Frozen Shoulder

[ginger]

Pain is by it's very nature , distressing. This is particularly so when occurring for , apparently , no reason. Added to which the sufferer of the so called "frozen shoulder" may hear of other sufferer's tales of woe, their various unsuccessfull attempts at dealing with it and the variety of opinions on it's cause, treatment and natural history. Little wonder that those with this diagnosis ( I should include here those with "impingement" diagnoses as well) have cause to be worried, anxious and more. It would seem to be a somewhat natural feature of any pain related problem that seems to confuse professionals whose poorly established opinions , ,in many cases , adds fuel to the anxiety fire.
I find commonly that once patients have had the problem explained to them , it's cause, it's likely sequence during appropriate treatment and an establishment of therapeutic attention, anxiety virtually ceases.

[SPPAWA]

Hello Alo,

Agreed, that last paper as not a real winner but I thought I would do a little better to support my view that an emotional predisposition may be an important factor that is often overlooked when a patient presents with a frozen shoulder. I hope you will find these interesting. If you can’t source them free just contact me privately and I can send you a copy if you’d like.


NEUROTICISM, EXTRAVERSION, ANXIETY AND TYPE A BEHAVIOUR AS MEDIATORS OF NECK, SHOULDER AND LOWER BACK PAIN IN FEMALE HOSPITAL STAFF 1996
Neck-shoulder pain and depressive symptoms: a coho... [Eur J Pain. 2010] - PubMed result


influence of comorbidity on self-assessment instrument scores of patients with idiopathic adhesive capsulitis 2002
http://www.ejbjs.org/cgi/content/abstract/84/7/1167

Neck–shoulder pain and depressive symptoms: A cohort study with a 7-year follow-up 2010
Elsevier

As for the pathohistological changes seen in the capsule, my theory would be that increase drive from uninhibited alpha motor neurons to glenohumeral capsular muscles may promote a metabolic deficiency and thus the associated fibrotic changes. I feel this increased drive could be produced secondary to a lack of decreased cortical inhibition. In this case cortical fatigue or possibly a TIA would allow a “release phenomenon” of more primitive brainstem postural reflexes drive tone to the capsular pattern seen in the pathology. If this were the case, increased output of rubrospinal projections could possibly promote the inappropriate alpha motor neuron tone to the end organ, in this case the capsular muscles of the shoulder. Granted, a trivial trauma which also offsets proper proprioceptive feedback to coordinative centers and potentially compromises reflexogenic fuel delivery could also promote such change. In the cases I have seen the trauma does not follow a typical natural history. In fact, as I’m sure you’ll agree, it usually worsens and shows an impressive recalcitrance to treatment. To me this is different to trivial traumas where TENS, IFT, soft tissue cryotherapy and manipulation at least provide some relief. Interesting stuff none the less. Let me know if you can’t get those articles and would like a read.

Keep well,

SPPAWA