Frozen Shoulder

Presenting symptoms

A 23 year-old woman caught an edge while ski racing and landed heavily on her left shoulder. Imaging revealed a fractured shoulder blade and a 3-cm tear in the rotator cuff. Physical therapy reduced pain and improved range of motion, but she subsequently developed a frozen shoulder. Her orthopedist recommended including NMT to her program before making any surgical decisions.

Evaluation, clinical reasoning & treatment strategizing

The causes of frozen shoulder, sometimes called adhesive capsulitis, are not fully understood. In this case, 360 NMT hoped to expedite the “thawing” process by first treating what we call the “big four” muscle culprits of a frozen shoulder: lower trapezius, pectoralis minor, serratus anterior and subscapularis. Later, other cuff and shoulder girdle muscles are included in the protocol.

Treatment

Trigger points found in all of the rotator cuff muscles referred pain directly into her shoulder joint.  To be thorough, we also treated scapula-thoracic and neck muscles. Local stretch, myofascial release and muscle energy techniques all helped to reduce pain and make small, steady improvements. NMT was able to keep other functionally related shoulder muscles healthy while she continued her therapeutic exercises prescribed by physical therapy.

Outcomes and follow-up

Ultimately, this patient was recommended to have a surgical repair for the cuff tear. Once healed, NMT continued post-operatively at two-week intervals to expedite recovery. When integrated into pre/post surgical rehabilitation programs, NMT can help reduce pain, reduce secondary trigger point dysfunction related to injury and restore muscle health. The patient returned to ski racing.