{"id":25356,"date":"2022-09-30T17:46:58","date_gmt":"2022-09-30T09:46:58","guid":{"rendered":"https:\/\/www.spinefitchiro.com\/?p=25356"},"modified":"2022-09-30T17:49:37","modified_gmt":"2022-09-30T09:49:37","slug":"case-study-3-treatments-used-in-treating-frozen-shoulder-within-6-months","status":"publish","type":"post","link":"https:\/\/spinefitchiro.com\/cn\/case-study-3-treatments-used-in-treating-frozen-shoulder-within-6-months\/","title":{"rendered":"Case Study: 3 Treatments Used in Treating Frozen Shoulder Within 6 Months"},"content":{"rendered":"<p style=\"text-align: justify;\"><span style=\"font-weight: 400;\">Mr. S, a 67 year old man, came in last year complaining of left shoulder pain that was causing him to have difficulty turning his neck, as well as lifting up his shoulder to do his daily activities. The main difficulty that he was having was actually putting his arm through his shirt sleeve as he \u2018had done for the past 50 years of his life\u2019!\u00a0<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-weight: 400;\">When we did an assessment, it was quite clear that it was a frozen shoulder:<\/span><\/p>\n<ul style=\"text-align: justify;\">\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Limited active movement of his left shoulder and pain pulling down the biceps, especially trying to lift it beyond 90 degrees<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">A classic \u2018hitching\u2019 or hiking of his left shoulder whenever he attempted lifting up the arm, due to poor movement of the shoulder joint and shoulder blade<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Inability to put his left hand behind his back, with a sharp and pulling pain when attempting it<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Passive movement of his shoulder was limited when testing for rotation (A classic sign of frozen shoulder is loss of range in rotation, either actively and passively)<\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify;\"><span style=\"font-weight: 400;\">In addition to that, he was also a <\/span><b>long-term smoker and diabetic<\/b><span style=\"font-weight: 400;\">, which are risk factors for developing frozen shoulder conditions (<\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3161397\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">1<\/span><\/a><span style=\"font-weight: 400;\">). His pain and stiffness had also been increasing the <\/span><b>past 3 months <\/b><span style=\"font-weight: 400;\">which is in line with the first phase of frozen shoulder (<\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK482162\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">2<\/span><\/a><span style=\"font-weight: 400;\">).<\/span><\/p>\n<h4 style=\"text-align: left;\"><b>Treatment 1 &#8211; Manual Therapy<\/b><\/h4>\n<p style=\"text-align: justify;\"><span style=\"font-weight: 400;\">As mentioned in our previous blog post talking about the <\/span><a href=\"https:\/\/www.spinefitchiro.com\/frozen-shoulder-chiropractic-or-physiotherapy\/\"><span style=\"font-weight: 400;\">different treatment options<\/span><\/a><span style=\"font-weight: 400;\"> of frozen shoulder, manual therapy is one of the recommendations according to <\/span><a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S003194061930080X\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">UKFROST guidelines<\/span><\/a><span style=\"font-weight: 400;\"> for frozen shoulder conditions. <\/span><\/p>\n<div id=\"attachment_25359\" style=\"width: 790px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/www.spinefitchiro.com\/wp-content\/uploads\/2022\/09\/amjcaserep-18-148-g001.jpg\"><img fetchpriority=\"high\" decoding=\"async\" aria-describedby=\"caption-attachment-25359\" class=\"size-full wp-image-25359\" src=\"https:\/\/www.spinefitchiro.com\/wp-content\/uploads\/2022\/09\/amjcaserep-18-148-g001.jpg\" alt=\"\" width=\"780\" height=\"589\" srcset=\"https:\/\/spinefitchiro.com\/wp-content\/uploads\/2022\/09\/amjcaserep-18-148-g001.jpg 780w, https:\/\/spinefitchiro.com\/wp-content\/uploads\/2022\/09\/amjcaserep-18-148-g001-300x227.jpg 300w, https:\/\/spinefitchiro.com\/wp-content\/uploads\/2022\/09\/amjcaserep-18-148-g001-768x580.jpg 768w\" sizes=\"(max-width: 780px) 100vw, 780px\" \/><\/a><p id=\"caption-attachment-25359\" class=\"wp-caption-text\"><em>Certain examples of shoulder joint mobilisation to increase range of motion of a stiff shoulder capsule<\/em><\/p><\/div>\n<p style=\"text-align: justify;\"><span style=\"font-weight: 400;\">These manual therapy techniques are called shoulder mobilisations. It involves the therapist placing their hands on the frozen shoulder and gripping it in a stable way, then applying pressure in different directions to encourage movement of the stiff joint.\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: center;\"><iframe src=\"https:\/\/gfycat.com\/ifr\/AdoredLameHermitcrab\" width=\"640\" height=\"412\" frameborder=\"0\" scrolling=\"no\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p style=\"text-align: center;\"><span style=\"font-size: 10pt;\"><i><span style=\"font-weight: 400;\">An example of how our shoulder joint and shoulder blade has to move to bring our arm upwards<\/span><\/i><\/span><\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: justify;\"><span style=\"font-weight: 400;\">Because our shoulder works in different planes of movements (going forward and backwards to flexion and extension, across your chest and away from it, and even turning in and out like putting your hand behind your back), your therapist needs to be aware of the ranges that you are limited it as well as the correct direction of pressure to apply for treatment to be effective.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-weight: 400;\">For Mr. S, his main shoulder joint restrictions were internal rotation (turning inwards), abduction to beyond 90 degrees, and poor shoulder blade movements. We focused on <\/span><b>inferior glides<\/b><span style=\"font-weight: 400;\">, and a method called <\/span><b>MWM<\/b><span style=\"font-weight: 400;\"> (mobilisation with movement, either <\/span><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/26157227\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Maitland or Kaltenborn<\/span><\/a><span style=\"font-weight: 400;\">) to help with rotation, as well as <\/span><b>passive mobilisation <\/b><span style=\"font-weight: 400;\">of his scapula.\u00a0<\/span><\/p>\n<h4 style=\"text-align: left;\"><b>Treatment 2 &#8211; Rehabilitative Exercises<\/b><\/h4>\n<p style=\"text-align: justify;\"><span style=\"font-weight: 400;\">Frozen shoulder doesn\u2019t just affect the passive structures of the joint. Your surrounding tendons and muscles also tend to tighten up as stiffness increases and range reduces. Because therapy is limited to 1-2 hours a week in the clinic, it really matters what you do at home!\u00a0<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-weight: 400;\">We started Mr. S on a regime of shoulder exercises including <\/span><b>stretches and strengthening within his tolerable range<\/b><span style=\"font-weight: 400;\">. Pushing to the end limits of the movement can be painful, so we guided him through each exercise so that he was familiar with what \u2018good\u2019 pain felt like versus \u2018bad\u2019 pain, where he should stop and rest.<\/span><\/p>\n<table style=\"border-collapse: collapse; width: 100%;\">\n<tbody>\n<tr>\n<td style=\"width: 50%;\"><a href=\"https:\/\/www.spinefitchiro.com\/wp-content\/uploads\/2022\/09\/finishing-position-for-the-sleeper-stretch.jpg\"><img decoding=\"async\" class=\"wp-image-25362 alignright\" src=\"https:\/\/www.spinefitchiro.com\/wp-content\/uploads\/2022\/09\/finishing-position-for-the-sleeper-stretch.jpg\" alt=\"\" width=\"400\" height=\"249\" srcset=\"https:\/\/spinefitchiro.com\/wp-content\/uploads\/2022\/09\/finishing-position-for-the-sleeper-stretch.jpg 786w, https:\/\/spinefitchiro.com\/wp-content\/uploads\/2022\/09\/finishing-position-for-the-sleeper-stretch-300x187.jpg 300w, https:\/\/spinefitchiro.com\/wp-content\/uploads\/2022\/09\/finishing-position-for-the-sleeper-stretch-768x478.jpg 768w\" sizes=\"(max-width: 400px) 100vw, 400px\" \/><\/a><\/td>\n<td style=\"width: 50%;\"><a href=\"https:\/\/www.spinefitchiro.com\/wp-content\/uploads\/2022\/09\/side-lying-dumbbell-external-rotation-3-2-1.jpg\"><img decoding=\"async\" class=\"wp-image-25364 alignleft\" src=\"https:\/\/www.spinefitchiro.com\/wp-content\/uploads\/2022\/09\/side-lying-dumbbell-external-rotation-3-2-1.jpg\" alt=\"\" width=\"400\" height=\"328\" srcset=\"https:\/\/spinefitchiro.com\/wp-content\/uploads\/2022\/09\/side-lying-dumbbell-external-rotation-3-2-1.jpg 736w, https:\/\/spinefitchiro.com\/wp-content\/uploads\/2022\/09\/side-lying-dumbbell-external-rotation-3-2-1-300x246.jpg 300w\" sizes=\"(max-width: 400px) 100vw, 400px\" \/><\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p style=\"text-align: center;\"><span style=\"font-size: 10pt;\"><i>An example of two movements that we had him practise regularly &#8211; the Sleeper Stretch (a passive stretch)\u00a0<\/i><i>and resisted external rotation (to strengthen the rotator cuff)<\/i><\/span><\/p>\n<h4 style=\"text-align: left;\"><b>Treatment 3 &#8211; Shockwave (ESWT)<\/b><\/h4>\n<p style=\"text-align: justify;\"><a href=\"https:\/\/www.spinefitchiro.com\/services\/shockwave-therapy\/\"><span style=\"font-weight: 400;\">Shockwave<\/span><\/a><span style=\"font-weight: 400;\">, also called extracorporeal shockwave therapy, was used as an adjunct to treatment. A <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC8819773\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-size: 11pt;\">meta-analyses<\/span><\/a><span style=\"font-weight: 400;\"> that compared the effectiveness of ESWT on patients with frozen shoulder in 20 studies showed that shockwave was beneficial by alleviating pain and improving function when used as an adjunct treatment.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-weight: 400;\">Some benefits of ESWT:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400; text-align: justify;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Upregulation of <\/span><b>nitric oxide<\/b><span style=\"font-weight: 400;\">, which is implicated in improved blood flow and physical movement function<\/span><\/li>\n<li style=\"font-weight: 400; text-align: justify;\" aria-level=\"1\"><b>Cavitation effect<\/b><span style=\"font-weight: 400;\"> between tissues promote the separation of adhesions or reduced fibrosis, and stimulates tissue regeneration<\/span><\/li>\n<li style=\"font-weight: 400; text-align: justify;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Creates changes in <\/span><b>nociceptors (pain receptors)<\/b><span style=\"font-weight: 400;\"> which helps to inhibit pain and reduce pain signal transmission<\/span><\/li>\n<li style=\"font-weight: 400; text-align: justify;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Stimulates growth of <\/span><b>new blood vessels<\/b><span style=\"font-weight: 400;\"> &#8211; important for conditions like frozen shoulder, as inflammation in the shoulder capsule is what contributes to stiffness and pain. New blood vessels means better circulation to increase cell oxygen carrying, produce anti-inflammatory effects, and move away inflammatory products.<\/span><\/li>\n<\/ul>\n<p style=\"text-align: center;\"><iframe title=\"YouTube video player\" src=\"https:\/\/www.youtube.com\/embed\/7aBgO72mthU?start=99\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p style=\"text-align: center;\"><span style=\"font-size: 10pt;\"><i>Watch how we do shoulder ESWT<\/i><\/span><\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: justify;\"><span style=\"font-weight: 400;\">Mr. S went through once a week of shockwave throughout the shoulder joint as well in addition to the first two treatments, and saw good effect. His recovery was complete within 6 months, and now has no issues with putting his arm through his shirt sleeve as he has always done!\u00a0<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-weight: 400;\">Frozen shoulder can be distressing and painful, but it doesn\u2019t have to last forever. If you are in the Kuala Lumpur region and need help with recovery for your frozen shoulder, contact us to get started!\u00a0<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Mr. S, a 67 year old man, came in last year complaining of left shoulder pain that was causing him to have difficulty turning his neck, as well as lifting up his shoulder to do his daily activities. The main difficulty that he was having was actually putting his arm through his shirt sleeve as&#8230;  <a class=\"excerpt-read-more\" href=\"https:\/\/spinefitchiro.com\/cn\/case-study-3-treatments-used-in-treating-frozen-shoulder-within-6-months\/\" title=\"Read Case Study: 3 Treatments Used in Treating Frozen Shoulder Within 6 Months\">Read more &raquo;<\/a><\/p>\n","protected":false},"author":1,"featured_media":25371,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[8,6],"tags":[],"class_list":["post-25356","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blog","category-health"],"acf":[],"_links":{"self":[{"href":"https:\/\/spinefitchiro.com\/cn\/wp-json\/wp\/v2\/posts\/25356","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/spinefitchiro.com\/cn\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/spinefitchiro.com\/cn\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/spinefitchiro.com\/cn\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/spinefitchiro.com\/cn\/wp-json\/wp\/v2\/comments?post=25356"}],"version-history":[{"count":10,"href":"https:\/\/spinefitchiro.com\/cn\/wp-json\/wp\/v2\/posts\/25356\/revisions"}],"predecessor-version":[{"id":25374,"href":"https:\/\/spinefitchiro.com\/cn\/wp-json\/wp\/v2\/posts\/25356\/revisions\/25374"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/spinefitchiro.com\/cn\/wp-json\/wp\/v2\/media\/25371"}],"wp:attachment":[{"href":"https:\/\/spinefitchiro.com\/cn\/wp-json\/wp\/v2\/media?parent=25356"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/spinefitchiro.com\/cn\/wp-json\/wp\/v2\/categories?post=25356"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/spinefitchiro.com\/cn\/wp-json\/wp\/v2\/tags?post=25356"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}