How to Thaw a Frozen Shoulder
(Chiropractic Corner column, The Portugal News)
Many times a week, patients walk into my clinic with a “Frozen Shoulder Syndrome“. They are usually having pain and inability to move their arm freely, with a restriction of their normal activities, whether it be lifting, playing golf or tennis, or just sleeping comfortably. In this short article, we’ll take a quick overview of the causes and look at a new treatment, the “Shoulder Revolution Solution”.
Historically, “Frozen Shoulder” meant that the true shoulder joint (made up of the shoulder blade and upper arm bone) and the capsule surrounding the joint, has become increasingly stiff due to inflammation, injury, previous surgery, or even autoimmune disease. This condition is called Adhesive Capsulitis since the commonly accepted thought is that an increase in sticky Fibrinogen, a protein that our body also uses for clotting blood, begins to tighten down the joint. This is what I was taught in school.
Increasingly in common usage, the term “frozen shoulder” has become a bit of a catch-all term for almost any limitation of the shoulder joint. Other common descriptions of shoulder limitation you might hear are tendonitis, bursitis, rotator cuff strain, impingement syndrome, and others. Interestingly, they all are a result of irritation to that particular tissue, not necessarily a separate disease process.
There is another thought coming out of sports medicine, that the “freezing” of the shoulder is caused by irritation or injury, even very minor trauma, causing confusion of the normal muscle activities. Very minor trauma can be walking a pulling dog or suddenly reaching to catch something falling, taking a deep divot while golfing or an awkward swing in tennis, which causes strain to one of the 17 muscles that attach to the shoulder blade.
The shoulder has a very shallow joint and is highly dependent upon the muscles to keep the correct alignment of the shoulder blade and arm bone. Curiously, the “injury” may be so minor that we aren’t even aware that it has occurred, but it sets off a chain reaction throughout the shoulder muscles, leading to a confusion of coordinated muscle contraction and relaxation.
Surprisingly, there are 18 muscles involved, 17 attach to the shoulder blade, plus the large chest muscle attaching to the upper arm bone. These muscles all need to have precisely coordinated movement with each other, contracting and relaxing at just the just right time. If not, there can be big problems.
Think of the shoulder as a symphony, and these 18 “musicians” need to know when to play and when not to play. If they are playing out of sync, the music is painful to listen to! This very thing happens to the shoulder: some muscles may be working too much (spasm) and some working too little or not at all, as well as muscles can be working at the wrong time. This combination of problems begins to alter the position of the shoulder causing strain on the entire system: muscles, tendons, ligaments, joints and bursa sac (a fluid-filled bubble to cushion tendons). With the shoulder joint having a shallow surface, the arm bone is pulled improperly, the nervous system becomes aware of things being not quite right, and then the muscles, attempting to protect the shoulder, begin to lock down or “freeze”. Restricted and/or improper motion follows, causing more irritation, which leads to more “freezing”. Over weeks (sometimes just days) the shoulder/arm begins to have less and less movement, and unfortunately for some, the arm becomes completely “frozen”, no motion at all.
Rarely, do I see a true Adhesive Capsulitis, but rather most cases of “frozen shoulder” are confused muscles creating a problem, which then cause the variously known conditions of tendonitis, muscle strain, rotator cuff injuries, etc.
What can be done? Traditional treatment (also what I was taught in school long ago) has consisted of using heat/cold, massage, ultrasound, some exercise, anti-inflammatory medications, and then possibly cortisone injections. Recovery with this mode of treatment can take four to six months for the shoulder to “thaw” and regain mobility. Multiple cortisone injections can lead to weakness of the tendons and ligaments.
Sports medicine has led the charge in finding new ways to get people back to activities much more quickly, most times within three to four weeks (instead of four to six months). First is an orthopedic examination, to rule out any underlying conditions; then determine which muscles are working too much or too little and which muscles are not doing their job at the correct time. Treatment is aimed at relaxing the spasmed muscles so they are not pulling the shoulder/arm out of position; followed by helping the weak muscles work more correctly, and all muscle working when they should. As the movement of the shoulder/arm is brought back into a more normal function, the strain on the tendons is reduced relieving the tendinitis, decreased twisting of the joint capsule helps prevent Adhesive Capsulitis, muscles spasm is reduced and muscles regain their normal strength and motion. The shoulder can then play sweet music once again!
While working as an Olympic team doctor for track and field, seeing lots of shoulder injuries (javelin throw, pole vault, discus throw, shot-put), as well as treating many golf and tennis players, I have had the opportunity to help many shoulder injuries recovery quickly, with little or no lasting ill effects from the “Frozen Shoulder Syndrome”. If you are having difficulties with your shoulder, seek out a sports medicine rehabilitation specialist who can offer you advanced care and give you the best opportunity to get back to your activities… fast !
Call us for a FREE Orthopedic Evaluation and Examination. Come in and see if you can quickly get back to your normal life… as 1000’s of others have!
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282 352 202
Helping people with Shoulder problems all over the Algarve, Portugal
Portimão, Lagoa, Lagos, Alvor, Carvoeiro, Silves, Porches, Monchique, Almancil, Praia da Rocha
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