zinc

Early on, I asked both my doctor and my physical therapist if there was anything I could do nutritionally to improve my condition. It's unfortunate, but still very typical, that medical professionals appear to know next to nothing about nutrition. In any case, nobody had a suggestion.

I went snooping around the internet to see if I could find anything. Nutritional supplements are one of those things that snake oil salesmen like to latch onto, and searching the internet turns up a ton of dubious claims.

As for the science, you can find suggestive, but not definitive, research that zinc is important to production of collagen. In rats, anyway.

A few years ago, I kept tabs on my diet. At the time, I appeared to be deficient in zinc. However, I hadn't noticed any issues caused by it, and I've always been reluctant to take supplements without reason, so I didn't do anything to correct the situation.

Is it possible that my zinc deficiency led to frozen shoulder? I suppose so, although I guess there's no way to know for sure. In any case, I decided to start taking a zinc supplement soon after I started physical therapy.

I'm taking chelated zinc (50 mg of zinc amino acid chelate, 333% of the RDA) since it's supposed to be one of the more bioavailable forms of zinc. In addition, since zinc interferes with copper absorption, I'm taking a copper supplement (2 mg of copper gluconate, 100% of the RDA). I take the zinc mid-morning on an empty stomach, since that's supposed to be better for absorption. That typically gives it a couple of hours to float around without a lot of competition. I take the copper later in the day, but not on an empty stomach, since I haven't read anything that indicates that would be useful.

Recall that I had noticed an article about shoulder pain in Nigerians at PubMed. When I first thought about zinc being a possible factor in frozen shoulder, I immediately wondered whether the Nigerian diet might be deficient in zinc, leading to more cases of frozen shoulder in that area of the world. However, it doesn't appear to be the case. Some research by Onianwa, et al, says that "the estimated weighted average dietary intakes for the entire adult population [of Nigeria] were calculated to be 2.64 mg Cu/day and 15.8 mg Zn/day" which is quite near the US RDA for those minerals. So, there are no helpful clues from that research.

stretching the coracohumeral ligament

This afternoon, I finished reading the article Positional Stretching of the Coracohumeral Ligament on a Patient with Adhesive Capsulitis: A Case Report, by Jose Orlando Ruiz. It sounded interesting and simple enough, so I decided to try it. The article can be summed up with one quote:

The primary purpose of this single-patient case report is to describe outcomes of a positional stretching technique following the anatomical orientation of the two bands of the CHL and rotator interval capsule in a patient with [adhesive capsulitis].

Of course, the case study was done on one person, so in some sense it's meaningless. On the other hand, I doubt it could hurt. In fact, my physical therapist has encouraged me to do general stretching exercises, even allowing weight-lifting, as long as I avoid painful movements (although in point of fact, the physical therapy exercises that were prescribed to me always cause the largest degree of pain). I've already been doing an exercise which is very similar to the one described, only I didn't go so far as to bring my affected arm behind my back for additional stretching.

The article describes pretty clearly the stretching exercise, and also shows a photo of the action (Fig 2). I didn't want to lie down, so I tried to emulate this position while standing. I brought my left arm behind my back as shown in the figure, and used my right arm to help keep it pinned back, meanwhile extending my chest out and focusing on bringing my scapula together in the back. I could feel a decent stretch in the front of the shoulder, and only a very minor amount of pain.

Actually, there's a bodybuilding pose called the side triceps which is quite similar to this move. However, in my case, I kept my hand supinated as described in the article and shown in the figure.

In addition, the article says the stretch is done with ice applied ("cryotherapy"), but I did not try that. The idea is that the cold helps to "contract the tissues in the new lengthened position". Hm, I don't know about that, but I might try that later, if the stretching alone seems to help.

At the moment, though, I'm wondering if this didn't cause me some excess pain later in the evening.

I should probably mention that I'm not a doctor and should you try this yourself, don't blame me if something goes wrong! I encourage you to consult your own physical therapist or doctor before trying it.

articles

I had asked my physical therapist for resources or articles to gain more insight into my condition. Yesterday, he gave me a couple of sites where I could look into frozen shoulder further. He pointed me to the article on adhesive capsulitis at the Professional Baseball Athletic Trainers Society. The article is okay, but it's mostly a rehash of the same information that I've found elsewhere online. There's quite a lot of discussion about surgical treatments, if you're into that kind of thing. The illustrations for the site are the best thing about it, although you wonder how correct they are. My preference is usually to go to wiki for general information like this.

In addition, he had told me to search PubMed for the terms "shoulder adhesive capsulitis". I'd actually already tried PubMed, but the first result I got was about shoulder pain in Nigerians, which didn't sound very relevant, and I had quickly decided to look elsewhere.

In fact, PubMed seems to be a good resource after all. Since he suggested I try it, I returned and immediately struck gold. I found a single case report¹ and a more extensive study².

I'm still in the process of reading the articles, and I'll write about them more if I find anything notable.

1 Positional Stretching of the Coracohumeral Ligament on a Patient with Adhesive Capsulitis: A Case Report, by Jose Orlando Ruiz
2 Comparison of High-Grade and Low-Grade Mobilization Techniques in the Management of Adhesive Capsulitis of the Shoulder: Randomized Controlled Trial, by Henricus M Vermeulen et al.