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.

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!

Google appears to frown on too many links, so phrases in bold, like that frozen shoulder treatments below, need to be put into the Site Search function in the navigation bar on your left if you want more information.

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.

• Thoracic Outlet syndrome
• Cervical facet syndrome
  
• A midthoracic fixation, with symptoms affecting one or more ribs, often all the way to the sterno costal joints. Tietzes Syndrome
• An AcromioClavicular joint fixation 

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.

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.

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.

USEFUL LINKS

Frozen Shoulder Causes and Chiropractic Treatment

• Frozen Shoulder home page. 

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