Frozen Shoulder Syndrome : Chiropractic Biophysics Patient Resources

What Is Frozen Shoulder?

Frozen shoulder, or adhesive capsulitis, is a condition that causes restriction of motion and pain in the shoulder joint. When a patient develops a frozen shoulder the capsule surrounding the joint contracts and bands of scar tissue called adhesions are formed within the joint. The contraction of the capsule and the formation of the adhesions cause the shoulder to become stiff and movement to become painful.

Who Does Frozen Shoulder Affect?

Frozen Shoulder usually affects women more than men and often occurs between the ages of 40 -60 years. Patients will experience severe loss of motion in the shoulder with pain that can travel down the arm and into the wrist. Usually the pain is dull and achy but can become sharp and severe with sudden movements. Lying on the affected side and lifting the arm above the head can cause the pain to become worse, making sleep and daily activities difficult.

What Causes Frozen Shoulder Syndrome?

There are several potential causative factors for Frozen Shoulder Syndrome:

· Failure to properly treat the shoulder after trauma or surgery,

· Long periods of immobilization, or,

· Although frozen shoulder is not a form of arthritis it can be caused by arthritis in the neck and/or shoulder,

· Often times there is no known injury or cause and in these cases poor postural alignment of the shoulder girdle and head and neck can increase pressures on the shoulder leading to pain, inflammation and possible frozen shoulder over time. See Figure 2.

· People with diabetes and thyroid conditions are at risk for development of this condition.

Examination Procedures for the Diagnosis of Frozen Shoulder

Although there are no specific tests for frozen shoulder, your doctor of chiropractic will most likely perform:

· Specific orthopedic tests for the shoulder;

· X-rays of the shoulder and cervical spine (neck);

· Possibly an MRI to rule out other underlying and/or contributing conditions of the tissues;

· Postural evaluation of the shoulder, ribcage, and head/neck. See Figure 2.

Figure 2. Shown is an abnormal head and shoulder posture. The head is positioned too far forward and the shoulders are extremely rounded forward called protraction of the shoulder region. These abnormal postures place increased pressure on the shoulder joint which may lead to inflammation, pain, and limited motion. Overtime this could be a causative factor for the development of frozen shoulder syndrome.

Common Chiropractic & Other Conservative Treatments

Treatment for frozen shoulder can be frustrating and slow. Initial treatment is geared towards increasing ROM and reducing pain and inflammation. Conservative treatment can consist of:

· Joint Manipulations and Adjustments. See Figure 3;

· Stretching;

· ROM Exercices;

· Massage Techniques (Myofascial release)

· Posture rehabilitation head, neck, shoulder girdle, and ribcage to reduce further stresses on the shoulder and surrounding joints. See Figure 3;

· Ice, heat, and low level laser therapy.

Figure 3. Shown are two types (there are several others) of shoulder adjustments that Chiropractors may perform on a patient with frozen shoulder syndrome. On the left is a drop table adjustment applied to the shoulder and on the right is an instrument adjustment applied to the shoulder. In each case the posture of the shoulder region is placed in a correct or opposite position and the joint is adjusted. This helps movement, alignment and improves pain in the shoulder region.

Common Medical Interventions

Medical treatment usually consists of anti-inflammatory medications and cortisone injections. Due to the relatively common adverse risks associated with these medications, conservative treatments may be safer and initially just as effective.¹

Chiropractic Care May Have a Positive Influence on Frozen Shoulder

There is evidence in the scientific literature that Chiropractic adjustments and rehabilitation procedures can be effective at improving the pain and disabilities in patients with frozen shoulder. This evidence comes from case control (called Level 3 evidence)² and a number of case studies (called Level 4 evidence)^3-8 investigations.

Collectively, these investigations indicate that patients benefit from a Chiropractic intervention aimed at improvement in and/or restoration of shoulder joint motion and alignment.^2-8 Thus, Chiropractic adjustments, advice, and rehabilitation procedures offer a safe and effective means of an initial course of treatment for people suffering from frozen shoulder induced health disorders.

References

1. Moore TJ, Cohen MR, Furberg CD. Serious adverse drug events reported to the food and drug administration; 1998-2005. Archives Internal Med 2007;167(16):1752-1759.

2. Harmeyer, Robert. Chiropractic Rehabilitation of The Frozen Shoulder. ACA Journal of Chiropractic 1995; 59-60.

3. Hauser, Russell R. Treatment of Acromioclavicular Dislocation Using Chiropractic Protocol Rehabilitation. Journal Sports Chiropractic & Rehabilitation 1996; 10:180-183.

4. Hildebrandt, RW. Basic Chiropractic Procedural Manual. 1973; 236-239.

5. Hildebrandt, RW. Basic Chiropractic Procedural Manual. 1973; 248-249.

6. Feeley, Karen M BA DC. Conservative Chiropractic Care Of Frozen Shoulder Syndrome: A Case Study. Chiropractic Research Journal 1992; 2:31-37.

7. Polkinghorn, Bradley S. Chiropractic Treatment Of Frozen Shoulder Syndrome (Adhesive Capsulitis) Utilizing Mechanical Force, Manually Assisted Short Lever Adjusting Procedures. Jornal Of Manipulative And Physiologic Therapeutics 1995; 18:105-115.

8. Roth, George B BSC, DC, ND. A New Approach to Frozen Shoulder: A Pilot Study Using Tensegrity Therapy. The American Chiropractor 2001; 23:23-24.

Disclaimer

The primary purpose of this list of and general discussion of health conditions is to inform the public of the possibility that use of Chiropractic care may be associated with positive improvements in a variety of health conditions for patients actively undergoing Chiropractic care. Many of these symptoms require co-management and/or referrals to other health care specialists. This information is not intended, nor should it be used, to diagnose or treat any individual’s unique health condition.