FROZEN SHOULDER

PAIN!

FROZEN SHOULDER is probably one of the most painful and debilitating conditions faced in the chiropractic clinic. What's more it remains extremely painful, and disabling, for a long period time, if not properly managed. Up to three years. Simple daily activities like taking off a t-shirt or putting on a coat, even combing one's hair become an ordeal. Sleep is invariably disturbed.

Prevention is the key! Nip the pain in the bud before the shoulder turns to ice.

Shoulder pain is caused by many conditions. The majority, but not all, are the result of irritation of nerves in the lower neck or upper thoracic spine. That is why chiropractic treats shoulder pain so successfully.

It is one of the more difficult conditions causing shoulder pain. It can be successfully treated with chiropractic, however the shrunken shoulder capsule, depending on how advanced the shoulder pain is, may take several months to resolve, even with chiropractic. Medically, the condition is acknowledged to take up to three years to resolve.

Shoulder Anatomy

To give the arm the large range of motion it enjoys, the socket is shallow and there are FOUR complex joints to give the shoulder stability. To understand why this joint gives such trouble some understanding of the shoulder anatomy will be instructive.

What is a Frozen Shoulder?

Frozen shoulder is a condition that causes substantial loss of movement in the shoulder joint. The joint capsule becomes shortened and tight, and adheres to the bone, hence the complete medical name for frozen shoulder is an ADHESIVE CAPSULITIS.

Irritation of the nerves from the lower neck to the muscles, tendons, ligaments or capsule is usually, but not always, central to this condition.

The diagnosis of frozen shoulder is often used for any painful shoulder condition associated with a loss of motion which is not strictly true.

The pain and disability in frozen shoulder are often extreme. Any and all movements of the shoulder, particularly internal rotation, become severely limited. Chiropractic treats the shoulder frozen capsule particularly successfully, but it remains a nuggety problem.

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What Are The Symptoms Of Frozen Shoulder?

Frozen shoulder is characterized by a extreme loss of shoulder motion. Raising the arm, both forwards and sideways, and turning it inwards becomes very limited and extremely painful. Thus taking off a T-shirt and particularly putting on a coat may cause extreme pain. Reaching the bra hook behind the back is quite impossible.

It is most common in the middle years around 40-50 and is twice as common in women as men.

This condition begins with just a little irritation in the shoulder, but rapidly enters the acute phase, characterised by extreme pain, sleep disturbance and functional impairment - you can't brush your teeth, get a cup out of the cupboard or clean the bath. Because chiropractic addresses function, it is able to treat frozen shoulder particularly well.

This is followed by a progressive stiffening phase as the shoulder motion worsens, particularly internal rotation, and raising the arm above the head. Extreme disability is common, with even simple everyday activities such as brushing the hair, dressing, and household work causing extreme shoulder pain. This phase may last several years if not properly treated.

The final phase, inadequately treated, often only begins after a year or two, with a mountain of frustration first to be experienced, is the resolution or thawing phase identified by the gradual return of both motion and function.

The overall course is variable but can last 12 - 36 months.

COMMON CAUSES

Subluxations and degenerative changes in the neck.
Old neck injuries such as whiplash, falls down the stairs, MVAs, horse falls, gymnastic injuries, rugby injuries.
Shoulder injuries, such as in skiing falls, which may or may not fracture any one of the arm bones, overuse (weight lifting, or gymming which is not properly supervised), improper warm-up before sport, and often there is no obvious cause. It may even start with a stiff neck.
Shoulder surgery.
It may also be associated with a variety of medical conditions: Hyperthyroidism, Diabetes, Heart and circulatory diseases, Degenerative arthritis of the shoulder.

While these common causes seem quite different, they all spring from any of the following fundamental causes of frozen shoulder:

Irritation of the nerves supplying the shoulder
Shortening of the capsule of the shoulder.
Medical conditions causing a high density of impurities in the blood which can settle near the shoulder joints, muscle joints, and the belt of muscles, blocking the normal blood circulation in these areas, which leads to shoulder pain and loss of motion in the shoulder joint.

All of the above may lead to inflammation in the shoulder joint capsule. This capsule includes the ligaments that attach the shoulder bones to each other. When inflammation occurs within the capsule, there is less ability for the shoulder bones to move freely within the joints (there are four shoulder joints). For this reason a frozen shoulder is also called an adhesive (scarred) capsulitis (inflamed joint capsule).

How is it treated?

The treatment is directed at four domains:

Shoulder pain is most often caused by subluxations in the neck. Neck pain and stiffness is commonly associated with this condition confirming the neck problem. Without treating the cause adequately, should it be in the neck, all other treatment options are slow and dependent on the body's natural recuperative powers. With no treatment at all this condition usually resolves within three years, owing to this natural healing power of the body. Three years of hell.
Movement. The worst treatment of this condition is immobilisation, as in a sling. It rapidly worsens the pain and stiffness. A gentle set of stretches for the frozen shoulder, done frequently, numerous times a day, is an essential part of the chiropractic care. As the movement returns, and the pain lessens, active rehab exercises are essential.
Key to shoulder treatment is mobilisation and/or adjusting the Acromio-Clavicular joint.
Management of any associated medical conditions such as Diabetes is essential.
Pain control is an important part of the management of this nasty condition. Ironically an ice pack, in a face-cloth, placed over the painful parts for about 20-30 minutes is best, followed by moist heat as in a shower, followed by the stretching program. Acupuncture, NSAIDs, and various electrical modalities may be helpful.

Surgery should be avoided except in the most extreme cases. Steroid injections may help but there is risk of infection and tendon rupture. However manipulation under anaesthetic in extreme cases can have benefit. For more information about the dangers of anaesthetics follow this link.

Sleeping on the non-painful shoulder, with a pillow placed in front of the body for the painful arm, is advisable.

A word of advice: if the frozen shoulder has become chronic, the chiropractic regime of increased movement may initially cause increased pain. Don't be dismayed, just do the stretches more gently, more carefully, and perhaps fewer repetitions. Ironically, do more icing, followed by moist heat. Be patient! It will get better with chiropractic care. This is certainly one condition where the saying, Rome wasn't built in a day, applies.

Treatment of the neck alone is not adequate. If your chiropractor is not treating the shoulder itself, talk to him. Perhaps consider a change to a sports-oriented chiropractor.

Go from FROZEN SHOULDER to SHOULDER REHAB.

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