Frozen Shoulder Syndrome and Treatment

Dr. McCluskey can help relieve frozen shoulder and shoulder pain.

Shoulder joint is one of the most mobile joint that is virtually used in all major muscular and functional activities across upper limb. Frozen shoulder (also known as adhesive capsulitis in scientific terms) is a condition that causes significant pain, discomfort and stiffness in shoulder joint that may compromise all the activities mediated by upper limbs.

Data and statistics indicate that the prevalence of frozen shoulder in general population is 2% with majority of the cases reported in individuals between the age of 40 and 60 years.  Besides physiological aging, certain medical and vascular health issues can also contribute to the pathogenesis of frozen shoulder syndrome.

According to a published report in peer reviewed scientific journal “Scandinavian journal of Rheumatology”, author B. Reeves (1) suggested that the pathogenesis of frozen shoulder can be divided into 3 major stages.

• Painful stage that marks the beginning of shoulder pain and discomfort (with moderate disability). You can take care of normal daily activities but with significant pain.
• Stiff stage follows painful stage in which the intensity of pain is less but stiffness limits the range of motion (you may encounter discomfort in doing simple tasks like grabbing an apple from the fridge or putting things in the pantry or lifting your grand-child for a warm hug)
• Duration of the second stage helps in suggesting the course and duration of recovery stage (the final stage of frozen shoulder syndrome according to the extensive experimentation conducted by Reeves in 49 study participants)

Causes of Frozen Shoulder Syndrome:

Adhesive capsulitis or frozen shoulder syndrome is caused by ongoing process of inflammation that affect the integrity of shoulder capsule in the beginning; however, if left untreated, it may involve all associated joint structures like muscles, tendons, ligaments and tissues to cause pain, discomfort and limited range of motion. Chronic untreated inflammatory lesions ultimately lead to thickening of joint components to cause stiffness and long term disability.

Following are some risk factors that contribute heavily to the pathogenesis of frozen shoulder syndrome:

• Diabetes is one of the most significant risk factor and according to clinical data, the risk of developing frozen shoulder is 71% higher in diabetics when compared to non-diabetics. According to another study conducted by Pal (3), 19% of all diabetics develop frozen shoulder syndrome at some point of their life.
• Female gender (study by Sheridan suggested that over 70% cases of Frozen shoulder are reported in females)
• Endocrinological or certain metabolic conditions like tuberculosis, hyper-secretion or hypo-secretion of thyroid hormone, Cushing syndrome and other endocrine ailments can affect the health of joint components.
• Advancing age increases the risk of degenerative bone disorders that further impedes normal circulation and remodeling of bones to limit inflammatory damage.
• History of prior injury or surgery involving shoulder joint

What are some of the most reliable treatment options for Frozen shoulder syndrome?

According to the report published in International orthopaedics, author Sharma (4) suggested that the treatment options for the management of frozen shoulder syndrome are numerous and the quality and efficacy of results vary with the age, gender and lifestyle of patients.

Treatment options are:

Pain killers:

In acute pain syndromes, over the counter pain killers are effective in reducing pain, swelling and discomfort. Non-steroidal anti-inflammatory agents are considered as the most common ‘temporary’ method of aborting acute attack. However, in chronic inflammation with extensive fibrosis and thickening of joint capsule, OTC pain-killers are usually ineffective. In all such cases, intracapsular steroid injections can be used to relieve acute pain

Joint distension:

This is another micro-invasive procedure that allow orthopedic surgeons to introduce small amounts of saline in the joint capsule to improve range of motion and mobility

Physiotherapy: 

Another management technique frozen shoulder is physiotherapy. Calculated physical therapy exercises that are performed under the supervision of expert care helps in relieving 70 to 90% complaints as suggested by the research conducted by Levine and associates (5)

Chiropractic Care:

One of the most effective holistic methods of treating frozen shoulder is chiropractic.

How can chiropractic care helps in managing frozen shoulder syndrome?

It can be excruciating trying to brush your teeth or combing your hair when your shoulder “locks” in place leaving you helpless.

Chiropractic adjustments help in improving the range of motion across the shoulder joint by thoracic and cervical manipulation. Francis X. Murphy (7) conducted an extensive study on 50 patients (in the age range of 40 to 70 years). All the patients were advised one chiropractic procedure for a period of 4 months and results were dramatic.

• 32% patients reported 100% resolution of pain symptoms, stiffness and restoration of complete range of motion across shoulder joint.
• 50% reported 90% improvement in the above parameters
• 16% showed 75% improvement in pain, stiffness and range of motion
• And 2% (or 1 patient) reported 50% improvement.

According to the study conducted by Polkinghorn (8) chiropractic adjustments are highly effective and can manage patients who are refractory to other common treatment modalities. Chiropractic adjustments techniques for the management of frozen shoulder include:

• Manually assisted chiropractic adjustments by short lever
• Low frequency instrumental adjustments
• Mechanical force

Chiropractic adjustments are helpful in improving the alignment of joint components to promote natural healing and early recovery. Most adjustments improve the range of motion to more than 90% within a period of 8 weeks.

Some chiropractic adjustments may cause pain initially, but with improvements in the tension across joint, the symptoms of pain decreases significantly. Besides adjustments and chiropractic manipulations, chiropractors also advise lifestyle modifications and exercises to improve the range of motion, pain and discomfort and independent mobility of shoulder joint. Although chiropractic treatment may take months, but the results are free of complications or side effects.

Other helpful tips that can improve the quality of outcomes are:

• Controlling your blood sugar levels under tight limits
• Maintaining regular physical activity
• Massaging of shoulder joint to improve range of motion

Speak to Dr. McCluskey to know more about the potential treatment options for your frozen shoulder syndrome.

References:

1. Reeves, B. (1975). The natural history of the frozen shoulder syndrome. Scandinavian journal of rheumatology, 4(4), 193-196.
2. Sheridan, M.A. and J.A. Hannafin, Upper extremity: emphasis on frozen shoulder. Orthop Clin North Am, 2006. 37(4): p. 531-9.
3. Pal, B., et al., Limitation of joint mobility and shoulder capsulitis in insulin- and non-insulin-dependent diabetes mellitus. Br J Rheumatol, 1986. 25(2): p. 147-51.
4. Sharma, R. K., Bajekal, R. A., & Bhan, S. (1993). Frozen shoulder syndrome. International orthopaedics, 17(5), 275-278.
5. Levine, W.N., et al., Nonoperative management of idiopathic adhesive capsulitis. J Shoulder Elbow Surg, 2007. 16(5): p. 569-73.
6. Bruckner, F.E. and C.J. Nye, A prospective study of adhesive capsulitis of the shoulder (“frozen shoulder’) in a high risk population. Q J Med, 1981. 50(198): p. 191-204.
7. Murphy, F. X., Hall, M. W., D’Amico, L., & Jensen, A. M. (2012). Chiropractic management of frozen shoulder syndrome using a novel technique: a retrospective case series of 50 patients. Journal of Chiropractic Medicine, 11(4), 267-272.
8. Polkinghorn, B. S. (1995). Chiropractic treatment of frozen shoulder syndrome (adhesive capsulitis) utilizing mechanical force, manually assisted short lever adjusting procedures. Journal of manipulative and physiological therapeutics, 18(2), 105-115.
9. McHardy, A., Hoskins, W., Pollard, H., Onley, R., & Windsham, R. (2008). Chiropractic treatment of upper extremity conditions: a systematic review. Journal of manipulative and physiological therapeutics, 31(2), 146-159.