Frozen Shoulder Causes and Chiropractic Treatment

Keywords: frozen shoulder causes and chiropractic treatment, frozen shoulder treatments, thoracic outlet syndrome, frozen shoulder exercises

An Adhesive Capsulitis, as it is known in medical terminology, is one of the most disabling and painful conditions to confront the healing professions.

Three Phases

  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 to 4 years to resolve, but after four years some 6% still have extreme pain and disability.

Frozen shoulder causes and chiropractic treatment.

Frozen Shoulder Chiropractic was also not considered, there being no scientific basis for the chiropractic frozen shoulder treatments either.

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.

"The problem with Frozen Shoulder is that there is no 'best' answer yet, medical or other, based on the existing literature. Personally I think FS is one of the most variable conditions - every patient is different."

Dr Shawn Thistle, DC, chiropractic researcher.

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, often three weeks, and the range of motion almost fully restored within a year.

The last ten percent 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 vary enormously but usually involve an injury to the lower neck or the shoulder girdle.

Most authorities describe frozen shoulder as idiopathic. No known cause. It comes of itself. And goes of itself? Yes, after about three years of intense misery. In all probability there are numerous causes. Minor trauma, rotator cuff strains, fractures, biochemical and probably others.

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, an inter scalene triangle impingement, in the ulna groove, between the bellies of the pronator teres muscle.

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.

Adson's test confirms the the tingling comes from an irritation within the Inter Scalene Triangle rather than a nerve root impingement. See the video at Adsons test but this is not a test to be done at home. It requires a great deal of experience to interpret the results.

Inter Scalene Triangle

The triangle made up of the scalene muscles and the first rib is one of the most sensitive areas in the lower neck. Through this narrow fissure travel the 5 trunks of the brachial plexus and the Subclavian artery, all vital in the normal function of the arm. Inter scalene triangle.

Scalene muscle spasm, first rib fixation and even cervical ribs should be considered.

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 inter 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 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 Causes and Chiropractic Treatment

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Interesting challenges of the day

1. Mrs B has had one of the nastiest of conditions; vertigo caused by a disturbance in the inner ear. Falling repeatedly and vomiting she consulted her doctor but medication didn't help. After two sessions of the Epley manoeuvres she was 50 percent better. After two weeks she was 75 percent improved; no longer vomiting or falling. She's not enjoying the Brandt Daroff home exercises.

2. Mr S, a 48 year old man, has right low back pain, groin pain and a numb feeling in his lower leg when he sports. For six months he's been off football. He too has two problems; a very treatable lumbar facet syndrome and a very serious blocked artery in the groin; it's called intermittent claudication. Smokers beware.  

3. Mr S looks like the leaning tower of Pisa; he has a slipped disc at L5 making him lean towards the opposite side. It's called the postero lateral disc hernia; we'll fix it, but he has to stop for a week or two. Antalgias are serious so take them seriously. 

4. Mrs V too has two conditions; a chronic low grade sciatica giving her an ache in the right leg, and a threatening Morton's neuroma. She's glad I'm back in Holland; chiropractic fixed it before, and we'll fix it again. 

5. Mrs W is one of the lucky ones, says her doctor. I agree. He says only 40% of patients with lumbar stenosis have a successful operation. We fixed a nasty slipped disc three years ago, but it came back two years later; the surgeon did a fine job but she has a weak ankle now giving her subtalar joint pain; it's routine stuff. 

6. I myself had an acute exacerbation of a femoral nerve lesion last year. One immediate treatment of the new strain by my colleague has fixed the pain in the lower back, but there's some residual numbness in the lower leg; no soaring tomorrow alas.

7. This lady is a 86 year old woman with a 63 scoliosis. Chronic lower back has been her lot in life but she's well pleased with chiropractic and comes for chiropractic help once a month; some conditions you can never cure.

8. She is an 78 year old woman, is doing remarkably well with a bad sciatica. But over 200 pounds she is not losing weight; in fact, gaining despite my suggestions. She's high risk for a stroke. I have referred her to a dietician to crack the whip.

9. A 61 year old man with upper cervical pain yesterday; it's not severe but also not getting better of its own accord. He's afraid it may turn very acute as when I treated him three years ago. Since then it's been fine. 

10. A 64 year old woman has had scheuermanns disease; it's left her with a spinal kyphosis and chronic middorsal pain. She responds well to chiropractic treatment provides she come every six weeks or so for maintenance treatment.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mrs D, a middle aged woman with hip pain of one year duration, despite other treatment. Xrays reveal an impingement syndrome and early hip arthritis. There's much to be done.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.

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Interesting questions from visitors

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You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

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