Tuesday, January 19, 2016

Frozen Shoulder and Related Conditions

Supraspinatus tendinopathy, bicipital tenosynovitis, infraspinatus myostrain, and subscapularis myostrain can often be diagnosed as Frozen Shoulder.

“Frozen shoulder” is a common diagnosis given for those experiencing shoulder pain, stiffness and a decrease in mobility. True frozen shoulder, which is called adhesive capsulitis, refers to a condition where there is a buildup of scar tissue in the joint capsule of the shoulder. There exist several other conditions which often get called “frozen shoulder,” but those can be more precisely differentiated. The most common of these conditions that I see in clinical practice are: supraspinatus tendinopathy; bicipital tenosynovitis; infraspinatus myostrain; and subscapularis myostrain. Each of these involves different structures, has variation in pain patterns and referrals, and, more importantly, requires a different treatment for a successful outcome.
Frozen shoulder and related conditions affect many people of different ages and they affect both men and women. Those between 40-60 years of age are more frequently afflicted with shoulder problems, and women experience shoulder pain much more frequently than men. 2-5% of the population in this age demographic will experience this problem. There is evidence showing that hormonal changes during menopause are linked to the greater frequency of shoulder pain experienced by women.
These conditions may be caused by trauma or they may come on insidiously, in which case there seems to be no apparent cause, although it’s possible that postural imbalances, age, nutritional deficiencies, changes in hormone levels, diabetes, Parkinson’s and other conditions may be contributing factors. Proper differentiation is crucial when treating so that mechanism of injury can be determined, target tissue can be assessed and treated, postural disparities can be corrected, and proper use of medicinals can be employed (herbals, nutraceuticals, or pharmaceuticals depending on the scope and treatment philosophy of the physician). In Sports Medicine Acupuncture®, this is extremely important as the injury or cause of pain will guide the proper use of acupuncture, myofascial release (a type of clinical, deep tissue massage), corrective exercises, and herbal medicine prescription.
I will discuss the four main causes of shoulder pain and stiffness in future posts and will link these blog posts together. Again, these conditions are:
  • Supraspinatus tendinopathy – an inflammation or irritation with fibrosis (extra fibrous tissue) of the tendon of the supraspinatus (one of the rotator cuff muscles). Tearing (either partial or full) may be present;
  • Bicipital tenosynovitis - an inflammation or irritation with fibrosis of the tendon sheath of the biceps brachii muscle;
  • Supscapularis myostrain - a pain pattern caused by trigger points affecting the subscapularis muscle (another of the rotator cuff muscles);
  • Infraspinatus myostrain - a pain pattern caused by trigger points affecting the infraspinatus muscle (yet another of the rotator cuff muscles).
For all of these conditions, mechanism of injury will be discussed (mechanism of injury describes the underlying causes of the injury), treatment options will be explored, and self-help corrective exercises will be discussed.

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