Neck pain and Frozen Shoulder commonly occur together. When pain...Read More
Dr. O’s specialized non-surgical operation to cure adhesive capsulitis frozen shoulder is a novel method that ensures a fast resolution of pain and a return to the functional ability for frozen shoulder sufferers. Considered a medical breakthrough, the mcd (manual capsular dissection) procedure is a truly revolutionary non-surgical operation developed by world-renowned frozen shoulder expert, Dr. Allan Gary Oolo-Austin at the world frozen shoulder clinics. It has had 98% clinical success in restoring range of motion and functionality to frozen shoulders.
Our unique method involves Dr. Oolo-Austin isolating the adhesive tissue inside and outside the shoulder capsule and separating it using extremely specific patient movements in conjunction with very specific mobilization procedures. Unlike orthoscopic surgery, the MCD Procedure is completely non-invasive and does not involve cutting into the shoulder. Although performed in a medical facility, it is not done in a hospital operating room with general anesthetic like invasive surgery or manipulation under general anesthesia.
Dr. O’s MCD Procedure is completed in about an hour. It is literally over before you know it. You will walk in painfully unable to move your shoulder and walk out almost fully functional . (Specific rehab exercises designed by Dr. Oolo-Austin are needed post-op to neurologically re-educate the unused shoulder muscles and maintain active range of motion. ) You will walk into our clinic unable to put your coat on yourself, unable to put your hand on your hip, unable to wash your hair with the affected arm, and often unable to work. After the MCD Procedure, these everyday activities will be returned to you within days or, at most, weeks.
It can be very frustrating experience going to doctor after doctor, and therapist after therapist who can’t seem to pinpoint the exact cause of your lack of mobility and shoulder pain. Even if they do correctly diagnose frozen shoulder, they certainly cannot cure it for you. Once a proper diagnosis finally has been made, often the only proposed solution is cortisone injetiions or surgery followed by a long and painful recovery and rehabilitation process. Surgery, whether it helps or not, still requires up to 9 months of heavy post-op physiotherapy sessions in an attempt to heal the damage inflicted to the tissues from the surgery itself. No matter which way you look at it, cutting open your body should always be your last resort.
Dr. Oolo-Austin’s MCD Procedure has been incredibly successful and is the first of its kind in the world. The MCD Procedure is performed with the patient relatively conscious and interactively participating to ensure than no damage occurs to the joint or surrounding tissues. Every person is unique, and this is one medical procedure that truly takes this fact into account. That’s why you need to know how our frozen shoulder diagnosis works.
Patients and family members attending a World Frozen Shoulder Clinic from visiting countries are provided with accommodation suggestions should they wish to stay for a few days. Although some busy executives fly in and out on the same day, it is recommended that patients stay for at least one or two follow-up visits. This is because Dr. Oolo-Austin’s specialized neurological muscule treatments will be applied after the MCD Procedure to your shoulder muscles in order to strengthen and restore their neurological ability lost due to inactivity. This helps to ensure optimal success and enable a short recovery and neuromuscular re-training period.
There is no other treatment in the world that enables such fast returns to functional ability for frozen shoulder sufferers than the MCD Procedure–whether it be MUA, hydrodilation, cortisone injections, surgery, physiotherapy, acupuncture, chiropractic, ART, or NAT. All of the aforementioned treatments which apply manual or physical medicine, require many months of repetitive sessions which will be either extremely painful, very slow-going in terms of progress, or relatively ineffective despite their advertised results. Other than the MCD Non-surgical Operative Procedure, there is NO treatment which can boast of a cure in only one visit. Hundreds of thousands of frozen shoulder sufferers have gone the traditional recommended route of months or years of painful physical therapy treatments. They all give the same story. “Nothing I tried helped!” or “I only started to begin to see some minor results in 10 visits” or “I tried physical therapy but it made it worse”. Don’t let yourself remain a victim of frozen shoulder! Immediate, real help is available to you with the revolutionary MCD Procedure!
Despite most medical professionals being familiar with adhesive capsulitis frozen shoulder, the details are still a complete mystery to them. Although they know that the shoulder capsule contracts and freezes due to the build-up of adhesions and scar tissue, there are no medical professionals including family doctors, orthopedic specialists, physiotherapists or chiropractors who can tell you what actually causes frozen shoulder. These health professionals are also at a complete loss in being able to provide you with a treatment that actually cures frozen shoulder. Traditional manual, chiropractic, or physical therapy treatments simply don’t work. Because so little is known by the medical community on frozen shoulder, symptoms are also frequently misdiagnosed.
After 98% clinical success in restoring range of motion and functionality to frozen shoulders for 10 years, the MCD Procedure to fix frozen shoulder was formally introduced to the international medical community by Dr. Oolo-Austin. Dr. Oolo-Austin co-authored a pilot study which was published in the Samara Medical Journal in Russia in 2012 with Dr. Maxim Bakhtadze, MD, PHD, Professor at the Russian Centre for Manual Medicine, Dept of Neurology and Neurosurgery. The MCD Procedure is the only procedure with no recorded complications in the over 15 years it has been performed worldwide. It is much safer than surgery.
Realistically, there are no other options to quickly, safely and effectively cure your frozen shoulder for a fast return to your normal daily activities and functional capabilities. Click here for comparison and explanation of other frozen shoulder treatment options. Say goodbye to your frozen shoulder once and for all! You can finally get the answers and the treatment you have been looking for!
Dr. Oolo-Austin has also developed a groundbreaking procedure to cure another type of frozen shoulder called Shoulder Impingement Syndrome, Frozen Shoulder Impingement, simply Frozen Shoulder or sometimes “Type 2” Frozen Shoulder. This is a novel procedure specifically designed to cure Shoulder Impingement Syndrome which incorporates a team of health professionals that apply Dr. O’s novel neurological muscle and pain resetting protocols. (It is not the MCD Procedure for Adhesive Capsulits.) . The procedure is called the “Myoneural Shoulder Impingement Procedure” (MSIP)
Whereas the MCD (Manual Capsular Dissection) Procedure to cure adhesive capsulitis frozen shoulder involves the taking of medication, Dr. Oolo-Austin’s MSIP shoulder impingement procedure is not always performed with the use of medications. If you have the type of frozen shoulder that is due to capsular adhesions, Dr. Oolo-Austin’s MCD Procedure is the only treatment that can alleviate symptoms and fix adhesive capsulitis in a single session.
If, however, you suffer from un-complicated frozen shoulder due to compromising shoulder impingement, you can get effectively treated with Dr. O’s Myoneural Shoulder Impingement Procedure.
With adhesive capsulitis frozen shoulder, all ranges of motion will be severely restricted–especially side raising (abduction), arm up behind your back (internal rotation) and the “I surrender” position (external rotation). Internal and external rotations are still possible by patients suffering from frozen shoulder impingement syndrome. With adhesive capsulitis, patients are often unable to wash their hair, do up their bra, or even simply put their affected hand on their hip. Both types of frozen shoulder can cause pain at night but with adhesive capsulitis, the pain can be excruciating and debilitating.
With impingement syndrome the patient will often still be able to raise their arm sideways without body or shoulder tilt between 90-120 degrees. Adhesive capsulitis sufferers are usually unable to raise their arm in any manner above 90 degrees without body tilt. Most impingement syndrome sufferers still have most of their other shoulder movement capabilities with pain only in some ranges at end point. Some impingement syndrome sufferers do not have limitations on side raises and only experience pain when they reach all the way up and back or partially up and back.
A research study showed that there was a 98% restoration of arm raise ability (abduction) within 2 days after Dr. Oolo-Austin’s MCD Procedure!
From the Research Study:
|Patient Number||Before Treatment||After 1st Treatment||After 2nd treatment||After 3rd Treatment|
Maxim Bakhtadze, MD, PhD and Allan Austin Oolo, DO, DC, CCRD, CCSP
Russian Journal of Manual Therapy, Dec, 2012.
The purpose of this article is to present and evaluate a neuromanual treatment for frozen shoulder (FS) using local anesthetic while the patient is fully conscious. The unique term neuromanual is used here to denote interactive, patient initiated, facilitative overload of shoulder muscle mechanoreceptors during the manual procedure. Although external incisions are not made, the term dissection is used in this article to denote the actual internal non-surgical separation of adhesed tissues during the procedure. (Using a therapeutic physical transduction, multimodal stimulation approach describes the neurosummative afferent overload methodology used in Dr. Oolo-Austin’s neuro-muscular treatment system which is also referred to in association with the phrases Functional Muscle Neurology and Myoneural Medicine. Historically neuro-muscular treatment system is the first physical medicine treatment method to simultaneously combine resisted exercise with manipulative soft tissue treatment.) Over 100 MCD Procedures have been performed since its inception in 2004. Dr. Oolo-Austin is also known as Dr. Austin Oolo.
For this study, shoulder abduction was measured before and after the treatment. The results showed near or complete recovery of shoulder abduction as well as increased muscle strength and decreased pain immediately following the procedure. Readers of this study familiar with the generally accepted difficulty in achieving even minor results with conservative treatment of FS will acknowledge that results such as these without surgery or manipulation under general anesthetic are unprecedented. The results of this study are statistically significant with a p value of 0.00057. There were 6 women and 4 men. The right shoulder was more frequently affected than the left one.
Method: 10 patients who were suffering with frozen shoulder were randomly assigned to the study. Arm abduction using a digital inclinometer called the Microfet 3 was used to measure arm abduction before and immediately after the procedure. A case study was also performed on one of the participants to determine patient’s feedback on the treatment. Results showed that there was a remarkable recovery in shoulder abduction in the first treatment. The study concluded that the MCD Procedure represents an excellent alternative for frozen shoulder patients not wishing to undergo painful prolonged lengthy treatment programs or higher risk procedures such as surgery or manipulation under general anesthesia.
Frozen Shoulder (FS) is a term used to describe what is otherwise referred to as adhesive capsulitis. The condition is commonly called frozen shoulder because of its trademark loss of movement ability (Yang et al 2007) being analogous to anything which is completely frozen. It is a terribly painful, debilitating condition displaying very significant restriction (both passive and active) of shoulder motion in an individual whose radiographs are typically normal. Persons having this affliction are usually not able to abduct or flex their affected arm up more than 20-90 degrees (Fayad et al 2007) and are often unable to place their hand behind their back due to accompanying restriction of humeral rotation. Basically there are no movements of the shoulder which are totally free and without pain. Movements such as putting on a jacket or bra are often impossible. Frozen shoulder may also be referred to as pericapsulitis and, although not well known by the public, occurs in up to 5% of the general population. (Wies 2004) It is more common in women (60%) (Wong, Tan 2010) and 5 times more common in the diabetic population. (Dias, Cutts, Massoud 2005) The exact cause for this condition is unknown but is sometimes associated with previous injury to the shoulder. Some medical researchers contend the condition results from synovial inflammation with subsequent reactive capsular fibrosis. This condition often lasts for up to 3 years or more (Wang et al. 2006) and, in some cases, even for the life of the patient. (Shaffer et al., 1992) Major factors associated with this condition are age (40-60 age group), diabetes (20 % are affected) (Pal et al 1986), prior shoulder surgery, Parkinson’s disease, multiple sclerosis and mental stress disorders.
Normally, the shoulder ball and socket joint allows more motion with more directions than any other joint in the body. In a frozen shoulder the capsule surrounding the joint contracts while the patient forms bands of adhesive scar tissue which drastically inhibits motion. In addition, one or more bursas may also stick together causing loss of ability to move the shoulder. (This seems to frequently occur with the subscapular bursa.) Contraction of the capsule with formation of the adhesions causes the shoulder to become remarkably stiff and cause movement beyond a certain degrees to become excruciatingly painful. The appearance is analogous to that of a hinge if one were to “freeze” it. The typical symptoms of FS is dull aching shoulder pain, severely limited shoulder movement, feeling incredible pain if it is moved beyond a certain point, difficulty with normal arm activities and feeling pain when sleeping on that shoulder. (Lorbach et al 2010) Although patients with frozen shoulder describe chronic pain symptoms, the primarily complaint is actually that of the severe debilitating stiffness The loss of range of motion causes various degrees of significantly impaired function, including limited reaching (overhead, across the chest, etc) and limited rotation (unable to scratch the back, put on a coat, etc). The three stages of frozen shoulder are the freezing stage (most pain, restrictive movement), the frozen stage, and the thawing stage (partial movement).
On physical examination, patients with a frozen shoulder will have at least a 50 percent reduction in both active and passive range of motion compared with the unaffected shoulder (Anderson, 2008). A digital inclinometer is recommended for accurate measurement of motion ranges. Range of motion is estimated as follows: 1) the Apley scratch test is used to assess rotation of the shoulder joint; patients with normal glenohumeral motion should be able to scratch the midback at the T8 to T10 level; patients with frozen shoulder are often not even able to scratch even their lower back; 2) the NFL touchdown sign is an active maneuver used to assess range of motion of the shoulder joint and the strength of abduction; patients with a frozen shoulder are unable to fully lift their arm straight overhead with most unable to abduct beyond 90 degrees; 3) passive movement of the arm in abduction and external rotation also is significantly reduced; the normal glenohumeral joint rotates externally to 90 degrees and abducts to 90 degrees.
The actual etiology of frozen shoulder is still unknown. Of note, however, is the first authors hypothesis that most frozen shoulders (and many cases of tendonitis) have a predisposing related cervical disc lesion etiology. In over 30 years of practice with clinical observations of thousands of shoulder syndromes, the MCD Procedure developer has observed that the vast majority of frozen shoulder cases have associated spinal lesions on the same side of the shoulder condition mostly at the level of C5-6. In this observation, it is considered more likely that the etiology of many shoulder condition are more likely to be cervicogenic rather than vice versa. It would stand to reason that, under the circumstance of being neurologically inhibited or impaired, the muscles of the shoulder would become damaged if put under a load which they would otherwise normally be able to accommodate. Overloading muscles is likely to happen when excessive force is put on normal tissues but also in cases when either normal or abnormal load is put on neurologically inhibited or otherwise damaged tissues.
The MCD (Manual Capsular Dissection) Procedure was performed on the study group by using non-incisive dissection of scar tissue in shoulder joints and bursas. The MCD Procedure involves a multimodal methodology with the patient awake and interactively participating during the procedure to facilitate outcome. With manipulation under anesthesia (MUA), the patient is completely flaccid and helpless. With the MCD Procedure, the patient is actually contracting specific muscles heavily during the manipulative dissection procedure. Follow up rehabilitative therapy and Dr. Oolo-Austin’s neuro-muscular retraining treatments are provided in stages over the period of 1 week to 6 weeks depending on the severity of the FS and the distance traveled by the patient for treatment. No surgical dissection instruments are used and no actual cutting or incisions of tissue is performed requiring sutures. The protocols of the MCD Procedure, in its entirety, last no more than 30 minutes with each actual dissection usually taking place in a matter seconds. The MCD Procedure is normally only required to be performed once during the course of the frozen shoulder treatment.
Prior to the procedure, patients are given local anesthetic injections in the common anterior and posterior shoulder joint injection sites. Unless contra-indicated, a corticosteroid is also injected simultaneously to prevent post-procedural inflammation. Medicine is also provided at the patient’s request or prescribed by the injecting physician if they are deemed to have pre-procedure anxiety. In the initial stages of its development, the procedure was actually performed without the aid of injectable medication with usually quite good results. In providing medication assistance, however, pain perception during the procedure was obviously found to be significantly reduced for the patient. Using local anesthetic then also usually makes the procedure easier to administer for the performing practitioner with more patient compliance and less resistance. (Although the shoulder is now frequently anesthetized during the procedure, patients do still experience some pain briefly during the actual procedure.)
The procedure requires 2 practitioners or therapists to perform with one attending to the scapulae and the other to the shoulder joint itself. A third person acting as an additional assistant is also recommended. The MCD Procedure is considered to be a better choice than performing manipulation under general anesthesia as it is performed with the patient fully conscious and interactively participating in the procedure to ensure than no iatrogenic damage occurs to the joint the bones or the surrounding tissues. In addition, the patient is able to immediately begin active range of movement exercises designed to create immediate sensorimotor retraining. Immediately following the procedure, patients are taken off of the treatment table and put through a series of MCD Procedure recovery exercises which involve movement in the full ranges of arm abduction and rotation to which they are newly capable. They are then sent home with a series of specific PNF exercises they are required to do hourly for 3 days prior to follow-up attendance for rehabilitative physiotherapy.
Other treatments for frozen shoulder include conventional physiotherapy, manual medicine, cortisone injections and surgery. Normally treatment requires a multitude of approaches and takes 9-18 months of often painful therapy to observe any difference if the patient is responsive unless spontaneous recovery occurs. (Dodenhoff et al 2000) In some cases, over exuberant practitioners have actually caused a worsening of the patients symptoms.
Early stages of Frozen Shoulder are often treated with physical therapy, exercises and home therapy. Various other forms of treatment have been employed, over the years, consisting of oral or injectable analgesics (pain killers), NSAID anti-inflammatory, steroid injections, physiotherapy and various forms of manual medicine including chiropractic and osteopathy. For refractory intractable cases, more aggressive treatment involves manipulation of the shoulder joint under anesthesia (Dias, et al., 2005) or an arthroscopic surgical capsular release (Griffen, 2003) or arthroscopic hydrodilation (Quraishi et al 2007). Doctors have tried using multiple shoulder manipulation techniques including manipulation with steroid injection, use of systemic steroids, manipulation following saline injection, manipulation under regional anesthesia and manipulation under general anesthesia (MUA). Although MUA is effective in terms of joint mobilization, it has been shown that iatrogenic intra-articular damage can result. (Loew, Heichel, Lehner 2005). When MUA is performed, it is with the intention of breaking up and mechanically dissecting or literally ripping open the adhesions surrounding the joint capsule to increase shoulder movement. While anesthetized, the patient is unconscious or under conscious sedation and in state of total muscular flaccidity. They are, therefore unable to provide any feedback or resist any forceful movements imposed upon their adhesed frozen shoulder joint. The practitioner also has little concept of where the physiological end range of shoulder joint movement exists with that patient.
According to Gill and Hawkins (2006) possible complications of surgical techniques include axillary neuropraxia, diffuse brachial plexopathy, operative instability, mild anterior instability with apprehension on full abduction and external rotation and diffuse swelling. Neurovascular damage is also reported by Zanotti, Kuhn (1997) as well as intra-articular lesions within the glenohumeral joint (Speed, 2006).
In addition to the above possible complications which can occur, there are also other basic complications of using general anesthetic for any surgery or manipulative procedure: Although uncommon, possible complications of GA are as follows:
Death (1/151,000 – 1/244,000), Hypothermia, Damage to mouth or pharynx including damage to teeth and artificial crowns during intubation, Hypoxemia, Hypercapnia and hypocapnia, Hypoventilation, Aspiration pneumonia, Perioperative neuropathy, Minor idiosyncratic/allergic reaction to agents, producing nausea and vomiting, Major idiosyncratic/all gic reaction to agents incites cardiovascular collapse, respiratory depression or obstruction and jaundice, Lung infections, Stoke, Heart Attack, Slow recovery from anesthetic due to poor cardiac, hepatic or renal function, drug interactions, incorrect drug or dosage, Hypotension, Hypertension, Arrhythmias, Malignant hyperpyrexia caused by anesthetic gas or suxamethonium, Prolonged apnea (non-breathing state) after succinylcholine caused by pseudocholinesterase deficiency (rare), Memory dysfunction. With some patients following general anesthesia, information is retained in the memory, but not accompanied by conscious recall of events, Awareness during surgery can occur when the patient is paralyzed but without effective anesthetic. (This means that the patient is literally tortured as the patient actually feels the pain of the cutting in the operation but is completely unable to respond.), Postoperative psychic trauma e.g. insomnia, depression, sleep disturbances, dreams, anxiety and fear of death which may persist for months or years, Malignant Hyperthermia (possibly fatal).
* It should be noted that cases of malignant hyperthermia (MH) which are very serious and known to be fatal, are normally brought on specifically by agents used in general anesthetics. General anesthetic drugs that have triggered MH include isoflurane, desflurane, enflurane, sevoflurane, methoxyflurane, cycl-propane halothane, and succinylcholine. MH, however, is not associated with drugs used for local or regional anesthesia.
The authors acknowledge that risks such as fractures or dislocations could exist with this procedure in certain circumstances. The MCD Procedure is designed specifically to prevent such occurrences but if performed improperly or without proper work-up and risks assessment for contra-indications or possibly with sudden uncontrolled movements by the patient during the procedure, injuries could conceivably result. The actual procedure itself is, therefore, not delineated in this article to mitigate liability from readers attempting to perform the MCD Procedure without proper qualifications or training. A randomized controlled study also still needs to be done with a much larger number of subjects to accurately ascertain success and risk factors.
To determine the potential effectiveness of the MCD Procedure on Frozen Shoulder.
Each frozen shoulder case presented themselves to the treatment facility having been previously diagnosed with frozen shoulder by a medical physician.
Case 1 – Patient was a 55 year old female referred to in the herein contained case study.
Case 2 – Patient was a diabetic female who had suffered with her frozen shoulder for 2 years. She had attended for 1 year of physiotherapy treatment with no results at all.
Case 3 – Patient was a diabetic male who had dislocated his shoulder previous to the freezing. It had been frozen for 4 months.
Case 4 – Patient had the condition for 9 months prior with no results from therapy
Case 5 – Patient had frozen shoulder for 3 years and had also had previous surgery for frozen shoulder 1 year prior with some results from physiotherapy but not complete as the shoulder was still not moving beyond
Case 6 – patient had the frozen shoulder for 4 years with no results from any forms of therapy
50 degrees abduction
Case 7 – Idiopathic patient who had had the condition for 6 months with physiotherapy not able to achieve results.
Case 8 – Idiopathic patient who had had the condition for 13 months with physiotherapy not able to achieve results.
Case 9 – Idiopathic with the condition existing for 26 months. No results with extensive physiotherapy and chiropractic treatments.
Case 10 – had a prior dislocation before onset of frozen shoulder
According to Aetna Clinical Policy Bulletin: no 0204 regarding Manipulation Under Anesthesia: MUA is considered medically necessary for chronic, refractory frozen shoulder (adhesive capsulitis) that meets the following criteria:
1. Adhesive capsulitis should be documented by restricted active and passive glenohumeral and scapulothoracic motion for at least 1-month duration which has either reached a plateau or worsened; and
2. Significant reduction in range of motion (at least a 50 percent reduction in both active and passive range of motion compared with the unaffected shoulder); and
3. Causing various degrees of impaired function, including limited reaching (e.g., overhead, across the chest) and limited rotation (eg, unable to scratch the back, difficulty putting on a coat); and
4. Persons have undergone at least 1 month of conservative management, and have failed to improve
Although only local anesthesia was used, this study was conducted in such a way that all 10 patient subjects fell within these guidelines.
Although most patients are referred by their physician and have already been diagnosed with frozen shoulder, the patients are still initially assessed with a physical examination wherein ranges passive assisted abduction ROM is measured digitally using Microfet III digital inclinometer. All subsequent measurements are also carried out using this device for accuracy. For the purposes of this article, we have only referred to the abduction component although all ranges of motion are treated during the procedure. Radiographs and/or MRIs are reviewed and a decision to go ahead with the procedure is made if there appear to be no contraindications. The procedure requires either 2 doctors or a doctor and an assistant.
The patients shoulder joint is injected from the anterior and posterior capsule with corticosteroids and local anesthetics. If they are particularly anxious, they are also provided with an oral benzodiazepine sedative prior to the procedure.
Once the anesthetic has taken effect, the procedure is conducted. Even with the anesthetic, the patient does briefly experience some pain during the procedure but this is of very short duration. (The procedure has also been carried out quite successfully without anesthetic in those patients who express a desire not to have the injection but the level of pain associated with the procedure in these cases is higher.) Quite audible cavitation releasing sounds will normally emanate from the involved shoulder as adhesions are dissected and separate during the procedure and the shoulder is abducted beyond its frozen ROM. Once the shoulder is up to or near its normal abduction range of motion (180 degrees) and the upper arm is held firmly up to the side of the head, the patient will usually understand that the treatment has been a success. Some, however, will not be able to fully comprehend that they are able to put their arm in a position which, in most cases, has been impossible and unexplored for months or years. A mental adjustment is often required. Most patients will experience a degree of shakiness immediately following the procedure as the mechanical separating dissection of the capsular adhesions comes as somewhat of a shock to their system. This post-procedure response is quite temporary and does not usually last more than a few hours. Immediately following the MCD Procedure, when the patient has adjusted to the new ROM, the patient is given proprioceptive neuromuscular facilitation (PNF) exercises which they need to do hourly during waking hours for a period of 3 days following the procedure.
Table 1: Measuring Passive/assisted Shoulder abduction before and after MCD Procedure following up with rehabilitation and physiotherapy.
|Patient Number||Before Treatment||After 1st Treatment||After 2nd treatment||After 3rd Treatment|
The above charts show total arm abduction range before and after the MCD Procedure.
A total of 10 subjects were studied. The average age of study subjects were 40 years. All subjects were medically diagnosed and confirmed to have adhesive capsulitis and had received physiotherapy prior to presentation with little or no results. Patients were screened with radiographs and/or MRI to confirm the absence of pathologies or contra-indications such as osteoporosis and degenerative joint arthritis. (Partial thickness rotator cuff tendon tears do not contraindicate performing the procedure.) There were 6 females and 4 males. The experimental group had average maximum of 51 degrees of abduction in the affected shoulder prior to the MCD Procedure. Following the procedure subjects retained an average of 177 degrees of shoulder abduction 2 days later.
A case study was performed on a 55 year old female (Case 1) who presented with a frozen shoulder. Her presenting symptoms were that of severely restricted shoulder motion, severe pain with certain movements and debilitating stiffness. Mrs. Smith stated that her shoulder pain and loss of motion varied in intensity and range, and was present for over 4 months. After examining the patient it was found that active and passive flexion, extension, abduction, adduction, internal rotation and external rotation were all restricted. She clearly fell within the guidelines for confirming the diagnosis of frozen shoulder as denoted in this article. The MCD Procedure was applied after which the patient’s abduction immediately improved to 180 degrees with ROM in all other directions also immediately showing significant improvement. There was still some pain at end ranges with a hard end feel; however there was a remarkable improvement from the initial assessment.
Follow-up neuro-muscular myoneural facilitated exercises also complimented and retained the increases in her ranges of motion. Dr. Oolo-Austin’s neuro-muscular assessment and treatment system is a multimodal manual treatment methodology which utilizes the concepts of neurosummation to stimulate increased sensorimotor activity and motor unit recruitment. It is consistent with the principles of neuroplaticity and enhanced corticoneural re-organization of sensorimotor and somatosensory systems and is deemed to be a treatment of choice for many neuromusculoskeletal rehabilitation practitioners.
During her interview, the patient referred to in the case study herein stated that she was very happy with the outcome of the procedure. This is the common reaction with patients often returning the following day ecstatic that they have regained their arm movement and their quality of life. Informed patients and therapists are aware that frozen shoulder has a natural history of about 10 to 18 months with or without treatment and that some cases never resolve completely. Most patients attending for the MCD Procedure, have also tried many other treatments and therapies with little or no discernable results. Like many others, Ms Smith stated that she had initially not been fully convinced the procedure would make any difference however she was shocked when she was able to fully abduct her shoulder immediately post-MCD.
Frozen shoulder is a surprisingly common condition, especially after the age of 40. The treatment for frozen shoulder has not been clear and can often have many negative side effects. With application of the MCD, all of the patients in this study experienced a dramatic full or near-complete return of normal shoulder movement. Shoulder abduction was measured before and after the MCD Procedure with measurements taken using the Microfet Digital Inclinometer. Movement of upper body and scapula during measurement was minimized by applying downward pressure on the acromion. Shoulder abduction angle was measured before and after the MCD Procedure. As can be observed in the graphs, there was dramatic and sudden improvement of shoulder abduction in every case, immediately following the MCD Procedure.
To date, there have been no treatments available which can easily and quickly restore shoulder ROM. Most of the literature indicates that even with treatment, resolution of this condition will not occur prior to its usual course of 18 months. (Rizk et al 1991). The results of this pilot study for treating frozen shoulder with Dr. Oolo-Austin’s MCD Procedure show great promise in enabling patients afflicted with this painful and debilitating disorder to achieve an unprolonged, quick recovery.
Dr. Oolo-Austin’s neuro-muscular assessment and treatment system using multimodal neurosummation has been clinically noted to improve the way patients with musculoskeletal disorders and pain syndromes respond to treatment. Historically, it was the first in history to introduce the concept of simultaneously combining stimulative soft tissue therapy with resisted exercise. Considered by some to be a leading innovation in the field of functional muscle neurology. The therapeutic effects of Dr. Oolo-Austin’s treatment methods are often reported by those using it to be clinically superlative.
The MCD Procedure combines Dr. Oolo-Austin’s multimodal neurosummatiion methodology with simultaneous shoulder joint mobilization. This statistically significant treatment combination has proven effective in a good number of cases and is brought forward for consideration as an improved methodology for treating frozen shoulder. Prior to the MCD Procedure, there had not been any other treatment documented which could re-mobilize a frozen shoulder in one procedure other than MUA or surgery. In light of the very positive findings of this study, it is recommended that further studies be conducted with larger test groups for corroborative verification.
Although over 300 million people worldwide suffer with this condition, frozen shoulder (adhesive capsulitis) still seems to be a relatively new condition in the medical world. The percentage of people suffering with this terrible affliction also seems to be growing yearly although the reason for this is still unclear. There are many different opinions on which treatment option is the best route to take.
Physical therapists may recommend lengthy rehabilitation programs while athletic therapists and shoulder specialists suggest surgery followed by a muscle-building program to strengthen the shoulder muscles.
None of these approaches enables a quick recovery and it is doubtful that they actually speed up the process much at all. Research indicates that some aggressive physical therapy approaches have been known to aggravate or make the frozen shoulder condition worse with the laying down of more reactive and debilitating scar tissue
Dr. Oolo-Austin’s MCD (Manual Capsular Dissection) Procedure is a revolutionary alternative that has proven to be extremely effective. A Russian medical study was published in 2012 in the Russian Journal of Manual Therapy and a medical peer reviewed study is expected to be released in Canada soon with presentations to physiotherapists and orthopedic surgeons commencing thereafter.
Below is a list of options and expected outcomes so that you can be better informed to decide on your frozen shoulder treatment options.
Though this treatment doesn’t eliminate the root cause of your Frozen Shoulder symptoms, Hydro-Cortisone steroid injections can be administered to provide patients with some temporary pain relief and a very small temporary improvement in range of motion. The challenge is that the effects usually only last 1 or 2 weeks and then the shoulder returns to the same or sometimes even worse state than before the injection. Cortisone is a powerful steroid which targets and temporarily decreases the amount of inflammation in the affected shoulder joint. Inflammation causes tightening and stiffening of an affected joint and pressure from inflammation causes pain. Decreasing the amount of inflammation in the frozen shoulder joint with the steroid injection will sometimes have the almost immediate effect of slightly increasing mobility and somewhat diminishing pain.
The problem is that the inflammation and pain is there for a reason, which is to provide a medium for healing and to protect the joint from further injury. When the inflammation is suddenly unnaturally reduced and the pain lessened with the steroid injection into the joint, patients will tend to use the shoulder more and can often cause more damage because the cause of the frozen shoulder has not been actually treated. Interestingly, cortisone steroid injections have been reported to actually cause an adhesive capsulitis frozen shoulder to develop when it is used to treat a simple impingement or rotator cuff tendonitis.
What’s more is that cortisone is a heavy steroid which actually breaks down and emulsifies the muscle tendons and ligaments. This makes anyone injected with cortisone more susceptible to serious injury of the rotator cuff and tearing of the shoulder tendons. It is for this reason that so many professional and elite athletes who have had cortisone injections later end up partially or completely tearing and severely damaging tendons in their bodies. The steroid drug cortisone also has very many undesirable side-effects that are common with any heavy steroid, all of which can be looked up on the internet under side effects of hydrocortisone.
In light of these facts, The American Medical Association has actually recommended that physicians do not inject any area of the body more than twice in a lifetime with cortisone. In certain cases depending on the patient case history, in the pre-op period just prior to the MCD Procedure being performed, a very small amount of cortisone will sometimes be locally injected into the shoulder capsule in addition to the anesthetic lidocaine. This is because, certain cases may be at greater risk of having an increased inflammatory response over the course of a few days following the MCD Procedure being performed. In these cases, cortisone can be helpful to prevent an inflammatory over-reaction post-op. Patients who have already had 2 steroid injections into the affected shoulder will not, however, receive any cortisone prior to the MCD Procedure.
Because of the reasons above, we do not recommend having cortisone injections in an attempt to cure a frozen shoulder. It will never cure it and it could end up making it worse.
Frozen shoulder surgery, called arthroscopic capsular release, is the among the few frozen shoulder treatment options that has a chance of actually working. In this process an arthroscope cuts through the skin and is inserted into the joint. Using this instrument the offensive adhesions are cut apart around and inside the capsule. If surgery is performed, immediate physical therapy for 2 months following the shoulder surgery is of utmost importance. If rehab does not begin soon after capsular release, the chance of the Frozen Shoulder returning is quite high.
Many people will try to avoid surgery whenever possible and for good reason. Surgery should always be your last option when all else has failed. There is a surgical procedure which cuts open the shoulder that has been shown to sometimes work in restoring range of motion to a frozen shoulder but, according to statistics, the results are about 50/50. The problem with surgery is twofold. Firstly, if the surgery does actually work, there will have been so much cut inside the shoulder capsule that the patient will have to attend for intensive physiotherapy rehabilitation for 6-8 weeks following the surgery to regain proper shoulder movement. The second problem is more serious in that surgery has also been shown in some cases to make the shoulder lay down more scar tissue which actually then worsens the frozen shoulder! No one with frozen shoulder wants this so think twice and think very carefully what your other, more conservative options are, before you consider going under the knife. In addition, the risks of using a general anesthetic are also significant and should not be taken lightly.
Alternately, a surgeon or qualified and specially licensed manual medicine specialist such as a Chiropractic or Osteopathic physician may also perform a manipulation under anesthesia. This is called MUA. These heavy and quite drastic manipulations are performed with the patient sedated in the operating room on the table under general anesthesia. The attending doctor suddenly forces the shoulder into end range positions to literally break and tear up adhesions caused by Frozen Shoulder. The problem with MUA is that the performing doctors also often break up the shoulder capsule–causing serious damage to the shoulder.
There is no actual surgery involved, meaning incisions are not made when a manipulation is performed. However this procedure is very forceful and is performed without any conscious input from the patient. As a result, research studies and statistics on MUA prove that many patients undergoing this procedure end up with permanent damage to the shoulder capsule and soft tissues of the shoulder joint. Damage to the nerves and breaking of the bones as well as shoulder dislocations have also been reported to occur with some frequency using MUA. It is for these reasons that MUA has largely fallen out of favor amongst health professionals as a treatment for frozen shoulder. Of the frozen shoulder treatment options, we strongly advise against MUA!
Diligent physical therapy is often essential for recovery of many conditions but not for adhesive capsulitis frozen shoulder. There is no evidence that physiotherapy helps frozen shoulder at all. Physical therapy targeting frozen shoulder adhesive capsulitis will take months to years of treatment for recovery, depending on the severity of the scarring of the tissues around the shoulder. Over aggressive physical therapy has also been shown to significantly worsen the frozen shoulder as the body responds to additional trauma by over-reacting and laying down more scar tissue around the shoulder capsule. All forms of physical therapy for adhesive capsulitis frozen shoulder are basically useless, can often be torturous and have sometimes been known to significantly worsen the condition. Frozen shoulder sufferers have notoriously spent thousands of dollars and countless hours attending for treatments over months and years which do nothing to help and sometimes worsen the condition. We believe you will find yourself wasting your time and money attending for physical therapy sessions to alleviate your adhesive capsulitis frozen shoulder. Before you attend for physical therapy, be sure to ask the physiotherapist if they have ever had much success with frozen shoulder. The only cases, they may site as being successful, would most likely have improved of their own accord during the timeframe of treatment.
It is very important for people with a frozen shoulder to avoid aggravating the shoulder tissues during the rehabilitation period. These individuals should avoid sudden, jerking motions or heavy lifting with the affected shoulder.
Almost all cases where the MCD Procedure was successfully conducted had first tried physiotherapy with no success.
The Neil Asher Technique is a gradual multiple-treatment osteopathic method of treating frozen shoulder. Although their web site posts a study which they did to prove that this technique is more effective than physiotherapy, the form of physiotherapy they used for comparison is, itself, notoriously ineffective for frozen shoulder. Either way, the technique is basically a soft tissue pressure technique which still requires many months of therapy for those in which it is reported to help. On the other hand, there are certainly patients who have come to our clinic for the MCD Procedure and said that the NAT had not worked at all. This being said, the Neil-Asher Technique is quite passive with no apparent risks for further damage and as such, if you feel you have the time and the money to try it out, we do not recommend against it. It’s better to go the conservative route first than to subject yourself to potential serious damage from treatments like surgery or MUA.
A significant number of cases where the MCD Procedure was successfully done had first tried NAT with no success.
Many practitioners advertise that they can treat adhesive capsulitis frozen shoulder using a muscle stripping soft tissue technique called “active release technique” aka ART. Although this technique is designed for and has good results with conditions caused by tissues that have adhesions which have developed in the fascia between the muscles, it is not a technique which is effective in being able to separate the much heavier and thick adhesions which encapsulate the shoulder joint itself in cases of adhesive capsulitis. The myofascial adhesions treated with ART are completely different and in different anatomical locations, being found between the muscles than the adhesions which surround the shoulder joint with frozen shoulder. A great number of cases presented to our World Frozen Shoulder Clinics have had unsuccessful ART treatments. Cases of reported improvement with ART still take many months or years to recover fully. These cases and others which still take a long time for recovery following treatments like ART or NAT, cause one to question whether or not the patient’s frozen shoulder would have recovered anyway without these treatments. Although there are numerous cases of frozen shoulder which can last for 5, 10 or more years, many cases of adhesive capsulitis will also mysteriously resolve themselves with no treatment at all within 2-3 years. But again, the problem with waiting so long is that 15% of the population never recover full mobility after natural resolution of adhesive capsulitis frozen shoulder. As such, one must always consider at which point in the lifeline of the shoulder condition was the therapy applied to be able to judge whether it was the therapy or the natural course of evolving resolution.
A large number of cases where the MCD Procedure was successfully performed first tried ART with no success.
A number of adhesive capsulitis frozen shoulder patients, where the MCD Procedure was successfully performed by Dr. Oolo-Austin, have said that they had first tried a chiropractic technique called “OTZ”, to treat their frozen shoulder with no success. Investigation revealed that the OTZ technique is a new chiropractic method of treating what OTZ practitioners advertise to the public as, “frozen shoulder syndrome.” These practitioners claim to be able to cure frozen shoulder by manipulating or adjusting the occiput (skull) and upper neck vertebrae (bones). This claim, however, is seen by most medical professionals as absolutely impossible with reference to the Adensive Capsulitis type of Frozen Shoulder as the heavy scar tissue and adhesions which surround the capsule of the shoulder cannot possibly be separated with a chiropractic adjustment of the neck vertebrae. To support the claims of OTZ practitioners, there are a number of YouTube videos showing apparent before and after videos and a number of patient testimonials on their web site. These patients in these videos are obviously real. The confusion, however, lies in the fact that the condition the OTZ practitioners refer to as “frozen shoulder” is actually not adhesive capsulitis frozen shoulder. The condition they post on their video and website appears to be classic shoulder impingement syndrome which, in some ways partially mimics adhesive capsulitis frozen shoulder in the way that side raising of the arm is restricted. What is apparently occurring with OTZ technique is a misinterpretation of the term frozen shoulder. (To their credit, in the courses they teach to chiropractors, they refer to the kind they treat as “type 1” frozen shoulder with “type 2” being the adhesive capsulitis variety.) The theory proposed by the OTZ camp with respect to the “true cause” of type 1 frozen shoulder, which is also medically termed “shoulder impingement syndrome”, is seen by Dr. Oolo-Austin as having some credibility. All this being said, although the OTZ chiropractic technique cannot be successful in treating adhesive capsulitis frozen shoulder, Dr. Oolo-Austin’s experience of OTZ practitioners is quite positive and he is of the opinion that the chiropractic manipulation, which OTZ practitioners perform for the occiput, is quite advanced.
Shoulder Impingement Syndrome can have many causative components including compression of the upper neck nerves (spinal accessory nerve) causing contraction of the upper trapezius muscle and restriction of shoulder bones and joint movement. Other factors include inflammation of the shoulder bursa (pads under the bones) at the top of the shoulder (bursitis) and rotator cuff muscle tendon inflammation (tendonitis).
Hydrodilatation is a new invasive medical method sometimes used in an attempt to cure frozen shoulder. With this procedure, the shoulder joint is injected with a lot of fluid until it is literally “blown up” from the inside out so as to tear up the shoulder joint adhesions using excessive pressure from within the joint capsule. The intended effect is to cause the offensive scar tissues and adhesions surrounding the joint capsule to explode and break open. A number of studies have shown some improved movement and pain reduction but there are no good published studies in the medical literature to confirm even these quite modest results. Medical studies do cite that this method has not been shown to be any more effective than cortisone injections (see above). An interesting point is that many subjects chosen for hydrodilatation studies have not been able to be used for the study because they have pleaded that the procedure be stopped due to severe excruciating pain from the procedure as more and more fluid is injected into the joint in an attempt to cause it to burst and rip apart. From a risk factor and complications perspective, damage to the shoulder joint capsule has been reported as have shoulder joint infections and premature shoulder joint arthritis . As the verdict is still really out on hydrodilatation, we do not, as of yet recommend this method.
A number of cases where the MCD Procedure was successfully conducted first tried hydrodilatation with no success.
For the record, Adhesive Capsulitis Frozen Shoulder cannot be cured by any method that does not create physical separation of the internal adhesive scar tissue surrounding the shoulder joint. Treatments designed to strip out fascial scar tissue between muscles such as active release technique (ART) or Myofascial Release do not address the shoulder capsule adhesions which is the cause of the condition and they are, therefore, never effective in providing an immediate resolution Standard treatment by massage therapists, physiotherapists, chiropractors and osteopaths will also not provide resolution from this terrible affliction.
In our opinion, physiotherapy, aggressive massage and chiropractic manual treatments are actually contraindicated and should not be conducted on cases of adhesive capsulitis frozen shoulder as research and clinical evidence shows that these kinds of physical therapy can often cause more inflammation and adhesion with a resultant prolongation of the condition. There have been many patients of Dr. Oolo-Austin’s who had suffered from adhesive capsulitis for 3-20 years. In all these cases, the patient had been told that the condition would finally resolve after 1-3 years and they had all been going for multiple painful physical therapy sessions which reportedly aggravated their condition. These are the cases not listed in medical literature.
Dr. Oolo-Austin’s groundbreaking MCD Procedure has been incredibly successful and is the first of its kind in the world.
The MCD Procedure is performed with the patient relatively conscious and interactively participating to ensure that no damage occurs to the joint or surrounding tissues. And because every person’s symptoms are unique, we’ve made sure that our MCD medical procedure truly takes this fact into account.
Call us for a free consultation so we can discuss your situation, provide medical advice, and answer your questions. With any luck, you’ll be on your way to one of our many offices around the world in short order, and finally, find the relief you deserve!