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Pathology of Frozen Shoulder Statistics of Frozen Shoulder Tradition East Asian Medical view of Frozen Shoulder Western Medical Tx of Frozen Shoulder Corticosteroid injection Physical Therapy TCM Tx of Frozen Shoulder Acupuncture Electro-Acupuncture
The cause of frozen shoulder is unknown, so its diagnosis is based on symptom criteria. Arthroscopic biopsy of patients with frozen shoulder revealed cellular evidence of both chronic inflammation and proliferative fibrosis (Hand, 2007)
Frozen shoulder lasted about 4 years. It affects females more often. There is no arm preference. It is not strongly association with other illness. Frozen shoulder has a positive natural history and will most often resolve on its own. If there is an acute and severe onset prognosis is not as good as slow progression. The most common treatment is physical therapy and steroid injection.
The mean interval from symptom onset to completion was 4.4 years, range 2 to 20 years. Of the 223 shoulders, 137 (61%) were female and 86 (39%) were male. The dominant arm was affected in 48% (129) and non-dominant in 52% (140). Of the 223 patients, 38(17%) had high cholesterol, 31(14%) were diabetic, 15 (7%) heart disease, 7 (3%) had Dupuytrens contracture, 6 (3%) had osteoporosis. Analyses of the severity of presenting symptoms yielded a subgroup at risk of a worse prognosis. Those patients who reported unbearable symptoms in the first 6 months had a significantly worse outcome compared to those who reported severe, moderate, or mild symptoms. Twenty-one percent of patients (9/42) with unbearable symptoms at onset went on to have persistent severe symptoms, compared to the 3.1% (7/227) without unbearable symptoms. Patients received a variety of treatments and often received more than one modality of treatment, including no treatment (95), steroid injection (139), physiotherapy (55), arthroscopic hydrodistension (20), manipulation under anesthesia (5), and arthroscopic release (5). Twenty percent of patients (45/223) reported bilateral symptoms. None occurred simultaneously. There were no recurrent cases. Symptoms were reported as slow in onset in 61% (163 shoulders) and sudden in 39% (106 shoulders). (Hand, 2008)
The closest relationship traditional Chinese medicine has to frozen shoulder is Bi Syndrome
Bi syndrome in the elderly is commonly caused by internal factors (deficiency of Qi and Blood).
Deficiency Stagnation Bi syndrome
Frozen shoulder often occurs around the age of 50. In Japan it is commonly known as fifty year old shoulder.
At forty-eight the yang energy of the head begins to deplete, the face becomes sallow, the hair grays, and the teeth deteriorate. By Fifty-six years the liver energy weakens, causing the tendons to stiffen. At forty-two all three yang-channels, taiyang, shoayang, yangming are exhausted, the entire face is wrinkled, and the hair begins to turn grey. At forty-nine years the ren and chong channels are completely empty, and the tien kui has dried up
All the arm meridians cross the shoulder. However, most of the important structures of the shoulder are in the lateral and posterior aspects and are thereby governed by the arm yang meridians. (Legge & Charles, 1999) Yang leaving the upper body is especially damaging to the shoulder because of its strong association with yang channels.
Three week course of 30mg of prdnisolone daily is of significant short term benefit in adhesive capsulities but benefits are not maintained beyond six weeks (Buchbinder, R., Hoving, J. L., Green, S., Hall, S., Forbes, A., & Nash, P., 2004) Intra-articular corticosteroids injections have the additive effect of providing rapid pain relief, mainly in the first couple of weeks of the exercise treatment period. By the 12th week there was no significant difference between the two groups. (Bal, 2008) intra-articular injection of corticosteroid, coupled with a simple home exercise program, is superior to a 12 session supervised physiotherapy program with steroids in improving shoulder pain and function at 6 weeks in patients. They found that 12 months after enrollment, all groups had achieved the same degree of improvement with respect to shoulder pain and disability. (Carette, 2003)
Use Heat
Heat has been found to be helpful in treating frozen shoulder. It is suggested that deep heat modality increases tissue temperature and its extensibility, making passive range of motion more effective (Pajareya, 2004).
Acupuncture reliefs pain but does little to increase range of motion It was concluded that the combination of acupuncture with shoulder exercise may offer effective treatment for frozen shoulder. (Sun, 2001)
Bibliography
Books Beers, M.H., Kaplan, L., & Berkwits, M., (eds.). (2006) The Merck Manual of Diagnosis and Therapy. Boston: Merck & Company, Incorporated, 2006. Legge & Charles,(1999) Close to the Bone. New York: Sydney College Maciocia, G. (1994) The Practice of Chinese Medicine : The Treatment of Diseases with Acupuncture and Chinese Herbs. New York: Churchill Livingstone Ni, Maoshing.(1995) The Yellow Emperor's Classic of Medicine : A New Translation of the Neijing Suwen with Commentary. Minneapolis: Shambhala Publications, Incorporated
Bibliography
Journals Hand, G. C. R., Athanasou, N. A., Matthews, T., & Carr, A. J. (2007). The pathology of frozen shoulder. The Journal of Bone & Joint Surgery 89, 928-932 Hand, C., Clipsham, K., Rees,J. L.,& Carr, A. J. (2008). Long-term outcome of frozen shoulder. Journal of Shoulder and Elbow Surgery 17, 232-236 Matsumoto Hiromi. (1998). Acupuncture treatment for Gojyukata (frozen shoulder). North Americal Journal of Oriental Medicine 5, 5-10 Sun, K. O., Chan, K. C., Lo, S. L., & Fong, D. Y. T. (2001). Acupuncture for frozen shoulder. Hong Kong Medical Journal 7, 381-391 Ma, T., Kao, M. J., Lin, I. H., Chiu, Y. L., Chien, C., Ho, T. J., Chu, B. C., & Chang, Y. H., (2006). A study on the clinical effects of physical therapy and acupuncture to treat spontaneous frozen shoulder. The American Journal of Chinese Medicine 34, 759-775
Bibliography
Journals
Buchbinder, R., Hoving, J. L., Green, S., Hall, S., Forbes, A., & Nash, P. (2004). Short course prednisolone for adhesive capsulitis (frozen shoulder of stiff painful shoulder): a randomized, double blind placebo controlled trial. Annuals of Rheumatic Diseases 63, 1460-1469 Bal, A., Eksioglu, E., Gulec, B., Aydog, E., Gurcay E., & Cakci A. (2008). Effectiveness of corticosteroid injection in adhesive capsulitis. Clinical Rehabilitation 22, 502-512 Buchbinder, R., Youd, J. M., Green, S., Stein, A., Forbes, A., Harris, A., Bennell, K., Bell, S., & Wright, W. J. (2007). Efficacy and cost-effectiveness of physiotherapy following glenohumeral joint distension for adhesive capsulitis: randomized trial. Arthritis Rheumatism 57, 1027-10237 Pajareya, K., Chadchavalpanichaya, N., Painmanakit, S., Kaidwan, C., Puttaruksa, P., & Wongsaranuchit, Y. (2004). Effectiveness of physical therapy for patients with adhesive capsulitis: a randomized controlled trial. Journal of The Medical Association of Thailand 87, 473-480 Carette, S., Moffet, H., Tardif, J., Bessette, L., Morin, F., Fremont, P., Bykerk, V., Thorne, C., Bell, M., Bensen, W., & Blanchett. (2003). Intraarticular corticosteroids, supervised physiotherapy, or a combination of the two in the treatment of adhesive capsulitis of the shoulder: a placebo-controlled trial. Arthritis Rheumatism 48, 829-838 Ulett, G., Han, S., & Han J. (1996). Electroacupuncture: mechanisms and clinical application. Biological Psychiatry 44, 129-138 Cheing, G., So, E., & Chao, C. (2008) Effectiveness of electroacupuncture and interferential electrotherapy in the management of frozen shoulder. Journal of Rehabilitation Medicine 40,166-170 Lin, M., Huang C., Lin, J., & Tsai, S. (1994) A comparison between the pain relief effect of electroacupuncture, regional never block and electroacupuncture plus regional never block in frozen shoulder. Department of Anesthesiology and Pain Center, Taipei Municipal Chung-Hsing Hospital. Marcus, A., & Gracer R. (1994) A modern approach to shoulder pain using the combined methods of acupuncture and Cyriax-based orthopaedic medicine. American Journal of Acupuncture vol22 no1 5-14