What Causes Frozen Shoulder – The Perfect Storm

Based on Dr. Austin Oolo’s clinical observations in treating thousands of frozen shoulder patients in over 35 years, there are 3 common denominators in patients suffering with adhesive capsulitis frozen shoulder. He calls this the Oolo-Austin Frozen Shoulder, Perfect Storm, Etiology Triad.

1. Lower neck disc pathology or nerve compression

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

2. Hormonal imbalance

Frozen shoulder always occurs in those with hormonal imbalances such as menopause, diabetes, thyroid, adrenal stress, testosterone imbalance, etc.

3. Shoulder strain injury

Is usually undetected by patient.

Dr. Austin Oolo’s theory on what causes Frozen Shoulder

It is Dr. Austin Oolo’s contention that the above triad of circumstances, which create a “perfect storm”, need to simultaneously exist within the body for the adhesive capsulitis type of frozen shoulder to develop.

His theory is that a lower neck disc or other neck condition first exists which causes some compression of the nerves in the lower neck. This leads to interference with the transmission of motor signals to the muscles of the corresponding shoulder. This transmission interference causes some of the shoulder muscles to be weaker than normal.

This condition is often completely undetected and asymptomatic. But patients in its advanced stages have symptoms of neck pain, upper shoulder pain, elbow/forearm pain, neck stiffness, headaches, or numbness in the hands. When a person strains or injures a muscle or tendon, the body responds with protective inflammation (swelling) in the area which also enhances the healing response. This inflammatory response is mediated by the immune system of the body which is closely linked to and somewhat governed by the hormonal (endocrine) system.

Inflammatory response and swelling

The inflammatory response increases following injury. It is at its peak of maximum tissue swelling three or four days after the initial injury. It is for this reason that many people will not feel anything notable when they pull or strain a muscle but wake up days later with pain and stiffness in the area of injury. (This is the same reason that someone feels a lot of stiffness and pain a couple of days after exercising heavily for the first time following a long period of inactivity.)

In cases of frozen shoulder, the person will perform a relatively innocuous activity which requires them to contract their shoulder muscles attached to the shoulder capsule, against a resistive load. It could be as simple as exercising with a new trainer or lifting a suitcase, child, or computer case.

Everyone has had such injuries which are usually referred to as a pulled muscle or shoulder sprain.

If the lifting activity causes stress on the muscles involved in meeting the resistance and they are weaker than normal, the muscle, its tendon, or the attaching joint capsule will tear slightly. Everyone has had such injuries which are usually referred to as a pulled muscle or shoulder sprain. This is most likely to occur if one muscle is relatively isolated during the lifting activity. Two muscles that are commonly isolated and stressed in the shoulder are the supraspinatus and the long biceps. Most of these common microscopic tear injuries heal without incident or residual effect.


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The swelling protects the area from further damage

An important part of the healing response is the inflammatory response. This response leads to temporary swelling of the tissues from an increase in water retention in the area of injury. If all goes as it should, the swelling increases for a few days. The swelling protects the area from further damage and promotes the secretions of hormones needed for the healing response. The damaged, torn tissues are repaired after which the swelling goes down and the person regains normal pain-free function.

When torn tissue is repaired, harder stronger tissue re-bonds the torn tissue together. This happens even on the microscopic level. This is what is commonly known as “scar” tissue or “adhesions” and it can be seen when the skin has been torn or cut open. These scar tissue adhesions also develop inside the tissues of the body in the muscles and tendons and other connective tissues of the joints–including the joint capsule.

In cases of adhesive capsulitis frozen shoulder, an initiation of the inflammation/healing response occurs which is much greater than it should be due to an imbalance in the hormones in the body. When the endocrine system is out of balance, the immune/healing response is also out of balance. If the imbalance is quite significant such as in cases of diabetes, thyroid disease, adrenal stress disorders or menopause, the healing response will be over-reactive or under-responsive.

Patients sometimes realize that it was something that strained the shoulder muscles or tendons such as sustained over-head work, starting a lawn mower, lifting a suitcase, etc.

In cases of the adhesive capsulitis type of frozen shoulder, it is over-reactive with an uncontrolled and over-exaggerated inflammation response and an equally uncontrolled and exaggerated healing response. Thus, excessive amounts of scar tissue form over the capsule of the shoulder joint. These are basically completely over-reactive, out of control protection and healing mechanisms caused by a hormonal imbalance.

Shoulder strain injury

Patients with frozen shoulder often wake up one day with a stiff and painful shoulder not being able to pinpoint any injury. But upon careful reflection they can sometimes remember what they were doing three or four days before the onset. Patients sometimes realize that it was something that strained the shoulder muscles or tendons such as sustained over-head work, starting a lawn mower, lifting a suitcase, etc. Not everyone remembers what strained their shoulder as it may have been something as simple as sleeping on it the wrong way. But something always causes the inflammation response to be initiated.

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Lower neck disc pathology or nerve compression

X-rays of frozen shoulder patients almost always show some bio-mechanic aberration of their necks with reverse curves and degenerative changes at C5-6 being very common. If the X-rays are negative, then the cause could be the compression of the nerves in the lower neck due to muscular stress/strain/spasm in the areas where the nerves exist and exit.

Hormonal imbalance

All frozen shoulder patients have a hormonal imbalance of some kind. If it is not something such as diabetes or thyroid disease, it could be severe chronic stress causing damaging adrenal dysfunction and high stress hormone levels (cortisol.) In addition to diabetes, or thyroid disease, hormonal imbalances such as menopause can cause the body to form excessive amounts of scar tissue. Normally, a small, often undetected, minor tear pull injury of the shoulder muscles or tissues is healed without forming scar tissue. But for those whose hormones are imbalanced, the immune healing response is uncontrolled and/or exaggerated.

If one reviews their own case of frozen shoulder they will invariably find that they can find the true cause of their frozen shoulder (adhesive capsulitis) in within Dr. Austin Oolo’s Frozen Shoulder Etiology Triad.

Until now, no one in the medical field has been able to pinpoint the true cause of the adhesive capsulitis type of frozen shoulder. Dr. Austin Oolo is the first person in the world to develop a theory of the cause.