Frozen shoulder

Health for Life Pilates and ChiropracticWhat is Frozen Shoulder and How Can Chiropractic Care Help? 

Frozen shoulder (Adhesive Capsulitis) is when individuals experience constant shoulder pain that interferes with movement of the arms and shoulder. Symptoms include: 

  • Increased pain at night, causing sleep problems for extended periods
  • Increased pain in cold conditions
  • Restricted movement/positions, resulting in chronic fatigue
  • Chronic pain that can predispose the patient to depression
  • Discomfor/pain in the neck and back areas attached to the frozen shoulder,
  • Intense pain and cramping that last for several minutes after certain shoulder movements
  • Injury to tissues surrounding the frozen shoulder, as other muscles compensate for the unmoving joint.

Frozen shoulder can last from five months to three years or more and is thought in some cases to be caused by injury or trauma to the area.
These problems can cause great frustration for patients and caregivers alike due to the slow nature of recovery.

Understanding the shoulder jointshoulder joint

First, let’s do a quick tour of shoulder anatomy. The shoulder joint is the most mobile and intricate joint in the body because it has so many bones, ligaments, tendons, bursae and the most important structure in our discussion, the joint capsule. The joint capsule is a stretchy bag that completely envelops the entire shoulder joint. The fluid lubricates the joint.

How does Frozen Shoulder develop?

Remember that there is a joint capsule that completely envelops the joint and provides lubrication. Because of the shoulder joint structure, this capsule is very loose (to allow mobility) and when the arm is held at its side, the capsule folds and sags down below the joint. (See picture below)shoulder-joint-capsule

Under normal conditions: when you abduct your arm (lift your arm up sideways) the capsule unfolds allowing for the extra movement. The inside of the capsule and part of the humeral head are lined with synovial tissue which produces the lubricating fluid (synovial fluid) of the joint.

Under abnormal conditions: e.g. injury; the joint capsule and the connective tissue surrounding the shoulder joint become inflamed. It is often one of the tendons in the joint that become inflamed. Because the shoulder is so interconnected the other structures in the shoulder also become inflamed because parts of the joint are not working properly. Eventually the tendons, ligaments, bursae and capsule become inflamed and the muscles that move the shoulder joint go into protective spasm. At this point, you have "frozen shoulder."

 The medical term, adhesive capsulitis, describes exactly what happens in this condition.

  1. The internal layer of the joint capsule becomes sticky when the capsule is inflamed.
  2. The internal surface of the capsule then sticks to itself which creates tough bands of tissue that decrease the stretchiness of the capsule.These tough bands, called adhesions, greatly restrict movement in the shoulder and cause chronic pain.

Who gets frozen shoulder?

There is some correlation with autoimmune diseases, diabetes and affects 40 to 70 year old people with 60% of them women. In approximately half of the cases the cause of the frozen shoulder is unknown. The other half of the cases are created from trauma or overuse. There is a typical time pattern in this condition.

What is the typical course of Frozen Shoulder?

Stage One: The "freezing" or painful stage, which may last from six weeks to nine months, and in which the patient has a slow onset of pain. As the pain worsens, the shoulder loses motion.

Stage Two: The "frozen" or adhesive stage is marked by a slow improvement in pain but the stiffness remains. This stage generally lasts four months to nine months.

Stage Three: The "thawing" or recovery, when shoulder motion slowly returns toward but never back to normal. This generally lasts five months to 26 months.

What treatments are available?

Unfortunately if left without treatment, the shoulder capsule continues to contract, leaving the individual in pain and with greatly reduced mobility. Therefore prompt and regular treatments are most effective and are aimed at reducing inflammation in and around the joint. These include combinations of:

  1. Manually moving the joint
  2. Using Trigger Point Therapy to mobilize the musculature
  3. Stretching and range of motion exercises
  4. Applying ice
  5. Using NSAID's (Non-Steroidal Anti-Inflammatory Drugs)
  6. Severe cases of this condition are treated with hydrodilation (injecting saline into the joint), injection of steroids into the joint or manipulation of the joint under anaesthesia. 

How can chiropractic treatments help with your Frozen Shoulder?

There are four chiropractic avenues of treatment that I use to treat frozen shoulder:

  1. Manual Chiropractic Treatments to unstick the capsule. It is slightly painful but very effective.
  2. Trigger Point Treatments to the four main muscles of the shoulder, the coracobrachialis, the biceps and the supraspinatus and the subscapularis.
  3. Chiropractic Spinal Assessment of the area near the shoulder to ensure correct mobility and movement.
  4. Patient At Home Instructions regarding in-home daily ice therapy and exercises to facilitate unlocking the muscle spasms in the shoulder.

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