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San Jose Chiropractor - Dr. Don Ajlouni
Serving Silicon Valley: Santa Clara, Campbell, Saratoga, Los Gatos, Milpitas, Morgan Hill and more...
Shoulder Problems


Frozen Shoulder

What is a Frozen Shoulder?

Frozen shoulder, or adhesive capsulitis, is a condition
that causes restriction of motion in the shoulder joint.
The cause of a frozen shoulder is not well understood,
but it often occurs for no known reason. Frozen
shoulder causes the capsule surrounding the shoulder to contract and form scar tissue.

What causes Frozen Shoulder?

Most often, frozen shoulder occurs with no associated injury or discernible cause.
There are patients who develop a frozen shoulder after a traumatic injury to the
shoulder, but this is not the usual cause. Some risk factors for developing a frozen
shoulder include:

Age & Gender

Frozen shoulder most commonly affects patients between the ages of 40 to 60 years
old, and it is twice as common in women than in men.

Shoulder Trauma or Surgery
Patients who sustain a shoulder injury, or undergo surgery on the shoulder can develop
a frozen shoulder joint. When injury or surgery is followed by prolonged joint
immobilization, the risk of developing a frozen shoulder is highest.

What are the typical symptoms of a frozen shoulder?

  • Shoulder pain; usually a dull, aching pain

  • Limited movement of the shoulder

  • Difficulty with activities such as brushing hair, putting on shirts/bras

  • Pain when trying to sleep on the affected shoulder


What are the stages of a frozen shoulder?

Painful/Freezing Stage

This is the most painful stage of a frozen shoulder.

Motion is restricted, but the shoulder is not as stiff as the frozen stage.
This painful stage typically lasts 6-12 weeks.

Frozen Stage
During the frozen stage, the pain usually eases up, but the stiffness
worsens. The frozen stage can last 4-6 months.

Thawing Stage
The thawing stage is gradual, and motion steadily improves over a lengthy
period of time. The thawing stage can last more than a year.

What tests are needed to diagnose a frozen shoulder?

Most often, a frozen shoulder can be diagnosed on examination, and no special tests
are needed. A x-ray is usually obtained to ensure the shoulder joint appears normal,
and there is not evidence of traumatic injury or arthritic changes to the joint. A MRI is
sometimes performed if the diagnosis is in question, but this test is better at looking
for other problems, rather than looking for frozen shoulder.

What is the treatment of a frozen shoulder?

Frozen shoulder treatment primarily consists of pain relief and chiropractic with
physiotherapy. Most patients find relief with these simple steps, although the entire
treatment process can take several months or longer.

Exercises and Stretching

Stretching exercises for frozen shoulder serves two functions:

First, to increase the motion in the joint

Second, to minimize the loss of muscle on the affected arm (muscle atrophy)

The importance of stretching and exercises cannot be overemphasized as these are
the key to successful frozen shoulder treatment and support the chiropractic
treatment plan. Patients cannot expect to have successful frozen shoulder treatment
if they do not perform exercises daily.


Rotator Cuff Syndrome

What is the rotator cuff?

The rotator cuff is the name for the tendons that surround the shoulder joint. The
rotator cuff is important in allowing the shoulder to function through a wide range of
motions. In part due to the rotator cuff, the shoulder joint can move and turn through
a wider range than any other joint in the body. This motion of the shoulder joint allows
us to perform an amazing variety of tasks with our arms.

What is a rotator cuff tear?

Like most orthopedic conditions, the most common mechanisms of a rotator cuff tear
are separated into 'repetitive use' and 'traumatic injuries.'

* Repetitive Use Injury
 In repetitive use injuries to the rotator cuff, repeated activities cause damage to the
rotator cuff tendons. Over time, the tendons wear thin and a rotator cuff tear can
develop within the tendons. Patients with repetitive use injuries to the rotator cuff
often have complaints of shoulder bursitis prior to developing a rotator cuff tear
through the tendons.

* Traumatic Injuries
 Traumatic injuries to the rotator cuff are seen after events such as falling on to an
outstretched hand. The traumatic event can cause a rotator cuff tear by injuring the
rotator cuff tendons. This mechanism is much less common than repetitive use
injuries, but when a rotator cuff tear occurs in a patient younger than 60 years old it is
usually a traumatic injury.

What are the symptoms of rotator cuff tear?

The most common symptom of a rotator cuff tear is pain. It is often difficult for a
patient to localize the pain to a specific area, rather it is described as a generalized
discomfort that is exacerbated with specific movements of the shoulder. Depending on
the severity of the rotator cuff tear, there may also be a loss of motion.

If the injury is an incomplete or partial tear, pain will likely be the most prominent
symptom; decreased strength may be demonstrated, but is usually not the patient's
primary complaint. However, in a complete rotator cuff tear, the patient will likely be
unable to move the shoulder through some normal motions. The diagnosis of a rotator
cuff tear is best made by a physical examination and an MRI.

The most common symptoms of rotator cuff tears are:

* Pain
 Often the pain is felt over the outside of the shoulder and upper arm. Pain while
performing overhead activities (with the arm above head height) and pain at night are
also quite common.

* Decreased strength
 Strength of the rotator cuff tendons can be tested by an orthopaedic surgeon. By
isolating the different tendons of the rotator cuff with special tests, your doctor can
determine the extent of the tear. Significant tears may affect a patients ability to
raise up their arm over their head.

* Difficulty with specific activities
 Patients often complain of difficulty performing activities such as combing their hair,
snapping a bra behind their back, reaching behind their back, or sleeping on the
affected shoulder.

How is a rotator cuff tear diagnosed?

X-rays of the shoulder will be obtained if there is a concern of a rotator cuff tear. Your
doctor will look for signs of a rotator cuff tear, although the rotator cuff tear itself
cannot be seen on a regular x-ray. Signs of a problem within the rotator cuff include a
narrowing of the space for the rotator cuff and bone spurs around the rotator cuff
tendons.

The test most commonly used to diagnose a rotator cuff tear is a MRI, but this is not
the only way to diagnose a rotator cuff tear. Ultrasound can also be used.

What is the initial treatment for a rotator cuff tear?

Because many rotator cuff tears do not need surgery, the standard treatment is to
start with conservative measures.

The first steps of rotator cuff treatment include:

* Physiotherapy/Chiropractic
  Physiotherapy is the most important step in the treatment of a rotator cuff injury.
Pain and inflammation control through modalities like therapeutic ultrasound,
interferential muscle stimulation, ice and/or heat can help. Myofascial release (deep
massage) can help break scar tissue and increase mobility. Strengthening the rotator
cuff muscles is important to maintain normal shoulder function. A few meetings can
help teach you exercises to help alleviate and prevent a recurrence of your shoulder
pain.

* Anti-Inflammatory Medications
  Medications are most helpful at controlling the symptoms of a rotator cuff tear.
Simple anti-inflammatory medications can be taken regularly for a short period, and
then be used when symptoms of a rotator cuff tear flare up.

* Cortisone Injections
  Cortisone injections can be incredibly helpful at limiting the acute inflammatory
process and allowing the patient to begin therapy. It is important to participate in the
therapy and exercises even if the shoulder feels better after an injection. The therapy
part of treatment will help prevent a recurrence of symptoms.



THE  CHIROPRACTIC  LIFESTYLE


Chiropractors are experts in the care of the bones, nerves, muscles and connective
tissues that make up about 60% of your body. All of the joints in your body are part of
this musculo-skeletal system and its optimal function is necessary for overall good
health. Ask your Doctor of Chiropractic for more information about a care program
that may include specific spinal adjustments, exercise recommendations, nutritional
advice or other conservative methods of care based on your health history, age,
current condition and lifestyle.


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REFERENCES:

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Kapandji, I. A., The Physiology of the Joints, Vol. 3, Churchill Livingstone, 1982.

Kellett, J., Acute Soft Tissue Injuries: A Review of the Literature, Medicine and Science of Sports and
Exercise, Vol. 18, No. 5, p.489-500, American College of Sports Medicine, 1986.

Kessler, R., Hertling, D., Management of Common Musculoskeletal Disorders, Harper and Row, 1983.