Last month’s newsletter on keloids and Dupuytren’s contracture provoked an interesting question from Dr. Margaret Taylor of Fullarton, Australia. She raised the question as to whether frozen shoulder could be related to keloids and Dupuytren’s. Orthopaedic surgeons describe inflammation and excess connective tissue in the shoulder capsule, so why not?
My first reaction to this question was to doubt a connection between these conditions because:
- Frozen shoulder has a distinct neurological component, in at least some cases.
- Frozen shoulder is usually self-limiting, resolving spontaneously after a year or two.
Perhaps the greatest story in the neural therapy narrative is Ferdinand Huneke’s discovery of the interference field in 1940. A woman with intractable right shoulder “capsular arthritis”, unresponsive to all treatments, is suddenly cured by injection of procaine into a scar in the left leg. This story, which is told in the Dosch textbook, does not give details of the shoulder condition. (In fact, “frozen shoulder” is an Anglo-American term and the German system of nomenclature of shoulder pathologies is different.) Nevertheless the picture is one of pain and severe restriction of shoulder movement followed by sudden resolution that can only be explained by a change mediated by the nervous system.
Dosch recommends segmental therapy into the skin, muscles and connective tissue of the shoulder region. Stellate ganglion blocks can be helpful. Dosch also advises searching for interference fields in the gall bladder and pancreas, and I have seen one frozen shoulder respond to treatment of a lung interference field. However these clinical observations do not directly answer Dr. Taylor’s question: Are keloids, Dupuytren’s contracture and frozen shoulder related?
I initially suggested to Dr. Taylor that she ask her surgical colleagues to perform a biopsy of the shoulder capsule and look for myofibroblasts—key players in “fibrocontractive” diseases. A little later, when I had time for an internet search I found that this has already been done. In fact, the histological similarity of Dupuytren’s and the capsule of the frozen shoulder was first reported in 1995 (Bunker). What is more, the same cytokine (TGF-b) that is involved in myofibroblast induction is active in both conditions.
A nice up-to-date overview of the clinical aspects of frozen shoulder can be found at http://www.shoulderdoc.co.uk/education/article.asp?article=843. And a fascinating report on the European Fascia Research Project on active contraction of fascia can be found at http://www.fasciaresearch.de/ReportIASIyeaook06.htm. I remember Professor Robert Ward, an expert in myofascial release technique, voicing his suspicion in the mid 1980’s that fascia was capable of active contraction. This intuition has proved to be correct and shown to be directly affected by autonomic nervous system function.
What does this mean for neural therapy? I think this research continues to confirm Speransky’s belief that all pathological processes are under nervous system control, even slowly developing conditions like Dupuytren’s and frozen shoulder. It also confirms the clinical intuition and experience of the neural therapy pioneers such as the Huneke brothers and father and son Dosch.
For detailed advice on treating frozen shoulder by neural therapy, see the Manual of Neural Therapy According to Huneke (first English edition pp. 238 and 239). The recently released new translation (second English edition) has enlarged this section and can be found on pages 191-193.
Which brings me to the latest news for all those interested in reading more about neural therapy: The long-awaited translation of the standard German textbook on neural therapy, Neural Therapy According to Huneke by Dosch has finally been released. Actually it has been available for a few months, but I did not become aware of it until a few weeks ago and I just received my copy from amazon.com.
I will have more to say about the book next month.