In our chiropractic clinics we often find the term 'frozen shoulder' misused.
The term is commonly used to describe any persistent shoulder pain and restricted movement.
Shoulder problems can be complex and require a thorough assessment to be accurately diagnosed and as with any other joint problem.
The success of any treatment depends on correct diagnosis and cooperation between patient and practitioner.
Frozen shoulder, or “adhesive capsulitis” to give it the medical term, refers to loss of arm movement at the shoulder joint combined with inflammation of the tissues within the joint capsule that surrounds the shoulder and is often accompanied by a great degree of pain during even the slightest movements.
These tissues become thickened and shortened and eventually 'stick' together, hence the medical term - adhesive capsulitis.
There are three stages:
1. “Freezing Phase” Initially, there is progressive limitation of all movements of the shoulder. This may follow a recent minor trauma, dislocation, prolonged immobilisation, heart attack (myocardial infarction) and sometimes neck problems (cervical radiculitis). Pain may or may not accompany this, although pain will be felt if you try to exceed the limited movement. This phase can last anywhere between 2 and 9 months.
2. “Frozen Phase” As the fluid in the joint becomes thickened there may be more pain and eventually, the condition progresses until all movement is greatly restricted. This phase can last from 4 to 12 months.
3. “Thawing Phase” As the inflammation begins to subside so does any pain experienced. During this phase movement in the shoulder begins to gradually return but may or may not recover 100% if left untreated. This phase characteristically lasts between 6 to 9 months.
Early diagnosis is vital because the condition is reversible.
Once it has progressed into the adhesive/frozen stage, some persistent restriction may remain.
The recovery period varies depending on how long the problem has been there and the severity of it. It is not uncommon for it to take up to 6 months to recover with treatment and up to 12-24 months without treatment.
The rotator cuff muscles play an important role in the movement of the shoulder.
They consist of the supraspinatus, infraspinatus and teres minor muscles. The rotator cuff tendon is a major source of pain and disability.
If it becomes inflamed (tendonitis) or torn; voluntary abduction, elevation and rotation of the shoulder is lost.
However, the chiropractor will be able to move the shoulder noting only a slight loss in movement due to pain.
Whereas with frozen shoulder, the chiropractor will not be able to move the joint. Rotator cuff muscle pain is usually due to trauma or overuse movements.
Bursas are fluid filled sacs that surround certain joints of the body and act to prevent excess friction between tissues and/or bony surfaces.
In the shoulder, you will find the sub-deltoid bursa that lies underneath the deltoid muscles. (These muscles make the rounded shape of the shoulder/arm).
The bursa can become inflamed (bursitis) or pinched
which in turn will produce pain and some limited movement of the
shoulder. Slight swelling and heat production may be felt.
It is one of the most common co-existing causes of shoulder pain seen in chiropractic practice.
When the spinal joints are sprained and become inflamed and irritated in the neck, it automatically triggers muscle spasm. It affects the muscles with the same nerve supply relating to the level that has been injured. Pressure may also occur on the surrounding nerve fibres, but that is less common.
The nerves supply information to the muscles of the shoulder and if these nerves become inflamed, the muscles go into spasm and weaken, and subsequently movement will be affected.
Even low-grade increase of muscle tension, due to neck problems, makes you more likely to develop shoulder pain and problems.
Chiropractic treatment can help this.