Shoulder Pain Treatment

Carpal tunnel syndrome and frozen shoulder problems often seem to occur in the same patients - sometimes at the same time but sometimes many months apart.

Carpal tunnel syndrome is a problem with irritation of the median nerve - one of the main nerves that runs from the forearm into the hand.

The median nerve runs on the palm of the hand side of the forearm - entering the palm of the hand at almost exactly the mid point of your wrist crease. It supplies power to the muscles of the thumb and sensation to the skin of the thumb and the first three fingers - sometimes also to a bit of the fourth or ring finger too. To get into the hand the nerve has to pass through a tunnel of bones and gristle. This tunnel is called the carpal tunnel - so the problem of nerve entrapment there is called Carpal Tunnel Syndrome.

The commonest reason for carpal tunnel syndrome to develop is when the median nerve is squeezed in the tunnel. This often happens during pregnancy or in diabetic patients or in those with an under active thyroid gland. Often no cause is found at all - it just seems to start from nowhere and this is called Idiopathic carpal tunnel syndrome.

Sometimes however, carpal tunnel syndrome can arise as a later consequence of frozen shoulder. The median nerve arises from nerve roots that run in the armpit or axilla - just below the shoulder in other words. This group of nerve roots is called the brachial plexus and a good going frozen shoulder can affect the brachial plexus and thus eventually lead to carpal tunnel syndrome.

Labels: carpal tunnel syndrome, cause of frozen shoulder, diabetes joint pain, nerve pain shoulder, shoulder pain

Does manipulation for frozen shoulder work?

Manipulation as a treatment for shoulder pain has been around for a long time. The word manipulation can be applied in several different ways.

When we think of shoulder pain in general then physiotherapists will use mobilisation or hands on type manipulation of the shoulder as a means of improving movement range in the joint and thus reducing the symptoms. Osteopaths or chiropractors will do much the same thing - and you might often find that your neck or back is treated at the same time. Not a bad idea actually since shoulder pain and neck pain or upper back pain often go hand in hand.

Manipulation for frozen shoulder is a slightly different issue however. Historically this has been a technique used when the patient is deeply asleep under a general anesthetic and the procedure is performed in an operating theater.

We know that frozen shoulder creates sticky adhesions inside the joint and we think that its these sticky areas that lead to the loss of movement. Manipulation of the shoulder under general anesthetic is a way of trying to force these adhesions apart - thus releasing the stuck shoulder and improving both pain and movement. This type of frozen shoulder manipulation seems to work but it's a very powerful - almost brutal technique - and there have been several reports in the past of arm bone fractures and other problems.

More modern (and more gentle) approaches include using keyhole surgery to break up the sticky adhesions.

Labels: cause of frozen shoulder, frozen shoulder manipulation, manipulation of the shoulder, shoulder injury, shoulder pain

It's long been known - and I've written extensively previously about it - that diabetic patients are more prone to frozen shoulder than the rest of the (non-diabetic) population.

A new study has shown however that it may not be only the shoulder that's affected. Indeed - the study seems to indicate that diabetics have increased stiffness in nearly all their joints - even if they are not aware of it and have no pain at the time.

The study compared the mobility of selected joints in diabetic and non-diabetics.

One hundred people comprising of 50 volunteer diabetics and 50 volunteer non-diabetics participated. The range of motion of the shoulder, elbow, wrist, fingers, hip and knee joins were measured.

The study revealed that there was a significant difference between joint mobility in the diabetic and non-diabetic subjects for all the joints measured - except the knee and elbow joints which showed no measurable differences.

There was also a slight but positive correlation between duration of diabetes and frequency of finger deformities.

The researchers concluded that reduced range of motion of some joints especially of the wrist, shoulder and hand could be seen as a complication of diabetes.

Labels: arthritis, cause of frozen shoulder, diabetes joint pain

The science behind frozen shoulder has always been somewhat mysterious.

Frozen shoulder experts often disagree on whether the problem is truly due to inflammation or not - some say that an auto immune reaction happens in the gristle around the shoulder.

Fibroblasts are cells that control wound healing and tissue repair. Some previous research has blamed overactive fibroblasts in the trigger of frozen shoulder.

A new study has looked at this in more detail. The aim of the study was to take fluid from the shoulder joint of patients with frozen shoulder and to see if this fluid affected fibroblast cells in a laboratory test tube. They also took fluid from patients without frozen shoulder for comparison.

The fluid from frozen shoulders caused a marked increase in the test tube fibroblast activity.

These findings demonstrate that fluid from shoulders with frozen shoulder contains chemicals or growth factors that influence fibroblast activity - and this may well be the basic trigger for the frozen shoulder process.

Labels: cause of frozen shoulder, frozen shoulder, shoulder pain