Frozen shoulder and ALS

[Smilemaker100]

My mother was recently diagnosed with "frozen shoulder" and has received her first round of cortisone injections. I am a bit concerned because her brother died from ALS about 6 years ago. Is "frozen shoulder" related in any way to ALS?

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[neurologist]

My mother was recently diagnosed with "frozen shoulder" and has received her first round of cortisone injections. I am a bit concerned because her brother died from ALS about 6 years ago. Is "frozen shoulder" related in any way to ALS?

No.

 

[play274]

My mother was recently diagnosed with "frozen shoulder" and has received her first round of cortisone injections. I am a bit concerned because her brother died from ALS about 6 years ago. Is "frozen shoulder" related in any way to ALS?

Without knowing more details and examining your mother, one should not answer your question with a simple "no." As with any disorder and symptom, one should think this out more carefully.

Although it is not likely that she has ALS with symptoms of a frozen shoulder, one cannot rule it out. Symptoms of ALS varies widely. Usually, it starts with weakness and/or - perhaps - cramping of one limb/side and segmental progression; however, I have seen too many different types of presentation and progression of this disease to simply peg it to one pattern.

More recently, epidemiological studies report that ALS is familial in about 5% of cases, and about 20-25% of this "5%" is via SOD1 mutation. Thus, the chances of her having a familial form of ALS is relatively low.

I feel that your worries are understandable. After all, ALS is a grave diagnosis and, from what I have seen, many good neurologists have occasionally missed this diagnosis. *If your mother is worried*, she should see a neurologist who can do a good examination of her and may perform an electrodiagnostic study among other studies. Considering that physicians who specialize in and see more of this disorder have "more practice," it may be preferrable for her to see a neurologist who is associated with an ALSA or MDA clinic.

One should stress that, even though an EMG in early motor neuron disease can be normal, it would not be appropriate for her to live in fear of this disease - for which there is no viable cure at this time (riluzole slows the progression of ALS to a minor degree, and other measures are, thus far, more or less supportive).

Best wishes to yourself and your family.

-274

 

[Smilemaker100]

Without knowing more details and examining your mother, one should not answer your question with a simple "no." As with any disorder and symptom, one should think this out more carefully.

Although it is not likely that she has ALS with symptoms of a frozen shoulder, one cannot rule it out. Symptoms of ALS varies widely. Usually, it starts with weakness and/or - perhaps - cramping of one limb/side and segmental progression; however, I have seen too many different types of presentation and progression of this disease to simply peg it to one pattern.

More recently, epidemiological studies report that ALS is familial in about 5% of cases, and about 20-25% of this "5%" is via SOD1 mutation. Thus, the chances of her having a familial form of ALS is relatively low.

I feel that your worries are understandable. After all, ALS is a grave diagnosis and, from what I have seen, many good neurologists have occasionally missed this diagnosis. *If your mother is worried*, she should see a neurologist who can do a good examination of her and may perform an electrodiagnostic study among other studies. Considering that physicians who specialize in and see more of this disorder have "more practice," it may be preferrable for her to see a neurologist who is associated with an ALSA or MDA clinic.

One should stress that, even though an EMG in early motor neuron disease can be normal, it would not be appropriate for her to live in fear of this disease - for which there is no viable cure at this time (riluzole slows the progression of ALS to a minor degree, and other measures are, thus far, more or less supportive).

Best wishes to yourself and your family.

-274

I haven't concluded that my mom has ALS because of the adhesive capsulitis (frozen shoulder). I merely entertained the possibility that it could be one of the signs. I know that ALS has a myriad signs and symptoms. It obviously takes several diagnostic tests to arrive at the conclusion that a patient is afflicted with ALS.

Another note...in a detailed discussion with my mom this evening, she mentioned that one of the initial complaints my uncle had was a nonspecific pain in one of his shoulders which was soon followed by fasciculations in his fingers.

I did a bit of online searching and came across a VERY pertinent abstract which was presented at the 15th Annual International Symposium on ALS/MND in 2004 (Philadelphia)

P.L. Ingles-Allred, Canada
Adhesive capsulitis: A Profile of Patients with ALS
Adhesive capsulitis, or frozen shoulder, is a condition that affects some people with ALS causing pain and reduced range of motion limiting function. The investigator reported on a study to determine the incidence of adhesive capsulitis and the demographic and disease characteristics associated with the condition at one ALS center.
This retrospective reviewed 87 patients – 63 men and 24 women – which was greater than the incidence of the condition in the general public, but lower than in other diseases with shoulder weakness or spasticity. The finding of more men than women with adhesive capsulitis in the ALS population differs from the higher predominance of the condition in women among the general population. More research is needed to have a better understanding of the development of this condition and treatment strategies that prove effective in managing or prevention adhesive capsulitis.

I did some searching on Medline and came across another interesting study which mentioned adhesive capsulitis occuring in higher incidence in subjects with Parkinson's disease.

Frozen shoulder and other shoulder disturbances in Parkinson's disease.Riley D, Lang AE, Blair RD, Birnbaum A, Reid B.

J Neurol Neurosurg Psychiatry. 1989 Jan;52(1):63-6.

Movement Disorders Clinic, Toronto Western Hospital, Canada.

The frequency of shoulder disturbances, particularly frozen shoulder, has not been assessed previously in Parkinson's disease. In a survey of 150 patients compared with 60 matched control subjects a significantly higher incidence of both a history of shoulder complaints (43% vs. 23%) and frozen shoulder (12.7% vs. 1.7%) was found in the Parkinson's disease population. Those developing a frozen shoulder had initial disease symptoms indicative of akinesia twice as frequently as tremor while the ratio was reversed in those without frozen shoulder. In at least 8% of the patients frozen shoulder was the first symptom of disease, occurring 0-2 years prior to the onset of more commonly recognised features. Parkinson's disease should be added to the list of causes of frozen shoulder, and clinicians must be aware that the latter is often the presenting symptom of Parkinson's disease.