Frozen Shoulder? Sounds like my last date….

26 Jul

Also known as Adhesive Capsulitis is a form of connective tissue inflammation that it affects the ligamentous capsule of the the shoulder joint, where scapula meets humerus.The shoulder is a very complex joint in order to attain the full six degrees of motion (the knee for instance only has 2) and to keep ball and socket joints (think of G.I. Joe figurines) from constantly dislocating from the socket, a heavy ligament capsule is needed to hold the arm in place. The causes are unknown, but physiologically speaking there is abnormal scar tissue build up as a result of inflammation of the capsule.

Prevalence is higher among the 50+ age groups and athletes that repetitively over use the shoulder joint. So in other words, non-use and overuse of the joint can predispose the joint to adhesive capsulitis.

Sufferers of this condition cannot raise their arm in flexion and abduction and the range of motion of the shoulder overall is greatly decreased with sharp, motion restricting pain, when the patient tries to move the shoulder. Because of this great motion limitation, patients have serious problems putting on clothing, brushing their teeth, or even opening doors. In many cases sleep is affected because laying on their back and turning over in their sleep can cause pain.

Symptoms include non-radiating sharp pain around where the deltoids meet the acromion, inability to move arm in a full arc of motion in all ranges of motion (typically frozen shoulder only affects one shoulder), great inflammation without proportional amount of swelling and redness, and the constant pain may also cause headaches and depression.

Common non-surgical therapies include, ultrasound therapy (to reduce the scarring of the tissue), hot and cold therapies, electronic muscle stimulation, active physical rehab, and later strengthening exercises when range of motion is restored.

Warning! This is a condition that can last for years if untreated, and even with fairly aggressive rehab, it may be months before pain symptoms (inflammation) reduce and maybe years before full motion is restored. Frequency of treatment is an important factor and patients with this condition should see their chiropractor or PT at least 2-3 times per week.

There is a common notion in our country that everything bigger is better and more is always more welcome, but in certain medical cases less is more and adhesive capsulitis can be one of those. Because of the great amount of inflammation and pain, highly aggressive treatment plans can sometimes backfire and progress may through range of motion can be lost if the therapy is creating further inflammation. However this is contradicted in the fact that the patient needs to break the scar tissue build up within the capsule and so movement and muscle techniques are mandatory. So the great difficulty in treating these patients is knowing when the threshold has been reached and being careful not to overdo the therapy.

Anti-inflammatory and antioxidant diets are important when dealing with this kind of injury. Although studies are inclonclusive on how adhesive capsulitis comes about, what is known is that it is an inflammatory condition much like bursitis. Ice and heat can have some palliative affect, but while only go so far and will not break down the buildup of scar tissue. The inflammatory conditions that result in pain can be reduced over time by increasing your intake of anti-inflammatory products. This may sound very scientific, but in reality it is about knowing your body and making common sense choices. For instance, when a person consumes great proportions of meat and disregard all the carbs (the AtKINS diet) you are creating an environment in your body that acidic and difficult to heal. Inflammation in this environement is more common. When you eat more fish and less meat, and supplement with unprocessed unrefined complex carbs (like whole grains), and you stop drinking all those sugary acidic drinks, and eat more alkaline foods like vegetables it creates a more amenable conditions in your body for healing. Peanuts are decidely inflammatory and should be avoided while cashew, almonds, and walnuts are a great way to get the right kinid of fatty acids in your body.  Another great strategy for along the anti-inflammatory route is to ingest great amounts of fish oils (EPA/DHA) as their is no toxic level and omega-3-fatty acids are important overall health and healing. Anti-oxidant foods like fruits and vegetable can also help the healing process.

Lastly there is always the option of surgery and corticosteroid injections. Though the injections can reduce the pain it will not reduce the scar tissue build up and gives just enough relief until they can be injected again. You may only have up to 4 injection in a year and 6 over a lifetime (many doctors will not tell patients this) the reason is that thought the injections reduce pain, the corticosteriod also eats away at the cartilage structures of the joint and eventually will lead to bone on bone contact. Injections are good for the pain, bad for the function. Surgery may be an option, but realize that after the surgical procedure, your rehab time may be just as long and as painful as if you had let the condition run its course. Some conditions can reoccur under the certain circumstances and post surgical trauma may lead to a greater probability of re-occurrence at some point in the future.




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