Stiffness and pain developing in the shoulder could be adhesive capsulitis, (frozen shoulder), a condition in the shoulder’s ball-and-socket joint/glenohumeral joint. It usually develops over time and limits the functional use of the arm. The pain and tightness restrict arm movement, and the duration of symptoms can persist for 12-18 months. The cause is often unknown, but it is more common in individuals over 40, individuals with diabetes, thyroid disease, and cardiac conditions have an increased risk of developing the condition, and women tend to develop the condition more than men. Chiropractic treatment can be effective at relieving pain and expediting recovery.
Stiffness and Pain
The shoulder joint allows more movement than any other joint in the body. A frozen shoulder causes the capsule surrounding the shoulder joint to contract and form scar tissue. The capsule contraction and the formation of adhesions cause the shoulder to become stiff, restrict movement, and cause pain and discomfort symptoms.
Stages
The progression is marked by three stages:
Freezing
Stiffness and pain begin to restrict motion.
Frozen
Movement and motion are severely restricted.
Thawing
The shoulder starts to loosen up.
It can take years to fully resolve symptoms.
In mild cases, a frozen shoulder can go away on its own but that does not mean that it is truly healed and correctly aligned.
Even in mild cases seeking treatment is recommended, rather than just waiting for it to go away.
Symptoms
Limited range of motion.
Stiffness and tightness.
Dull or aching pain throughout the shoulder.
Pain can radiate into the upper arm.
Pain can be triggered by the smallest movements.
The symptoms are not always due to weakness or injury, but actual joint stiffness.
Causes
Most frozen shoulders occur with no injury or discernible cause but the condition is often linked to a systemic condition or one that affects the entire body.
Age and Gender
Frozen shoulder most commonly affects individuals between the ages of 40 to 60, and is more common in women than in men.
Endocrine Disorders
Individuals with diabetes have an increased risk of developing a frozen shoulder.
Other endocrine abnormalities like thyroid problems can also lead to the development of this condition.
Shoulder Trauma and/or Surgery
Individuals who sustain a shoulder injury, or undergo surgery on the shoulder can develop a stiff and painful joint.
When injury or surgery is followed by prolonged immobilization/resting the arm, the risk of developing a frozen shoulder increases.
Other Systemic Conditions
Several systemic conditions such as heart disease have also been associated with an increased risk of developing the condition and can include:
High cholesterol
Adrenal disease
Heart and lung disease
Parkinson’s disease
Stiffness and pain can also be associated with damage to the joint from injuries or other shoulder problems that include:
A frozen shoulder associated with any of these causes is considered secondary.
Treatment
A diagnosis is made by observing the range of motion in the shoulder, considering the two types:
Active Range
This is how far an individual can move a body part on their own.
Passive Range
This is how far another person like a therapist or doctor can move the body part.
Therapies
Chiropractic, massage, and physical therapy involve stretches, realignment, and exercises to relieve pain symptoms and restore mobility and function.
Usually, strength is not affected by a frozen shoulder but a chiropractor may want to strengthen the surrounding muscles to better support the shoulder and prevent worsening the injury or causing a new injury.
Anti-inflammatory medications and corticosteroid injections may help manage pain symptoms.
Getting a diagnosis and treatment during the freezing stage can keep the condition from progressing and expedite recovery time.
Enhancing Health: Evaluation and Treatment
References
Brun, Shane. “Idiopathic frozen shoulder.” Australian Journal of general practice vol. 48,11 (2019): 757-761. doi:10.31128/AJGP-07-19-4992
Chan, Hui Bin Yvonne, et al. “Physical therapy in the management of frozen shoulder.” Singapore medical journal vol. 58,12 (2017): 685-689. doi:10.11622/smedj.2017107
Cho, Chul-Hyun, et al. “Treatment Strategy for Frozen Shoulder.” Clinics in orthopedic surgery vol. 11,3 (2019): 249-257. doi:10.4055/cios.2019.11.3.249
Duzgun, Irem, et al. “Which method for frozen shoulder mobilization: manual posterior capsule stretching or scapular mobilization?.” Journal of Musculoskeletal & neuronal interactions vol. 19,3 (2019): 311-316.
Jain, Tarang K, and Neena K Sharma. “The effectiveness of physiotherapeutic interventions in the treatment of frozen shoulder/adhesive capsulitis: a systematic review.” Journal of back and musculoskeletal rehabilitation vol. 27,3 (2014): 247-73. doi:10.3233/BMR-130443
Kim, Min-Su, et al. “Diagnosis and treatment of calcific tendinitis of the shoulder.” Clinics in shoulder and elbow vol. 23,4 210-216. 27 Nov. 2020, doi:10.5397/cise.2020.00318
Millar, Neal L et al. “Frozen shoulder.” Nature reviews. Disease primers vol. 8,1 59. 8 Sep. 2022, doi:10.1038/s41572-022-00386-2
Vitamin B12 and Shoulder Injuries. Most shoulder injuries involve the muscles, ligaments, and tendons. Individuals that perform repetitive arm motions/movements, constantly lift objects as part of their job, and athletes that use their arms repetitively have an increase in developing/experiencing shoulder injuries and problems. Shoulder injuries are commonly caused by physical activities that involve:
Excessive motions
Repetitive motions
Overhead motions
Sports like swimming, tennis, pitching, and weightlifting involve these repetitive arm/shoulder motions that contribute to shoulder injuries.
Injuries can also be brought on from everyday activities like washing/painting walls, hanging curtains/plants, and gardening.
Shoulder Injury Symptoms
If there is discomfort and/or pain in and around the shoulder here are a few ways to analyze the situation.
Does the shoulder feel like it could pop out or slide out of its socket?
Is there a lack of strength in the shoulder for normal daily activities?
If yes was an answer to any of these questions, individuals should consult an orthopedic surgeon and/or chiropractor for assistance in determining the problem and its severity.
Injury Categories
Individuals often underestimate the extent of an injury and usually just push/play through the discomfort and pain. This is how powerful the brain is as it ignores steady pain, weakness, or limitation of joint motion. Shoulder injuries and problems are grouped in the following categories.
Instability
This is when a shoulder joint moves/shifts or is forced out of its normal position. This is called instability and can result in dislocation of the joints in the shoulder. Individuals will experience pain when raising their arms. It can feel as if the shoulder is slipping out.
Impingement
Impingement is caused by excessive rubbing/friction of the muscles against the top part of the shoulder blade, known as the acromion. Impingement can happen during physical activities that require excessive overhead arm motion. Medical examination and care are recommended for inflammation, as it could eventually lead to a more serious injury.
Injuries
Bursitis
The bursa is the fluid-filled sacs that cushions the joints. These can become swollen and irritated from repetitive motions, falls, or other injuries. Individuals will notice the pain most when moving/rotating the shoulder.
Cartilage tear
The cartilage – the rubbery padding that goes around the rim of the shoulder joint can get damaged from repetitive motions, overextending, falls, or from intense force to the shoulder. With this type of injury individuals feel pain when reaching overhead, weakness, and/or catching, locking, and grinding feelings.
Rotator cuff tear
The rotator cuff consists of a group of muscles and tendons that hold the arm in place and allow for lifting the arm up and overhead. It can get damaged through overuse, falls, and regular wear and tear with age. Pain often presents at night, when lifting objects, and there could be a cracking sound when trying to move or rotate.
Frozen shoulder
This condition limits the joint’s movement. What happens is abnormal bands of tissue called adhesions build up in the joint and restrict movement. The shoulder can freeze up from not using it. This could be because pain or surgery causes an individual to use it less. This is when adhesions begin to build up.
Separation
This injury affects the joint where the collarbone and shoulder blade join. It is known as the acromioclavicular or AC joint. A fall or hard impact can tear the ligaments that hold it together. If the collarbone gets pushed out of place a bump forms/develops on top of the shoulder.
Fracture
A bone can break or crack from a vehicle accident, fall, or takes a hard hit. The most common fractures are to the clavicle – collarbone and the humerus – arm bone closest to the shoulder. This type of injury causes a great deal of pain and bruising. If the collarbone is broken, the shoulder can sag with the inability to lift the arm.
Vitamin B12
Rotator cuff injuries involve dysfunctional and/or damaged connective tissue. This could be from impaired collagen synthesisVitamin B12 helps combat inflammation and plays a significant role in collagen formation. Low vitamin B12 status can be directly linked to pro-inflammatory cytokines. This means that a lack of vitamin B12 increases inflammation.
Researchers followed a group of individuals to determine if their individual vitamin B12 levels correlated with an increased risk of a rotator cuff tear. To begin the study, levels of vitamin B12 were measured along with other nutrients that included:
Vitamin D
Zinc
Calcium
Magnesium
Folate
Homocysteine and blood sugar biomarkers, which are both associated with B12 metabolism were also measured. Homocysteine is a metabolite that builds up in the blood when specific nutrients, like B12, folate, or B6 become deficient. Elevated levels of homocysteine can be harmful and cause damage to blood vessels and brain tissue when not detoxified properly. In the study, the homocysteine levels did not differ between the groups, but vitamin B12 levels were significantly different.
The patients that were included were a healthy group that did not have any rotator cuff injury during the study.
The second group all experienced a rotator cuff tear that required surgery during the study.
With the various nutrients measured, only vitamin B12 and vitamin D showed differences. With the B12 and D being lower in the group that had the shoulder injury.
Specifically, the B12 levels in the healthy group were 627 pg/mL compared to 528 pg/mL in the injured group. This was a 16% decrease.
These subclinical deficiencies are usually missed with traditional serum testing which is why functional nutritional testing is clinically recommended.
Body Compositional Testing
Disclaimer
The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the musculoskeletal system’s injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.
Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, CTG*
email: coach@elpasofunctionalmedicine.com
phone: 915-850-0900
Licensed in Texas & New Mexico
References
American Society for Surgery of the Hand: Shoulder Pain.
American Academy of Family Physicians: Shoulder Pain.
Headaches can be detrimental to a high quality of life.� Especially, migraine and tension headaches.�Some deal with them on a weekly, or even daily, basis.�They can range from minor to life-changing afflictions. There are various causes, symptoms, and treatment options. The first step in treating headaches is understanding the type of headache it is.
Some people think they have a migraine, when in fact, they are suffering from a tension headache. Tension headaches are more common. But the Migraine Research Foundation found that 1 in 4 U.S. households include someone that suffers from migraines. Determining what type of headache can take some research.
Here are some things to think about to determine if the headache is a migraine or a tension headache.
Headache/s origin
According to the Mayo Clinic, migraines often begin in adolescence or early adulthood. Tension headaches can start at any time in an individual’s life.� An adult just beginning to have recurring headaches means that they are most likely tension headaches.
Where is the pain located
Migraines usually happen on one side of the head. Tension headaches can affect both sides of the head and can produce intense pressure on the forehead. The location of the pain can be a key indicator of the type of headache.
Describe the pain
If it is a dull pain, with pressure, and tenderness around the scalp, this could mean a tension headache. If the pain is throbbing or pulsing pain, it could be a migraine. Both headaches can present intense pain, just different types of pain.
Other symptoms
Migraines often come with symptoms beyond head pain.
Nausea
Light sensitivity
Sound sensitivity
Seeing bright flashing/sparkling lights
A sensation of Pins and needles in one or both arms
Dizziness
Individuals not experiencing any of these symptoms are more than likely dealing with a tension headache.
Functionality
Those with tension headaches can still perform jobs, drive, read, and operate through daily life even though it can be painful and frustrating. Migraines are very different. Lying down in a dark, quiet room with an eye mask on until the headache passes is how many handle their migraines. If the headache disrupts your life it is more than likely a migraine.
Over the counter pain killers
Tension headaches can usually be relieved with over-the-counter pain meds. However,�this type of treatment does not work for migraines. When a migraine shifts into full force, the individual has to go through it. Headaches that respond well to nonprescription pain killers means it’s a tension headache. The majority will at some point deal with a headache.
Although tension headaches are more common that doesn’t rule out the possibility of the headache being a migraine. Just a little insight as to the type of headache that is presenting, and some proactive treatments. No matter the type of headache, if the pain is severe, or starts up after a head injury, seek medical treatment.
Frozen shoulder syndrome is one common condition that affects the joint, limiting mobility and causing pain. When something goes wrong, it can dramatically impact a person�s quality of life. The shoulder bears the brunt of a lot of work even in day to day activity. The joint itself is quite complex with a wide range of motion, and that ability can become compromised due to overuse, injury, or age. The goal of the chiropractor is to keep the shoulder moving naturally and ensuring that it is a pain-free. Chiropractic is an effective treatment that helps patients regain range of motion and decrease or eliminate their pain.
What is frozen shoulder?
Frozen shoulder, or adhesive capsulitis, is characterized by pain, stiffness, and limited range of motion of the shoulder joint. It can occur as a result of overuse or after an injury, but can also be caused by diabetes or other diseases or even stroke.
It happens when the tissues that surround the joint become stiff, and scar tissue begins to form in the area. Shoulder movements become painful and difficult. It typically has a gradual onset, then goes away just as slowly. It can take a year or longer for the condition to subside.
What are the symptoms of frozen shoulder?
There are three stages of frozen shoulder and from onset to resolution. It develops gradually and subsides just as slowly with each stage lasting several months.
Stage 1 � Freezing Stage � The shoulder experiences pain during movement and the
Stage 2 � Frozen Stage � The shoulder is stiffer, but the pain may begin to decrease. However, using it becomes increasingly difficult.
Stage 3 � Thawing Stage � The shoulder begins to �loosen� and the range of motion starts to return.
Some patients may experience worsening pain at night which can lead to sleep problems.
What causes frozen shoulder?
Frozen shoulder often develops when the patient ceases regular use of the joint due to injury, pain, or a chronic health condition. There is no single cause of frozen shoulder; it can be caused by any problem involving the shoulder that prevents the patient from maintaining a full range of motion.
It can also happen when the capsule that encases the connective tissue of the shoulder becomes thick and tight. The movement of the shoulder joint is restricted, impacting its ability to move.
People who are 40 and older tend to be more at risk for frozen shoulder, and it occurs more often in women.
Patients who have had prolonged mobility of the shoulder or their shoulder has been completely immobilized are also at risk. These mobility issues may result from conditions including:
Broken Arm
Surgery recovery
Rotator cuff injury
Stroke
Certain diseases can also place patients in the high-risk category for frozen shoulder. Some disorders that may increase that risk includes:
Cardiovascular disease
Diabetes
Parkinson�s disease
Underactive thyroid
Tuberculosis
Overactive thyroid
How can chiropractic help frozen shoulder?
The primary treatment for frozen shoulder involves pain management and preserving the shoulder�s range of motion. Over the counter pain, relievers like NSAIDs and aspirin are often the first line of treatment. Physical therapy may also be used.
In situations where the symptoms persist, more aggressive treatment may be necessary. Doctors may recommend invasive remedies such as surgery and steroid injections.
However, chiropractic can treat the condition from onset through resolution. Even in instances where the symptoms persist, chiropractic can still be very effective. It can be as effective as more aggressive measures without drugs or invasive procedures. Regular chiropractic care can help return range of motion to the shoulder and return the patient�s quality of life.
Adhesive capsulitis, also known as frozen shoulder, is a condition that causes pain and stiffness in the shoulder joint. The onset of symptoms is gradual, steadily worsening over time, then resolves. The entire process occurs over a one to three-year period. The limited range of motion in the shoulder that is a primary symptom is also one of the signs that doctors use to diagnose the condition. An x-ray may be used to determine if an underlying condition such as a broken bone or arthritis may be causing the problem.
What Causes Frozen Shoulder?
The shoulder is one of the most dynamic joints in the body. It has a very wide range of motion and endures a lot of wear and tear with normal use. The joint is a network of ligaments and tendons that connect bone and muscle. It is all encased in connective tissue capsule. When that tissue thickens, it constricts to tighten around the shoulder joint. This restricts movement and causes pain.
In some cases, the cause is due to an injury or other conditions, but in other cases the cause is unknown. There is some evidence that suggests people with diabetes and other chronic diseases are more likely to develop the condition. It is also more prevalent in people who have had an arm fracture or surgery � something that causes them to keep their shoulder immobilized for an extended period of time. Women (particularly postmenopausal women) tend to be at higher risk and it most often occurs in people who are 40 to 70 years old.
Treatment for Frozen Shoulder
Most treatments for frozen shoulder focuses on preserving the joint�s range of motion and minimizing pain. Over the counter medications like ibuprofen and aspirin are usually the first line of defense. They help reduce inflammation and pain. However, in more severe cases a doctor may prescribe anti-inflammatory drugs and pain medication. Physical therapy may also be an option.
Other treatments for frozen shoulder include:
Shoulder manipulation � while the patient is under a general anesthetic, the doctor moves the shoulder to loosen the tightened tissue.
Joint distension � sterile water is injected into the joint capsule. This stretches the tissue and improves range of motion.
Steroid injection � corticosteroids are injected directly into the shoulder joint.
Surgery � this is a last resort so it�s very rare, but the doctor may go in and remove the adhesions and scar tissue from inside the shoulder joint.
Chiropractic for Frozen Shoulder
Chiropractic is an effective treatment for frozen shoulder. Many patients see their general practitioner first to get a diagnosis and to make sure that there are no underlying conditions that should be treated before chiropractic is pursued. However, most chiropractors do have the capabilities to use x-rays and other diagnostic tools to adequately assess the patient.
A 2012 study involved reviewing the case files of 20 males and 30 female patients with frozen shoulder who underwent chiropractic treatment. All subjects sought treatment between 11 and 51 days with the median being 28 days. Of the 50 cases:
16 resolved completely
25 were 75% to 90% improved
8 were 50% to 75% improved
1 was 0% to 50% improved
Chiropractic can help reduce the pain, improve the shoulder�s range of motion, and speed recovery. The treatment depends on the symptoms that are present, how progressed the condition is, and how long the patient has had the condition.
One common chiropractic technique used to treat frozen shoulder is the Niel Asher Technique. It involves the manipulation of the joints and muscle tissues. The chiropractor applies pressure and stretches key points to help reduce pain and resolve the condition. It can make a tremendous difference in the patient�s life.
Shoulder Pain Rehabilitation
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