Frozen Shoulder ,Acromioclavicular Sprain

– THOMAS E,SPORTS MEDICINE
Frozen Shoulder
 As the number of older people participating in active sport increases, the incidence of ‘frozen shoulder’ or ‘adhesive capsulitis’ becomes more frequent. It is uncertain whether this is because sports involve a wider range of shoulder movements, and the sports person notices the limitation earlier, or that more sports participation to a greater age predisposes the sufferer to injury. Whatever the cause, movement at the shoulder becomes limited, either by pain or stiffness, and the person complains that the normal activities of living become difficult.
 Joint mobilising techniques may be the preferred treatment, and can resolve the condition. Unfortunately, this condition can easily become permanent, with the shoulder self-limiting to a very small range of movements. I see too many older patients who have not been able to lift their arms for months or even years, and who still expect miracles. I usually treat them constitutionally, that is with the remedy that fits their whole symptom picture.
 Referral to an osteopath or chiropractor may help when the shoulder condition is generated by a problem in the region of the cervical spine. I have also known acupuncture to help. The normal expectation would be for the amount of mobility to improve over a period of eighteen months to two years, and for pain to diminish over the first six months. Homoeopathic medicines can help to relieve the pain.
 CASE 26
 Georgia is a high-powered executive in the public relations business. She likes to play golf and walk in the hills, and at the age of fifty still considers herself very fit. Her osteopath suggested she should come to see me because her right shoulder had become very stiff, her voice was very hoarse and she felt under too much stress at work.
 She could not raise her arm above shoulder height, and even that was with an extreme lifting of the shoulder girdle. The pain was awful every morning and made her scream. She slept with her arm under her head, but that made her shoulder extremely painful and stiff. She had had rheumatoid arthritis as a child, and it now seemed to be settled in her shoulder. It hurt to move it. The pain made her weep, and she cried as she told me about it.
 The stress at work came from her feeling that neither her clients nor her bosses appreciated her. She worked hard, but was indignant that she did not get the recognition she deserved. If someone criticised her she felt ‘really awful. I could scream, but I keep it inside’.
 She talked about her husband who had died three years earlier, and said that she had never really grieved for him at the time. Now the grief was with her all the time.
 Georgia’s remedy was Staphysagria. I gave her the 200c potency because of the balance of mental, emotional and physical symptoms; indignation, bottling up her emotions, anger especially, feeling unappreciated, her unresolved grief, sensitivity to criticism, intolerable tearing pain in shoulder and hoarseness.
 She took one tablet morning and night for three days. Her voice was better at once. She felt better about work and was less stressed. With prolonged mobilising and manipulation her shoulder improved gradually, and six months later she had 70% mobility.
 Although I would recommend that someone like Georgia who had a chronically frozen shoulder should see a specialist or a qualified homoeopath for an in-depth consultation, there are a few remedies that could help in the short term.
 Bryonia
 This may be useful if the slightest movement is painful.
 Dosage: One Bryonia 30c. Repeat as necessary for up to seven days.
 Ferrum Metallicum
 Ferrum may be effective for a frozen right shoulder. The person insists on trying to lift his arm even though it is extremely painful to do so. Moving the arm is intensely painful. There may be cracking or crepitus in the joint, and the pain is tearing and stinging. It is worse at night.
 Look for an excitable, nervous person who is sensitive to the least noise. He feels much better when working or doing something.
 Dosage: One Ferrum 200c three times daily if the symptoms fit, for not more than seven days.
 Lycopodium
 The condition may have originated with lifting a weight and begun as a stiff neck. Tearing and shooting pain in the right shoulder, with tension and weakness. It feels as if arthritis were attacking the shoulder, and this makes it difficult to move the arm. The pain is worse at night, and on waking from sleep. It may be worse at about 4 p.m.  Tends to keep moving his arm to relieve the pain.
 Dosage. One Lycopodium 30c daily until the pain is relieved, then take one as necessary, for not more than seven days.
 Natrum Muriaticum
 A paralytic heaviness of the arm with a wrenching pain in the shoulder prevents the arm from being moved or elevated. The shoulder feels sprained. There may also be aching and rigidity in the neck with painful stiffness. Trembling of the hands may accompany the shoulder symptoms. The pain is worse between 9 a.m.  and 11 a.m.  and may come on then. This person dislikes the heat of the sun. She cannot stand sympathy and brushes it off or ignores it.
 Dosage: One Natrum Mur. 200c three times daily, for not more than seven days.
 Rhus Toxicodendron
 Burning pains in the shoulder with stiffness brought on by overexertion or lifting a weight. The right arm feels weak and paralysed, especially at night and in bed or at rest. Stiffness and pain are worse on first movement but relieved by constant motion. The patient is restless and always moving. There is painful tension of the neck when he tries to move his arm, but this eases with movement.
 Dosage: One Rhus Tox. 200c taken last thing at night or first in the morning as necessary, for not more than seven days.
 Ruta Graveolens
 Wrenching pain in the shoulder that is worse when the arm hangs down, and when resting on the arms. Neck symptoms probably absent. There will be a dull tearing pain in the humerus, and he feels bruised. The shoulder is rigid, and very weak. He feels worse when cold, damp, sitting and lying. He may be anxious, nervous, restless and depressed in the late evening. Because of the damage to tendons, Ruta should be given regularly during recovery. The pains are sore, bruised, and aching and the arms are restless.
 Dosage: One Ruta 200c daily for two to three weeks.

Acromioclavicular Sprain
 Falling on to the point of the shoulder is a common cause of damage in the acromioclavicular joint among rugby lock forwards, horse riders and cyclists, as well as mountain bikers who fall and land on their shoulder. There may be some tearing in the acromioclavicular and coraclavicular ligaments which normally stabilise the joint, and there may be springing of the lateral end of the clavicle. There is tenderness, pain and swelling over the top of the shoulder and pain when the scapula moves. The pain can go on for three to six weeks.
 Arnica
 This remedy is very specific for injuries from a fall. Take it immediately after the fall and every hour for the remainder of day. It will prevent shock, relieve the immediate pain and reduce the internal damage, haemorrhage, inflammation and swelling.
 Dosage: One dose of Arnica taken immediately in any potency will help.
 Bryonia
 If any movement is painful following injury Bryonia will make it easier.
 Dosage: One Bryonia 30c for not more than six doses.
 Chelidonium
 Dosage: If Bryonia does not work on an injured right shoulder, try Chelidonium 30c three times daily, for not more than seven days.
 Rhus Toxicodendron
 See above and Chapter 10.
 Ruta Graveolens
 Helps to promote healing of ligaments and tendons.
 Dosage: One Ruta 30c three times daily, for not more than seven days.
 Sanguinaria
 He cannot raise or rotate the right arm. Movement makes it really much worse, especially moving in bed. It is much worse at night in bed. Pain on top of the shoulder, in the acromioclavicular region, and in the deltoid. Rheumatic pain in the shoulder extending to the elbow. Pain under the scapula, worse moving and breathing. He may be irritable and morose, and unwilling to make any effort.
 Dosage: One Sanguinaria 30c for not more than seven days.
 CASE 27
 A twenty-eight year old paralympic athlete who specialised in swimming and table tennis suffered terrible pains in his right shoulder and both wrists. The pain was worse during training on the road in wet weather, and was much better when training in the USA. His muscles were generally stiff and painful after sleep or sitting for long periods. He felt as if he had a hangover even if he had not been drinking. His head felt heavy. His arms were numb. His thirst for cold drinks was increased. The pains stopped him getting to sleep.
 This person is restless, and finds it difficult to sit still for long. He is very impatient, and quite angry that his symptoms have stopped him training. Because he is recognised as being a successful athlete it gives him a sense of belonging to society despite his paralysis.
 Comment
 Because of his restlessness, continually changing position, worse in wet weather, better in warm sunny weather, impatience and anger at being injured, he was given Rhus Tox. 1M, one tablet. Ten minutes later he said that he felt strangely peaceful.
 He was asked to report again the next day by telephone, but did not. A week later he rang to apologise for not telephoning. He had gone off on a training camp, and had forgotten his condition.