Frozen Shoulder
This problem is known medically as Adhesive Capsulitis. One source stated that this problem affects 2% of the US population. Women are more affected than men, making up 70% of patients with this problem. Women between ages 40 and 70 are most likely to suffer a frozen shoulder, and diseases such as diabetes, thyroid diseases, Parkinsons, and cardiac disease make it more likely for someone to have a frozen shoulder. It is estimated that diabetes makes it 10%-20% more likely a person will have frozen shoulder.
If you have a frozen shoulder, you know it. This problem is marked by pain, more pain while trying to sleep, and limited movement of your shoulder. Some shoulder pain may be a tear in a rotator cuff muscle, and this can be determined with an MRI if your doctor recommends that. Usually the inability to move the shoulder without causing pain is adhesive capsulitis (frozen shoulder). What occurs in this case is that the joint capsule, essentially a wad of connective tissue surrounding the ball and socket joint of the shoulder, shrinks and contracts around the joint. Most doctors will diagnose the problem in a regular office visit, but there is also a procedure called Arthrography that injects a dye into the connective tissue. When followed by an X-ray, the X-ray shows the shrinkage of the joint capsule. The cause of this problem is not known.
One of the hardest parts of having a frozen shoulder is how long the problem goes on- whether you measure it in stages (One- freezing, Two- frozen, Three-Thawing), or all in a lump sum, the pain and difficulty moving the shoulder last for a year or more. The folks I have seen with this problem are understandably very frustrated and angry that they are having such pain and not much can be done for it. One source stated that with available treatment, 90% of people improve. This may be true, but improvement can not be too fast when you are suffering with this problem!
So, what treatments are available for frozen shoulder? With a team of an MD, physical therapist, and acupuncturist/massage therapist, you can avail yourself of ultrasound, electric stimulation, range of motion excercises, ice and heat treatments, strengthening exercises, acupuncture, massage and/or trigger point therapy. There is also a host of painkilling medications. Many doctors do not know acupuncture can be used to help decrease pain and improve mobility, but the Mayo clinic recognizes this as an adjunctive therapy (http://www.mayoclinic.com/health/frozen-shoulder/DS00416/DSECTION=9). There is a full length article describing one study of acupuncture for frozen shoulder written by four Korean doctors that concluded acupuncture is a viable addition to a treatment program (http://www.hkam.org.hk/publications/hkmj/article_pdfs/hkm0112p381.pdf). This study showed that at 6 weeks, there was no great difference when acupuncture was added to exercise, but that by 20 weeks, a much larger amount of progress had been made by the acupuncture group. A paper copy of this article is available in our office.
A couple of treatment techniques are more highly invasive than the above suggestions: anesthetized mobilization and surgery (essentially cutting the capsule to allow more movement). These techniques are tempting if you are suffering and would like the problem to just go away already, but unfortunately they do not show great success. It seems that the recovery from these techniques is just as long as the original prognosis for a frozen shoulder to loosen on its own.
A final issue when it comes to frozen shoulder is how much the patient and therapist should force the shoulder to move. Therapists are divided on this issue. Most patients would likely prefer a low grade movement, which would be considerably less painful. Is “high grade” mobilization better for frozen shoulder than “low grade”? This study showed that high grade mobilization “appeared to be better” than low grade, but also concluded that the overall differences were small, and that “over a period of 12 months, both groups improved”(http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16506872&query_hl=7&itool=pubmed_docsum). A middle ground of working the shoulder as much as possible without undue pain is probably the best route.
I have a great deal of respect for the patience that I have seen people summon when they are affected with a frozen shoulder. It means a lot to me to be able to offer some relief and progress to these individuals.
Wishing you the best of health,
Marian Hughes, LAc
This material does not constitute medical advice. It is intended for informational purposes only. Please consult your physician for specific treatment options.