John presented to the office with pain and loss of motion in his right shoulder with associated pain in the right side of his neck and upper back. This had been going on for a couple of months after he had slipped and fallen on some ice and landed on his right side. He did not feel much pain from the fall, but as the weeks went on, his shoulder range of motion kept decreasing and the pain in his shoulder, neck and upper back kept increasing. John loved to golf and, with the warmer weather fast approaching, he realized there was no way that he could swing a golf club with the condition that his shoulder was in — he needed to do something about it.
Frozen shoulder, or adhesive capsulitis, is a painful condition in which the movement of the shoulder becomes limited. This occurs when the strong connective tissue (shoulder capsule) surrounding the shoulder becomes thick, stiff and inflamed. This can be caused by trauma to the area but often the person cannot recall any certain event that caused the symptoms. The person will often develop discomfort in the same side neck and upper back as they start to compensate and recruit other muscles to help with the loss of motion and pain. This can also lead to tendinosis of the supraspinatus tendon (rotator cuff muscle) as it starts to get pinched under the bone in the upper shoulder causing impingement syndrome.
Upon examination, John only had 90 degrees (180 degrees is normal) of shoulder abduction and 40 degrees (90 degrees is normal) of external rotation — and it was very painful. This is only about half of the normal ranges for these movements and are very important for the golf swing. Performing some orthopedic tests also confirmed the impingement syndrome. John also had a lack of extension and rotation through his thoracic spine, also was limiting his ability to swing a golf club and often results in more strain on the shoulder.
His treatment included 6 visits over 8 weeks using a combination of:
- Active Release Techniques (ART)
- Spinal manipulation
- Class IV laser therapy
- Stretches and rehabilitative exercises
After treatment, John was very close to full range of motion in his shoulder. He was able to perform a full golf swing pain free. The discomfort in his neck and upper back had also cleared up, and he was very pleased with his progress. The battle is not always over just because the motion has improved and the pain is slim to none as there can still be some tissue restriction and muscle imbalances that can hang around. Dr. Aten stressed the importance of continuing the home stretches and exercises and recommended a couple of follow-up visits stretched out over a 2-3 month period to ensure the symptoms do not return.
DR. ALEX ATEN
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