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.