(Keywords: acromioclavicular joint, rotator cuff syndrome, frozen shoulder exercises, arm pain treatments, chiropractic help )
This 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 time if not properly managed. Up to three years and longer.
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.
And understanding of shoulder anatomy will help you grasp the complexity of this painful condition.
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.
To deepen the socket there is a labrum which is often involved in the impingement syndromes. For example, a fall on the outstretched arm may tear the labrum. It can only be diagnosed on an mri or ultrasound scan.
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What is a Frozen Shoulder? FS
Adhesive capsulitis, it's medical name, 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.
It is one of the most painful conditions treated in chiropractic clinics. Prevention is the word, but it can develop with frightening rapidity.
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.
A diagnosis of adhesive capsulitis 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 frozen capsule particularly successfully, but it remains a nuggety problem. There simply is no quick fix.
Often the cause lies elsewhere so the cervical spine, the first rib, the acromio clavicular joint must all be carefully examined.
The triceps muscle in the upper arm, and the subscapularis muscle beneath the shoulder blade are often involved.
What Are The Symptoms Of Frozen Shoulder?
FS 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 to 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.
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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 to 36 months.
Any and all conditions of the human body are affected by a defective blood circulatory system and that includes FS. 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:
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.
"Frozen shoulder is very poorly diagnosed and managed."
Dr David Connell, a consultant in radiology at the Royal National Orthopaedic Hospital in Stanmore.
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).
Ribs pertain 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 there's a giant.
How is Frozen Shoulder treated?
Chiropractic Help treatment is directed at four domains:
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
For more information about the dangers of anaesthetics: ANAESTHETIC ALZHEIMERS.
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 FS 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.
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Even a nasty frozen shoulder shouldn't cost you more than 10-15 chiropractic treatments. Perhaps a lot less.
FROZEN SHOULDER TREATMENTS
- a systematic review of the literature
Literature reviews find there is no place for anti inflammatories in the treatment of FS. 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. FS TREATMENTS - a literature review.
From the Chiropractic Coalface
It was good to see a lady yesterday who brought her husband for a torn calf muscle. He was unable to drive...
Two years ago she had a severely frozen left shoulder. She has almost no pain. Read more at Arm pain case histories ...
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Interesting challenges of the day
1. Mr B has the trophy for the most acute neck in February. He has quite advanced lower neck arthritis for a forty year old, thanks to a severe fall on the head from a trampoline. But this is upper cervical pain. Right rotation is simply impossible. Luckily he is improving rapidly, eighty percent better he says after three treatments. See cervical facet syndrome.
2. Mrs C is a new patient with a long history of lower back pain, hip pain and pain in both feet. We'll see how we get on, Rome wasn't built in a day.
3. Miss U sprained her ankle two months ago, wearing high heels. She still has severe mid foot pain. Xrays and perhaps a CT scan.
4. Mr V is 86 years old and hurt his back helping his wife into the car. Just one treatment of the sacroiliac joint and he's eighty percent better. It's not always like that.
5. Mr W lay on his back knocking down a pillar. Turning his head causes severe vertigo. He needs the Epley exercises, not pills, research shows. Update, he's fine.
6. Mrs X, a young mother has severe lower back pain, with numbness down the posterior thigh, calf and side of foot. It started after a long drive in the car. Update, she's forty percent less painful after four treatments, but the leg is still numb. Update two; she 60% better, but it's slow and is going to take the full 6 weeks to heal. Further update; a setback, after lifting her child she now has leg pain. It's going to the be difficult.
7. Mrs Y, a 70 year old woman is on maintenance care fo a nasty lumbar stenosis despite having to do everything at home. Her husband has a hospital acquired infection in the shoulder. After 4 operations he is incapacitated and going rapidly down hill.
8. Mrs Z, an 78 year old woman is doing remarkably well with a bad sciatica. But at over 200 lbs she is not losing weight, in fact gaining despite my suggestions. She's high risk for a stroke. Referral to a dietician to crack the whip.
9. Mr A, a 73 year old engineer, still working, is doing fine after a long episode of lower back pain. Some pain on the side of the hip remains after five treatments. Reassured him it's not hip arthritis.
10. Mrs B, a 64 year old woman has had Scheuermanns disease; it's left with a spinal kyphosis and chronic middorsal pain. She responds well to chiropractic treatment, provides she come every six weeks or so for treatment.
11. Mr C, a young engineer fell off his mountain bike injuring his cervical spine and pelvis. Luckily both responded very quickly to a few chiropractic adjustments. Update: his neck is sore again. It all goes back to a whiplash injury ten years ago when he was rammed by a fully laden truck carrying a load of stone. Time for Xrays.
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. Both Mrs E and I can't believe how much better her lower back and leg pain are. Surgery for a scoliosis and spondylolysthesis three years ago helped greatly for one year. But then her leg went lame and weak. He was responded extremely well despite all expectations.
And so the day goes. Chiropractors shouldn't be treating the elderly? Bunkum.
Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?
Greetings, Dr B.
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.
Your own unresolved problem. Pose a question
Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.
You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what chiropractors do.
The quickest and most interesting way is to read one of my ebooks of anecdotes. Described by a reader as gems, both funny and healthful, from the life and work of a chiropractor, you'll love them. Priced right at $2.99, though Kindle fiddles the price without telling me.