In the summer of 2010, when I was 44 years old, I was clearing some brush and experienced a sharp and unfamiliar pain in my right shoulder. I have always been quite active, so I am accustomed to a wide variety of aches and pains and consider myself to have a high-degree of pain tolerance. This pain was unusual and too painful to push through. So I put away my tools and headed to the couch. At this point I made a poor decision, one I hope to help you to avoid.
I assumed that after several days of rest, my shoulder would feel better. As days, then weeks, and then months passed, the situation deteriorated. Making certain motions with my arm caused severe pain. Furthermore, I was starting to experience the ill effects of sleep deprivation since rolling the wrong way in bed would wake me up several times a night. I was starting to get depressed thinking that this was a sign of age and perhaps would not get better. Finally, in January of 2011, a full six months later, I went to the doctor. I was diagnosed with a condition that I had never heard of before, frozen shoulder, also known as adhesive capsulitis.
The shoulder is a ball and socket style joint. Its movements are lubricated with synovial fluid that is contained within a capsule encircling the ball and socket. Frozen shoulder occurs when the tissue in the capsule becomes inflamed, causing it to become thick and stiff. Frozen shoulder occurs primarily between the ages of 40 and 70, 70% of the sufferers are women. The cause is generally unknown. If you have frozen shoulder, resting it for prolonged periods of time as I did, leads to further thickening and swelling of the capsule and eventually to the formation of scar tissue. If scar tissue is allowed to form, the range of motion of the shoulder joint can be permanently reduced. Therefore, it is important to be able to recognize the symptoms of frozen shoulder so that you can seek medical attention promptly if you experience them.
Since there are many conditions other than frozen shoulder, including bursitis and rotator cuff tears, which can also cause shoulder discomfort, misdiagnosis is a risk. In my experience, there are three features that distinguish frozen shoulder from other possible causes. The first is its sudden onset with no apparent cause or injury. The second is that the pain is far worse than your average ache or pain. The third, and to me the most distinctive, is the limitation in range of motion for one particular movement. If you believe that you may have frozen shoulder, try this test. Lay down on the floor on your back. Now try to lay your arms flat on the ground in a goal post shape such that your upper arms are aligned with your shoulders and your lower arms are parallel with your neck. If you cannot get the upper arm on the side of your body with the painful shoulder to lie flat on the ground, this is a strong indication that you have frozen shoulder.
If you are diagnosed with frozen shoulder, your doctor will likely give you a corticosteroid shot and assign you some stretching exercises. I should warn you that the corticosteroid shot for frozen shoulder is no small pinprick. I received my first of these shots in January of 2011. The needle is rather large and the volume of liquid injected is ten cubic centimeters. The shot is rather painful and its beneficial effects are not apparent for several days. In fact, it is quite possible that your shoulder will feel worse until you body finishes absorbing the excess fluid. Over the first couple of days, my shoulder made some rather impressive popping noises, sort of like a very large knuckle cracking. After a week or so, it felt somewhat better and I began to faithfully execute my stretching exercises. Three months later, I was dissatisfied with my progress and went back to the doctor. This time he ordered an MRI that pinpointed the location of the capsule inflammation. He used this information to aim the big scary needle for my second shot. Again, relief was not immediate, but within two weeks my shoulder felt much better and within a couple of months I was back at 100% and it has remained so for the last five years.
All was well on the shoulder front until January of this year when, out of the blue, I had a now familiar pain in my left shoulder. If you have frozen shoulder on one side, you are at increased risk of getting it in the other. This time I went directly to the doctor and got a shot. In a reprise of my experience with my right shoulder, I was back in three months for an MRI and a second shot. That was in May, and at this point I’d say I am about 95% recovered. Although my data set is limited to just two shoulders, it seems as though the effectiveness of the corticosteroid shots, at least for frozen shoulder, is highly dependent on location of delivery. If this is true, getting some imagery, MRI or otherwise, should improve the rate of success for the first try.
So that’s my frozen shoulder story. If any of this sounds familiar to you, get off the couch and call the doctor.
Jeff Danner discussed this column with Aaron Keck on WCHL.
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