Restriction in the range of movement of the shoulder is a common problem seen here at the Backroom Chiropractic Clinic. I have chosen to compare the cases of 2 individuals who presented with similar symptoms but were found to have completely different causes for their problems.
Patient A presented with limited and painful left shoulder abduction (rotation of the shoulder joint to move the arm straight out and away from the midline of the body). This keen cyclist had developed problems after being involved in a road traffic accident twelve months earlier. He had been left with numbness in his left thumb and index finger. He received manual therapy sessions through his accident insurance cover; unfortunately this treatment seemed to aggravate his symptoms and at the time of his presentation to me, he had extreme pain in the top of his shoulder, limited abduction and his shoulder was hitching up.
Patient B is a computer technician who also presented with a history of limited shoulder abduction. His symptoms had been present for 9 months and were not associated with any traumatic injury.
Outwardly both cases had the appearance of Adhesive Capsulitis (commonly known as frozen shoulder). This debilitating condition causes pain and stiffness in the shoulder joint. Treatment options are very limited; if full function ever does return it can take many years. Chiropractic therapy is normally aimed at trying to preserve remaining shoulder function
In these cases, however, there were definite underlying causes for the shoulder restriction.
Patient A: examination showed no evidence of neurological impairment, but very weak shoulder muscular function. I arranged MRI scanning which revealed a major tear of the supraspinatus (one of the four main muscles of the shoulder girdle). This, in my opinion, is likely to require surgical correction
Patient B: examination revealed neurological dysfunction and we able to isolate the cause of the shoulder movement restriction to an impingement of nerves in his lower neck. He underwent a short course of manipulation and some soft tissue therapy and now has a full return of shoulder function.
The presentations of these two cases serve to compound my belief that Frozen Shoulder is over diagnosed. A full history an appropriate examination may elicit, as in my two examples, the presence of an underlying, treatable cause
Ben Smith February 2019
