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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, which is why it gets such a high Quick DASH rating (see lower down).
Prevention is the key! Nip the pain in the bud before your 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 and very occasionally a whole year to resolve, even with chiropractic. Medically, the condition is acknowledged to take up to three years to resolve.
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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? FS
FS 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.
Arm pain treatments at the Chiropractic Coalface always begin with a search for 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.
If you love to read, you will probably enjoy chiropractor Bernard Preston's second book of chiropractic help anecdotes, Bats in my Belfry .
Says chiropractor Emma Maria Nygren:
"I am looking forward to your third book, Dr Preston. I really enjoyed reading Frog and Bats! They make you think, laugh and relax just like a good book should!"
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.
Old neck injuries such as
WHIPLASH CHIROPRACTIC
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.
Read more about NECK PAIN ANATOMY >>
Shoulder surgery.
It may also be associated with a variety of medical conditions: Hyperthyroidism, Diabetes, Degenerative arthritis of the shoulder, Heart and circulatory diseases.
ATHEROSCLEROSIS
Any and all conditions of the human body are affected by a defective blood circulatory system and that includes frozen shoulder. Insufficient oxygen means that tissues can't heal.
PATHOPHYSIOLOGY OF ATHEROSCLEROSIS - hardening of the arteries explained in layman's terms.
While these common causes of frozen shoulder may seem quite different, they all result in one or more of the following:
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 (inflammed joint capsule).
"This condition is very poorly diagnosed and managed,"
Dr David Connell, a consultant in radiology at the Royal National Orthopaedic Hospital in Stanmore.
CERVICAL RIBS
Ribs belong correctly to the thoracic spine but very occasionally a cervical rib may affect the nerve and blood supply to the arm causing amongst other things frozen shoulder. Usually the ribs are small and of little clinical significance, but every now and then...
CERVICAL RIBS ...
How is it treated?
Chiropractic Help 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 ( NECK PAIN TREATMENT ),
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 ( ROTATOR CUFF STRENGTHENING )
are essential.
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.
A frozen shoulder can sometimes be a real bastard, excuse the French. It can be a very mean condition. There is new research coming out on the effectiveness of microcurrent stimulation in the treatment of Frozen Shoulder.
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.
FROZEN SHOULDER TREATMENTS - a systematic review of the literature
Literature reviews find there is no place for anti inflammatories in the treatment of frozen shoulder. Vigorous mobilization of the joint, active and passive exercises reaching but not exceeding the pain threshold, deep muscle treatment and a invasive therapy known as hydrodilatation all appear to have some but limited benefit.
There is no research showing that chiropractic treatment helps (that I know of any way), yet it is one of the favourite conditions that I like to treat. But... Rome wasn't built in a day, nor is a chronic frozen shoulder fixed in a week. Come early, within two weeks, and with chiropractic help you can expect the pain to be over in a month, perhaps less.
Issue #23 Maintenance Chiropractic Care / Ways to cook salmon
Issue #22 Slump Test for sciatica / How to grow radishes
Issue #21: Neck Arm pain / Planning the summer vegetable garden
...
Issue #09: Friday Fun: Headache
Issue #08: Spinal Stenosis/ Celery
Issue #07: Root of all Healing / Garbanzo beans /Chickpeas
Issue #06: Safety on the Stairs / Ginger
Issue #05: Safety in the home / Red foods
Issue #04: Whiplash and the Joints of Luschka / Parsley
Issue #03: How to stop falling / Danger of a low fat diet
Issue #01: Tingling in the arms and hands / Apples
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FROZEN SHOULDER
It's not generally known that chiropractic help is (in my opinion) the treatment of choice. Do you have a neighbour or colleague who's been muttering...?
BRACHIAL PLEXUS
Arm Pain
SHOULDER
"The brachial plexus is a network of nerves that originates from the spinal cord and controls muscle movements and sensation in the shoulder, arm and hand."
"My thumb, forefinger and middle finger went weak after cuff surgery."
"Hello,I take it you've been back to the surgeon.
It's probably temporary inflammation of the median nerve, but of course could be worse... I'm afraid I don't think chiropractic has anything to offer at this stage.
Once everything has healed up, if you don't get the strength back, or your fingers remain numb and tingly, then I'd consult a local chiro to see if there is also a problem in your neck or the first rib.