Dear list,
This isn't specifically related to Rhys's email, though I wanted to put it
forward anyway: I have had two patients with a Stage I frozen shoulder of
less than 1 week onset. In both these patients, the pathology was / is
muscular in origin. They both had lateral shoulder pain (one had forearm
pain associated with it) that was a constant ache, with a restriction of
abduction > ER > flexion. They both were very tender on palpation of
subscapularis. In the first patient this did not reproduce her shoulder
pain, nor in the second. However, in the second patient, the subscapularis
trigger points reproduced her forearm pain.
Initial treatment of the subscap trigger points resulted in an immediate
gain in range (patient 1: abd 110 to 180, patient 2: abd 120 to 130), and
reduction of pain. The first patient was discharged after approximately
three weeks with full range and no pain. The second patient I am currently
still treating.
I have treated other frozen shoulder patients with a distinct lack of
success, as is normal for the treatment of frozen shoulder, where it must
simply run its course. However, these cases were either in the later part
of Stage I, or in Stage II. Hence, trigger point therapy is unlikely to
ameliorate the problem because the capsular and muscular structures will
have tightened up as a result of 'immobilisation'.
I am not saying that a frozen shoulder is simply muscular in origin, but
what I am putting forward is that if a frozen shoulder is picked up early
enough, and if signs are found in the muscular system (subscapularis), then
it is possible that those patients may not have to put up with a long
period of 2-8 years of shoulder pain and restricted function.
I would appreciate comments and experiences from the list.
Daniel Belavy
Physiotherapist
Brisbane, Australia
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