or entirely impossible. 

Frozen shoulder occurs when the strong connective tissue surrounding the shoulder capsule contracts and forms scar tissue, causing an anatomical obstruction that prevents the upper arm bone (humeral head) from travelling through a normal range of motion in the shoulder joint capsule. 

Although the reasons for developing frozen shoulder remain poorly understood by many in the medical community, there are strong theories as to why certain people develop frozen shoulder, as well as mounting evidence on the best way to treat frozen shoulder. 

The leading authority on this matter is Dr. Oolo-Austin, the founder of the World Frozen Shoulder Clinic, based in Toronto, Ontario, Canada. His clinical observations from treating thousands of frozen shoulder patients over the course of decades led him to the realization that there are 3 common denominators in patients suffering with adhesive capsulitis frozen shoulder; they are the “frozen shoulder perfect storm, etiology triad.”

Frozen Shoulder Perfect Storm, Etiology Triad


Lower neck disc pathology or nerve compression

Frozen Shoulder almost always occurs in patients with lower neck disc conditions or muscle contraction conditions that compress the nerves supplying the shoulder and arm with motor and sensory information. (eg. thoracic outlet syndrome.)

Hormonal imbalance

Frozen shoulder only occurs when there are hormonal imbalances, such as those caused by menopause, diabetes, thyroid conditions, adrenal stress, Parkinson’s disease, testosterone imbalances, amongst others.
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Shoulder Injury

Rather than severe, acute injuries, these are usually shoulder strain injuries that often go undetected by the patient when they occur.


It is Dr. Oolo-Austin’s contention that the above triad of causative circumstances (etiology), which create a “perfect storm” for the development of adhesive capsulitis (arthrofibrosis) frozen shoulder, need to simultaneously exist within the body for the adhesive capsulitis variety of frozen shoulder to develop.

According to his theory, a pre-existing lower neck disc pathology (or nerve compression) leads to interference with the transmission of motor signals (both movement and strength) to the muscles of the corresponding shoulder. This transmission interference weakens the musculature that surrounds the shoulder joint capsule.

When they first develop, these nerve or disc issues are often asymptomatic and undetected. When they reach the advanced stages, patients have symptoms of neck pain, upper shoulder pain, elbow/forearm pain, neck stiffness, headaches, or numbness in the hands.

Dr. Allan Gary Oolo-Austin

When a person strains or injures a muscle or tendon, the body responds with protective inflammation in the area to facilitate the healing response. This inflammatory response is mediated by the body’s immune system, which is closely linked to and governed by the endocrine system.

The ensuing swelling protects the area from further damage and promotes the secretion of hormones required for the body’s healing response. Once damaged tissues are repaired, the swelling subsides and normal, pain-free function returns.

When torn tissues are repaired, it leads to harder and stronger tissue, commonly known as “scar tissue” or “adhesions.” Scar tissue and adhesions can develop anywhere in the body, including in the muscles, tendons and other connective tissues of a ball-and-socket joint, such as the shoulder.

Shoulder Joint Implications

In cases of adhesive capsulitis frozen shoulder, the inflammatory response that occurs is much greater than it should be due to a hormonal imbalance. When the endocrine system is out of balance, the healing response will either be over-reactive or under-responsive.

In cases of frozen shoulder from adhesive capsulitis, the body’s over-reactive and uncontrolled inflammatory and healing responses create excessive amounts of scar tissue. Over time, these adhesions accumulate, causing pain and limiting shoulder motion.

Find out more about the frozen shoulder symptoms.

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Frozen shoulder sufferers usually wake up with symptoms that appear, seemingly, without cause. Short of a major accident, minor strains often go unnoticed, even after a consultation with a physical therapist. However, upon reflection patients are sometimes able to recall an unusual movement or strain in the days leading up to the onset of symptoms. They range from working overhead to starting a lawn mower awkwardly or many other potential causes. The original cause is not always apparent, but the body’s inflammatory response is always initiated by something.
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In similar fashion to shoulder strain injuries, lower neck disc pathology or nerve compression can easily go unnoticed until it results in other problems. Often resulting from mysterious circumstances, these issues could be caused by something as innocuous as sleeping in an uncomfortable position.
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All frozen shoulder patients have a hormonal imbalance of some kind. If not due to a condition, such as diabetes or thyroid disease, it could be from chronic stress, which causes adrenal dysfunction and high cortisol levels. Hormonal imbalances, such as menopause, can cause the body’s healing mechanism to create excessive amounts of scar tissue. Normally, a small, often undetected, minor shoulder muscle tear injury heals without forming very much scar tissue, however, for people with hormonal imbalances,an exaggerated or uncontrolled healing response can create excessive scar tissue.

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For more information about the MCD procedure and how it could help relieve your shoulder problems, simply contact the World Frozen Shoulder Clinic for your free consultation.


Learn More on Frozen Shoulder​

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How to Sleep with a Frozen Shoulder

Frozen Shoulder Exercises

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