Frozen Shoulder

[cheema]

Hi To all Physios
Its Really is breath taking to say that treatment of frozen shoulder without causing considerable pain to patients is AlMOST IMPOSSIBLE........................................ ..

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[somasimple]

Hi,

Treating everyday "frozen shoulders" lets me think that is totally possible with neuromobilizations and active muscular relaxation.

If you hurt the patient then his brain will protect him a bit further and you lose a chance to get closer the improvement.

Listen to their stories and their bodies, use soft technique avoid others...

[Physiobase]

Hi Cheema

Physio Live Chat: This part of the forum is for posting messages about having a live chat session, not for posting general messages. I have therefore moved this message and reply into the general physio section

regards

PhysioBob

[nickhedonia]

Dear Cheema, non painfull treatment for " frozen shoulder" that is effective and has permanent results achieved quickly is indeed possible . Not just possible but easy . Stop treating the shoulder. Treat the cause of the problem first, you will find that with appropriately skillfull mobilisation treatments to relevant facet joints of the neck ( c3456) pain releif is almost instant. Certainly within ten minutes. This is a lasting effect.So called frozen shoulder needs to simply be understood as a referred problem. Leave the shoulder alone untill the effect of several sessions of facet joint mobilisation has done its work. If mobilisation is new to you , as it appears to be for some readers of this forum , learn it. You will find this method to be the sine qua non of musculoskeletal management.

[Aamir]

Hi, nickhedonia, this is Aamir Bhatti,

Your approach, as well as those persons who are saying "treat it without pain" are more correct in point of view.

So, could you please tell me where i can find "facet joint mobilisation techniques on net". Also, please define it in short for people who are new to this technique.

Thanks

Aamir Bhatti

[MrPhysio+]

A true frozen shoulder is frozen due to an adhesive capsulitis. Shoulder impingement, or shoulder movement inhibited by pain or weakness are different problems, and can be sorted out by mobilisation of the glenohumeral joint or cervical mobilisation of the facet joints, respectively.
Evidence based medicine suggests that adhesive capsulitis is made worse by mobilisation techniques, whether it is gentle or very firm.
The only way to sort out the problem is to 'unstick' the capsular adhesions, which is done using a technique called glenohumeral capsular hydrodilation. The technique involves an injection of local anaesthetic around the upper shoulder, then a saline solution containing a small amount of short acting anaesthetic and very low dosage corticosteroid is injected into the shoulder capsule. The Doctor injecting the solution can feel the resistance of the capsule against the syringe plunger, and the resistance can suddenly give way as the adhesion frees. There may be more than one adhesion, therefore the Doctor continues to inject the saline to a maximum of 40 mililitres in an average sized person.
Following the procedure, and whilst the anaesthetic continues to work, the patient should move the shoulder through the maximum achievable range of movement, and should do pendular exercises for a few days post procedure. If a therapist is available, passive range of motion should be attempted as soon as possible after the injection, preferably immediately after injection.

If a patient has very limited internal rotation (hand behind the back), limited active and passive flexion, and cannot easily lay on the affected shoulder at night, plus has had the symptoms for greater than three months: they are ideal subjects for the procedure.
It has become popular amongst radiologists to do the procedure with X-ray guidance of the needle, however I have found better results from a Doctor with good anatomical landnmark and palpation skills, doing the injection in rooms. The whole job can be done in less than 20 minutes, with significant pain reduction and increased range of movement. The patient may or may not be in pain afterwards, but must continue to move the shoulder to avoid the redevelopment of the adhesions from the newly raw areas. Pain medication to allow for pain reduced movement is a very good idea.

The technique does not work if there is a capsular tear, as the fluid leaks out with inducing sufficient tension to remove the adhesions.
If you can arrange the above technique, you and your patients will be amazed at the results. The condition must, of course, be correctly diagnosed before attempting hydrodilation.

[urigellar]

Quote ........." The only way to sort out the problem is to 'unstick' the capsular adhesions, which is done using a technique called glenohumeral capsular hydrodilation. "

as far as i am aware injecting frozen shoulders is a contraversial approach and has poor evidence to back it up.......it is certainly not the only way to sort out the problem.

If there is a capsular restriction then get it moving! That is what the shoulder is there for after all! obviously the more painful ones you go gently at first and i'm all for neurodynamic exercises in the early stages. But when it is chronic......push it.......not with mobs (no long term benefit) but with appropriate exercise.

[nmuralidharan]

hai,
the quote"Evidence based medicine suggests that adhesive capsulitis is made worse by mobilisation techniques, whether it is gentle or very firm."needs reference because almost all of us do mobs to a shoulder that is frozen.if the reference which contradicts this can be given it will be very useful.
expecting your reply.
thanx

[nickhedonia]

there really is a better answer folks to all those who find the frozen shoulder /adhesive capsulitis issue perplexing. Mobilising the shoulder first would be to ignore the cause of this painfull condition. I well remember the first time I began to treat the neck of a wretched woman in thursday island, whose shoulder remained tender and sore after months of regular attention by my newly graduated self. It was not till I began to mobilise her C3456 facet joints , for what appeared to be a different problem that real and lasting results began. In the years since then I have no doubt treated thousands of similar cases, 99%of which turned out to have referred pain to the shoulder. Some of these had gone on to become so immobile that pain relief had to be followed by various stretching to the glenohumeral and scapulothoracic joints and dura. continuous mobilisation to facet joints will relieve mysterious shoulder pain . This is not a short term effect, the effect when done correctly is permanent. If you are not getting these results then it can only be your method and application that needs more work. You can lead a horse to water....

[somasimple]

Geoff,

This is not a short term effect, the effect when done correctly is permanent.

Without being mischievous, have you some good references to give to the poor unbelievers we stay?

I ask for quite nothing, just one, only one please!

[nmuralidharan]

hai nickhedonia,
what you said was true.i tried mobilising the c345 facets of a patient who came to me with periarthritis and the results were remarcable.he was in the freezing stage though.initially he had pain during the initial ranges and then i tried mobilising the facets and the pain reduced from 6 in vas to 3.then the range also improved.
could you please give me any literature proof for this so that i can tell my collegues to follow the same thing?
expecting your reply.
murali

[mageshanand]

hey i dont totally agree with the concept of mobilizing the facet joints alone cos even if it is the referred pain from neck the process of immobilisation would have definitely affected the components of shoulder and regarding the distension of the capsule why cant we try manual trraction holding the arm proximally and puliing it out and give very gentle grade one mobilisation, i have given good results with technique

[rbriefmd]

I would love to help, but I cannot understand the question

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Rochelle Brief Physical Therapy Physiatry Physiatrist and Physical Therapy and Rehabilitation

[somasimple]

Hi Doc,

The original question was in my opinion: is it possible to treat/cure “frozen” shoulders without pain?
The topic then grew to the possible causes of “frozen” shoulders and their possible treatments. As you may see by yourself, the PT community has not a consensus about it.

[spicefemme]

hi can someone please give me the correct treatment protocol for frozen shoulder? i am an internee in my 3rd month of intrnship and would also like to know which books i have to refer for frozen shoulder
please contact fast
thank you
sohina