Frozen shoulder causes and chiropractic treatment

Frozen shoulder causes and chiropractic treatment outlines our protocol in the management of this very painful and debilitating condition.

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

Frozen shoulder man

This page was last updated by Dr Barrie Lewis on 24th January, 2019.

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!

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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 treatment by us 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.

Frozen shoulder causes and chiropractic treatment

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 Adson's 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.

Interscalene triangle cervical ribs

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...

Thus frozen shoulder causes and the chiropractic treatment thereof may be quite variable.

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.

Thoracic outlet syndrome

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.

Learning from patients

Doctors learn a lot from their patients; they gain new and important insights. Today a middle aged man with a particularly stubborn frozen shoulder of some three months duration, just getting worse despite orthodox treatment shared his experience that from the start every chiropractic treatment increased the range of motion, and decreased the pain; but that without the exercises done daily, it slowly slipped back to its former stiffness.

He felt that the home exercise programme was to maintain the increased range of motion from the treatment, until the next consultation when there would again be another small improvement, yet again to be sustained with his own efforts.

In six weeks the pain is about 70% less and all the ranges of motion except for external rotation have improved greatly. Most important, nights are no longer agony.

You can live with some residual stiffness, but not with pain that wakens you through the night and is so disabling during the day. He can now reach his back pocket wallet.

He is already into the thawing phase.


Frozen Shoulder Causes and Chiropractic Treatment

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

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. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

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.

Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?

Interesting questions from visitors

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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.