Frozen Shoulder – All Affected, Raise Your Hand

schoolgirl rightIt arrives quickly or slowly, with a sudden stab in the night, or a gradual inability to brush your hair or raise your arm. Adhesive capsulitis – frozen shoulder – can span the range from a temporary inconvenience to a serious disability.

The shoulder is a complex structure, designed to sustain impressive forces over an amazing range of movement. Complex structures lend themselves to myriad problems – tendinitis, bursitis, arthritis, and ligament damage, to name only a few. Adhesive capsulitis develops from an inability (preceding injury) or disinclination (posture and use) to move the glenohumeral joint through its full range of motion. Protein and collagen fibers inside the joint’s synovial fluid adhere the capsule to the humerus, and sew the folds of the lax joint capsule to itself.

Frozen shoulder is differentially diagnosed by its characteristic pain pattern, and by the capsular restriction of range in flexion, abduction and external rotation. Assessment and treatment are often made more interesting by secondary or pre-existing problems in the area; seldom does any problem in the upper arm-shoulder joint-scapula area happen by itself.

Advice on treatment spans the spectrum: the Merck Manual doesn’t mention it at all; MedicineNet dictates aggressive NSAID, cortisone, and physical therapy, with surgical intervention if needed, usually consisting of forced abduction and external rotation under anaesthesia. Physical therapy, involving passive and active range of motion exercises, is almost always mentioned. Pain management in the early stages of frozen shoulder is always a good idea.

Many alternative and complementary therapies can help speed the recovery from adhesive capsulitis. Competent massage therapy is one, and here’s why. Shoulder pain creates collateral muscle tension and discomfort from mid-back to neck and beyond; limited movement necessitates inventive use of arm, shoulder and back. In short, the problem doesn’t stay local. As this becomes a comprehensive problem, so it most benefits from a comprehensive treatment. Massage

Massage therapy techniques are admirably suited to adhesive capsulitis. Massage eases spasm in shoulder, back and neck muscles, and myofascial therapy loosens fascial tightness contributing to the loss of motion. Joint range of motion and mobilization can help with pain management in the early stages, and assist greatly in challenging the joint and recovering range quickly in the recovery stage. Massage therapists have an intimate anatomical and functional knowledge of the shoulder complex, and have great success in helping patients with this condition.

Recovery from adhesive capsulitis requires some time. However, with the abundance of therapies available to help, including massage therapy, it doesn’t have to take forever. Sufferers don’t have to go home and wait for the pain and limitation to go away. Active involvement in their treatment, and a good, knowledgeable pair of hands, can lessen their discomfort and speed their return to function.


Massage Therapy Case Study – Adhesive Capsulitis vs. Arthritis

baking_breadEdie was a wonderful home-visit client, and not just because she was always baking. She was also a real therapeutic challenge.

Edie was 93 when I saw her. “I’m having trouble reaching the rolling pin, dear,” she said to me, “my doctor says you might be able to help.” The answer wasn’t long in coming: Edie’s arms were stuck to her sides.

Symphony Of Movement

Lift your arm out to the side. This simple movement – called abduction or elevation – is actually a complex symphony of movements at the glenohumeral joint (arm to shoulder blade), the scapulothoracic junction (shoulder blade to ribcage) and both ends of the clavicle (collarbone). Edie’s problem was a splendid case of adhesive capsulitis, where the glenohumeral joint gets sewn together by overzealous connective tissue. The limitation on her left was about 80%, and on the right was 100%; if she wanted to reach anything above her waist, she had to lean her whole body to the side.

We went to work. We did soft tissue and neuromuscular massage all around her shoulder girdle to the tolerance of a 93-year-old, we did fascial release around the clavicle and scapula, and we did gentle joint mobilizations to work the adhesions loose. Over the course of three sessions we gained ground, giving Edie some increased range.

Hidden Arthritis

Then we hit a wall. “That hurts, but different,” she reported. I assessed, and scratched my head, and then I got it. We had loosened up Edie’s adhesive capsulitis enough to hit her hidden case of arthritis. While the adhesions had kept her shoulder joints limited from within, the cartilage at the edges of her shoulder joints had been quietly withering from lack of use. In effect, her joints had rusted out.

We worked together for a few more sessions. I loosened up Edie’s shoulders to the point where she bumped up against her new pain, and that’s as good as it was going to get. She could reach her rolling pins; the rest of her baking gear she simply moved to the lower shelves. On our last visit she sent me home with cookies, and I left with a new appreciation for the fascinating challenges of age.