a good paper which reviews the complexites of this enigmatic condition is
Stam , Frozen Shoulder : a review of current concepts, Physiotherapy Sept 94
No 9 p 588-597
It is very difficult to differentiate at the early stages frozen shoulder
from many other conditions ....perhaps this is why everything gets labelled
as frozen sholder ?
I feel that if an understanding of more difficult clinical problems could be
obtained eg diabetic frozen shoulder than a clearer understanding of the
problem could be gained to the benefit of the wider population?
Many of the treatment regimes concentrate on the removal of the mechanical
problem .....In true frozen shoulder ( however you define it
......insidious pain and stiffness with no mechanical trauma ) patients
often reach a variable time period and spontaneous or vast improvement in
movement occurs ......Therefore a mechanical cause of the problem was
unlikely.....perhaps it was a vascular problem due to irritation of the
sympathetic efferents in the anterior root and local vasoconstriction.......
I agree that a pragmatic approach has to be taken clinically . Traumatic
stiffness is entirely different to insidious frozen shoulder . Trigger point
theory is i feel a bit of a red herring . I do feel that treating trigger
points is valid but are not a common feature of the clincal picture of
frozen shoulder .
Obviously there are many subgroups in this condition ......perhaps research
needs to focus on identifying patterns in these subgroups . Clinicians
usually do this by experience .Stam suggests that clinical diagnosis should
form the major procedure for diagnosis and differential diagnosis.... I
agree .
Claims of real improvement with acupuncture trigger point therapy thoracic
mobilisation steroids etc may be treating sensitivity and motor disturbances
around the shoulder girdle but don't influence frozen shouldler as I have
experienced it.
Ian Stevens
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