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Frozen shoulder and numbness in the arm
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Frozen shoulder and numbness in the arm - June 1, 2006 8:39:00 PM
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PJM
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From: Australia
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I've had a run of people with frozen shoulder and arm numbness and pain in addition to the shoulder limitation and shoulder pain.
Do others have similar experience?
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Re: Frozen shoulder and numbness in the arm - June 2, 2006 9:05:00 AM
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PHSPT
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From: Oklahoma
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I have exp this w/ some pnts. I feel is a secondary condition and not truly associated w/ capsulitis.
I probe further on their Past Med Hx,any prior injuries, MOI (mechanism of injury, any comorbidities that may be the cause of neurological Sx's.
Im just rambling here, but i dont see much correlation to F shoulder.
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Re: Frozen shoulder and numbness in the arm - June 3, 2006 10:00:00 AM
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srcase
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I think it is relavtively common to find neurological involvement in frozen shoulder. In another thread, Nari brings up the point that some believe frozen shoulders are neurological in orgin. Plus, if you think about the anatomy....how close is the brachial plexus to the capsule?? It's sitting right next to it. Not to mention muscle spasms in scalenes, pec minor, and axillary muscles. The question really becomes, is there such thing as true frozen shoulder??
Sarah
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Re: Frozen shoulder and numbness in the arm - June 3, 2006 12:04:00 PM
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Randy Dixon
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My question is when you ask :Do others have similar experience?
Do you mean shoulder problems or do you mean are there runs of a certain diagnosis. Like all of the sudden everyone comes in with the same complaint?
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Re: Frozen shoulder and numbness in the arm - June 4, 2006 12:12:00 AM
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nari
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PJ20,
"Frozen" means, in my vocabulary, stiff and rigid, and in some cases of this syndrome the capsule, according to those who have seen it,is very tight. This is adhesive capsulitis, and it is not very common; but can follow on from the initial pain and loss of function.
If you are asking specifically about adhesive capsulitis, then I've never heard of numbness as a feature of it.
Referred pain from the neck can cause shoulder pain, numbness, hyperasthesia and weakness. I think you may mean this condition. ??
Many 'frozen' shoulders become miraculously free with neurodynamic mobilisation for some minutes; which means the capsule was perfectly OK. It is worth noting that many doctors call a stiff shoulder 'frozen', but that does not seem to occur with knees and elbows and spines and fingers. Confusing, isn't it?
Nari
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Re: Frozen shoulder and numbness in the arm - June 5, 2006 12:04:00 AM
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ginger
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From: Melbourne Victoria
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PJ, the so called frozen shoulder , without trauma as likely contributor , is for the most part a referred pain /inflammatory/altered sensation problem arising from hypomobile cervical joints .
Mobilise C3456 on the side of pain
( continuously is the most effective, described elsewhere on these pages many times ). The inflammatory event at joint and nerve will resolve relative to the improvements in facet mobility. This is a permanent result in most cases , unless the situation has progressed to an inflammory capsulitis ( as Nari mentioned ) , in which case it will still be necessary to restore full pain free , resistance free, movements to the cervical joints as mentioned , before any attention will be of value to the shoulder . Otherwise you will just waste time and effort on matters which may well ( and most likely will ) resolve without attention to the shoulder at all.
The issue of altered sensations as you have desrcibed them , in addition to the pain and stiffness is best seen and understood in the light of an inflammatory neuralgic event providing referred sensations , pain and other neuralgic related effects to their dermatomal/myotomal areas.
Don't waste time on the shoulder at the early stages , cervical mobs will clear it up nicely.
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: Frozen shoulder and numbness in the arm - June 5, 2006 3:18:00 AM
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Tom Reeves DPT ATC
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Ginger,
How does cervical facet hypomobility cause inflamation in the shoulder? I understand referred and radiating pain but those are not inflamation.
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Re: Frozen shoulder and numbness in the arm - June 5, 2006 4:30:00 AM
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PHSPT
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Ginger,
I think we may be pushing it a bit far w/ the "Vertebral mobs for everything approach" Adhesive capsulitis is a condition w/ an unknown etiology. What we do know from it, is the gradual and progressive loss of ROM.
As the condition worsens there is a potential for somatosensory referral, which is what all of us experience w/ this pop.
But to say that this condition has an inflammatory etiology originating at the cerv joints....you area scaring me ginger....
No offense Ginger.. much love here, but quite frankly comments like that without any true base of support can detract some clinicians out there.
Best course of action is depending on the stage of the capsulitis.
if you are pounding on this pnt's neck at the frozen stage, you'd crack your thumbs mobing him/her before you change anything at the shld.
Heres a good article for the optimal txs for capsulitis.
Have a good week people
"adhesive capsulitis a treatment approach" Hannafin MD et al. 2000. Clinical orthopedic and related research journal.
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Re: Frozen shoulder and numbness in the arm - June 5, 2006 5:45:00 PM
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ginger
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From: Melbourne Victoria
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I beg to differ PHS, It is you who are still connected to adhesive capsulitis as a condition with an unknown aetiology. I'm saying to you in the most straight forward no nonsense way I can , with the utmost sincerity, that if you mobilise the central spine first, the vast majority of shoulder pain / dysfunction/ stiffness problems will be resolved. In fact there I witness a positive corelation between every advancement in freedom and mobility at the relevant cervical and upper thoracic facet joints, to the painfull condition known asd "frozen shoulder" . Lets say this again for those who think I may just be beating an empty drum , Were you , or anyone capable of mobilising facet joints effectively, to approach a person with frozen shoulder and do nothing other than mobilise their cervical facet jonts with good effect , then that problem would be resolved , as is routinely done in my rooms ( and over nearly 20 years ) without any attention to the shoulder at all. There will always be a few who go on to a stage of tightness and stiffness at the glenohumeral joint, before effective facet joint movements can be restored. In these cases some attention post hands on Rx is called for. For the majority however I find every reason in my own experiences with frozen shoulder to state this as firmly as possible. Don't waste time on the shoulder, get your act together at the source of the problem. The Gregory Peck.
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: Frozen shoulder and numbness in the arm - June 6, 2006 7:56:00 AM
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Shill
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Boy, if I had a great and effective way to treat a problem with which others often fail, I'd write a book on it, or I'd at least do a case study. Id want people to know that it wasnt just my opinion, it was effective treatment, bolstered by research. Maybe its just me?
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Steve Hill PT
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Re: Frozen shoulder and numbness in the arm - June 6, 2006 8:26:00 AM
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Sebastian Asselbergs
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Let me jump in with a bit of theoretical leg work for Ginger: IF a cervical joint has an effect on the neral in-and output of the nerve root, it can affect the function of the related muscles, including those essential to proper biomechanics of the sgleno-humeral joint, which in turn then can lead to poor and irritating biomechanics, which in trun can lead to defensive and adaptive patterning, which can lead to.....reduced capsular mobility....
With a bit of mental streeeeeeetching one can follow the logic....It doesn't have to be referred pain per se - it can be altered biomechanics secondary to dysfunctional neural out-input.
Now I need a coffee....
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Mundi vult decipi
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Re: Frozen shoulder and numbness in the arm - June 6, 2006 8:27:00 AM
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Sebastian Asselbergs
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..and I'll work on my spelling and editing...
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Re: Frozen shoulder and numbness in the arm - June 6, 2006 4:10:00 PM
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ginger
Posts: 660
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From: Melbourne Victoria
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Sebastian , I hope you got that coffee, I'm worried I may be OD'ing on the local brew. South Melbourne is a coffee lovers paradise with evry second shop and cafe selling the wonderful stuff.
As you have iterated , the logic is in my view not a difficult progression to make. I like to keep it as simple as possible when I describe the cacscade of events leading to pain , and for the most part it is simple. The best part of the equation though has to be the effect the attetion I pay has to facet joints has on musculoskeletal pain/dysfunction. Rapid, effective and long term.
Shill ,
while I totally agree with you about a book, I am working steadily towards being able to provide studies on the framework and models I propose to you and others. Today I am expecting a reply ( hopefully in the affirmative) to a proposal I made last week to a hospital about using resources and creating a research related project.
Wish me luck , I'm keen to proceed , but have a lot of juggling of lifestyle/money/practice matters to resolve before the ink can really hit the paper.
Cheers
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: Frozen shoulder and numbness in the arm - June 7, 2006 5:51:00 AM
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Shill
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From: Madison WI USA
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Good on ya mate.
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Steve Hill PT
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Re: Frozen shoulder and numbness in the arm - June 8, 2006 12:39:00 AM
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Randy Dixon
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Ginger,
How does cervical facet hypomobility cause inflamation in the shoulder? I understand referred and radiating pain but those are not inflamation.-Tom Reeves
Tom,
Here is some idea how. If you effect the vagus nerve or your manipulation influences the ANS which influence the vagus..etc.
http://www.nature.com/nature/journal/v421/n6921/full/421328a.html
Nature 420, 853-859 (19 December 2002) | doi: 10.1038/nature01321
The inflammatory reflex
Kevin J. Tracey
Top of pageAbstractInflammation is a local, protective response to microbial invasion or injury. It must be fine-tuned and regulated precisely, because deficiencies or excesses of the inflammatory response cause morbidity and shorten lifespan. The discovery that cholinergic neurons inhibit acute inflammation has qualitatively expanded our understanding of how the nervous system modulates immune responses. The nervous system reflexively regulates the inflammatory response in real time, just as it controls heart rate and other vital functions. The opportunity now exists to apply this insight to the treatment of inflammation through selective and reversible 'hard-wired' neural systems.
I may have two different but similar articles above.
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Re: Frozen shoulder and numbness in the arm - June 8, 2006 12:42:00 AM
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Randy Dixon
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Oh yeah, I got referred to the article in another forum, maybe by Nari?. I don't want to steal the credit if it makes me seem smart and I don't want to take the blame if it makes me look stupid.
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Re: Frozen shoulder and numbness in the arm - June 8, 2006 1:39:00 AM
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nari
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From: Australia
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Randy,
Whichever way it goes, I can't remember if it was me, but Libert's paper was referred because of its useful content. :)
Nari
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Re: Frozen shoulder and numbness in the arm - June 13, 2006 6:50:00 PM
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ginger
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From: Melbourne Victoria
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Sebastian and Shill , got word today that my proposal as mentioned earlier was enthusiasticaly recieved. I start in mid July. thanks for your support.
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: Frozen shoulder and numbness in the arm - June 13, 2006 11:59:00 PM
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nari
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From: Australia
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Ginger
Goodonya.
I completely support Sebastian's proposal that the neurological dysfunction comes first, followed by secondary biomechanics. So if we treat neurodynamically first, there is a hope (dependent on the time frame) that secondary changes can be averted. This happens clinically - it just needs to be tested....
Nari
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Re: Frozen shoulder and numbness in the arm - June 14, 2006 3:48:00 PM
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ginger
Posts: 660
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From: Melbourne Victoria
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Nari,
This is supported by my observations and treatment outcomes too. Within the framework of my model the notion that a neurological event precedes activity and biomechanics associated with it is , I believe, a central theme that is worthy of exploration . Thanks to you for your help and critiques.
As you have stated , treating neurodynamically first is effective, I think we both do , but with a different focus.
Cheers
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
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