FROZEN SHOULDER CAUSES and CHIROPRACTIC TREATMENT

A Frozen shoulder, known in medical terminology as an Adhesive Capsulitis, is one of the most disabling and painful conditions to confront the healing professions.

THREE PHASES

FROZEN SHOULDER CAUSES and CHIROPRACTIC TREATMENT

1. A freezing phase lasting about 6 mos.
2. A frozen phase lasting about 12 mos.
3. A thawing phase lasting 18 mos.

Three years of misery!

A recent literature search of Frozen Shoulder treatments by a team of medical experts found that no one frozen shoulder treatment or team of experts has the monopoly on solutions to this tough problem, though some treatments do help. The most common treatment at the medical coalface, anti inflammatory drugs was not even considered, having absolutely no scientific basis in the treatment of this nasty condition. They simply don't help.

Classically, a Frozen Shoulder takes 2-4 years to resolve, but after four years some 6% still have extreme pain and disability.

FROZEN SHOULDER CAUSES and CHIROPRACTIC TREATMENT

But, and it's a big but, as Carl Sagan said, "Absence of proof is not the same as proof of absence." We chiropractors simply haven't done the research.

Research Review Service

Another but: At the Chiropractic Coalface, there are few conditions that I love more than the challenge of a Frozen Shoulder. In my experience, it's rare that the pain is not substantially less within six weeks, and the range of motion almost fully restored within a year. The last 10% of external rotation may take longer but, in the absence of pain, it's not disabling at all. But can that audacious claim be demonstrated scientifically?

What treatments do help?

That literature search found that there was some scientific basis that the following treatments might help:

1. Corticosteroid injections brought significant pain reduction but no increased range of motion. There is also a danger of tendon rupture associated with the treatment. Other research found that these injections gave no more relief than a placebo. After two years external rotation was still very limited.

2. Hydrodilatation together with corticosteroid injections may bring further relief. Some research was positive, other not at all convincing.

3. High grade mobilisation was found after one year to increase mobility and lesseN disability.

4. Mobilisation at the end-rage proved helpful at twelve weeks. Exercise and manipulation beyond the pain threshold was found to be less effective.

5. Other research showed that home exercises plus a vigorous manipulation under anaesthetic (it's extremely painful, no one could tolerate it otherwise) had some effect.

6. Deep friction massage and joint mobilisation were found to be more effective than standard physiotherapy.

7. Acupuncture plus exercise is more effective than exercise alone.

You will notice considerable contradictions in the above, therapy in the hands of one practitioner not being the same as in the hands of another.

Frozen Shoulder causes

What does Chiropractic have to add?

The basis of chiropractic is that many of the conditions affecting the arm, be it Carpal Tunnel Syndrome, Tennis Elbow or Frozen Shoulder are caused by nerve irritation. That could be a nerve root impingement, a Scalene Triangle impingement, in the ulna groove, between the bellies of the Pronator teres...

Certainly the Chiropractic examination of the Frozen shoulder usually unearths some of the following:

• Poor scapular rhythm with an acute myofasciitis in the Subscapularis muscle amongst others.

• A fixation of the first rib and/or anterior and middle scalene tightness.

• A positive Adson's test.

  
  
  
  

• Thoracic Outlet syndrome
  
  
• Cervical facet syndrome
  
  
• A midthoracic fixation, with symptoms affecting one or more ribs, often all the way to the sterno costal joints. Tietzes Syndrome ...
  
  
• An AcromioClavicular joint fixation
  
  

Inter Scalene Triangle

FROZEN SHOULDER CAUSES and CHIROPRACTIC TREATMENT

In short Frozen shoulder causes are extremely variable and the condition presents in many different ways. In one case it's internal rotation that is most affected, others external rotation. In one case a rhomboid spasm is key, another the levator scapular or subclavius muscle...

In my experience what they all have in common is

1. extreme shoulder pain,
2. severe disability, with sleep disturbance and difficulty dressing and undressing.
3. resistance to treatment of any sort, and
4. a first rib fixation.

What is uncertain is whether that first rib fixation, affecting both the blood supply and nerve supply to the shoulder is a cause, or a subsequent result of the condition. Chicken or egg? Either way, both the blood supply and the innervation of the shoulder are compromised in the scalene triangle.

Chiropractic Frozen Shoulder treatments

FROZEN SHOULDER CAUSES and CHIROPRACTIC TREATMENT

1. Adjustment of the first rib and/or low cervical subluxations.
2. Active release of the anterior and medial Scalene muscles.
3. Adjustment of any upper-to-mid thoracic rib fixations.
4. Evaluation of the rhythm of the whole rib(s) involved, from its costo-thoracic origin to the costo-sternal joints, including the intercostal muscles.
5. Evaluation and adjustment of the acromio-clavicular joint.
6. High grade mobilisation at the end point of the scapulo-humeral joint, not exceeding the pain threshhold, focusing on the ROM most affected.
7. A vigorous home exercise programme, working towards and encountering but not exceeding the pain threshhold.
8. Deep active release of the muscles involved, especially the subscapularis.
9. Acupuncture
10. Electro-stimulation.

Frozen Shoulder exercises

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