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Getting
the Cold Shoulder?
By
Victoria L. Magown, CMTPT,
LMT and George S. Pellegrino, LMT, CMTPT
The “cold shoulder”, or as it is more commonly referred to,
frozen shoulder, occurs more frequently than most people realize. The
reason for this is simply a matter of degrees.
Sometimes the “cold shoulder” can be as subtle as the inability
to hold your arm over your head for long periods of time as when
blow-drying or curling your hair. It also shows up as the inability to
reach your back pocket. This is the stage when the shoulder is beginning
to "freeze".
In the advanced stages, shoulder pain can be so pronounced that
any movement of the shoulder or arm can be inhibited. This is when the
shoulder has reached the final stage, "frozen". Unfortunately, most
people hope this pain and restriction will simply go away. For this
reason, seeking help is delayed until the shoulder dysfunction is at an
advanced stage.
When Tom came to MyoRehab with severe right shoulder pain, he was
unable to raise his arm to shoulder height. His occupations as a
handyman and massage therapist required intense use of his shoulder
muscles. After a paint scraping job a few months earlier, his shoulder
became nearly incapacitated. The repetitive motion of the shoulder and
arm performing even simple tasks increased the pain and restriction.
On his first visit, we performed a Range of Motion evaluation,
looking for restriction in muscles indicating the presence of Trigger
Points. A Trigger Point is a hypersensitive focus of pain in a muscle
that restricts range of motion, referring pain in a predictable pattern
most often away from the site of the Trigger Point. With the results of
the Range Of Motion testing and a chart of his pain patterns, we were
able to identify the muscles causing the problem.
One of the primary muscles involved in frozen shoulder is the
subscapularis (illustration A). This muscle is located on the front
(anterior) of the shoulder blade (scapula). The subscapularis is also a
major contributor to a condition known as "rounded shoulders". It pulls
the shoulder and arm forward, in toward the body and downward, giving
the appearance of rounded the shoulders. When the subscapularis develops
Trigger Points, moving the shoulder and arm can be very difficult and
painful.
The teres major and latissimus dorsi (illustration B) together
with the pectoralis major (illustration C) assist the subscapularis and
can also contribute to rounded shoulders. When the subscapularis causes
restriction, these additional muscles are also likely to become
involved. This was certainly the case for Tom.
Being a healthcare professional, Tom knew the benefits of getting
treatment early. Had the shoulder already become completely frozen,
other pathological changes in the shoulder joint would have occurred
increasing the number of treatments required to restore his shoulder to
full function.
In Tom's case, the “thawing” began after just a few treatments.
By the third visit, Tom was able to lift his right arm several degrees
above shoulder level with only discomfort instead of pain. He was given
a specific Home Exercise program to retrain his shoulder muscles to
remain at their normal length, pain free. By the fifth treatment, he was
able to lift his right arm over his head with minimal discomfort.
We helped Tom develop ergonomically correct postures and
movements to perform his work. Tom quickly realized changing his work
habits and adding specific exercises for his shoulder would allow him to
remain a massage therapist and handyman contractor for many years to
come.
Are you getting the “cold shoulder”? Don't wait until it freezes. Give us a call at MyoRehab
OR click here to set up your thirty minute consultation
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