Last January, I wrote about whether or not I had frozen shoulder, and I how I was managing acute shoulder pain without a firm diagnosis (see that post here). Reader response was phenomenal. More people stopped by diabetes 24-7 to read about shoulder pain almost as much as my story on the Islet Sheet. Even today, I receive hundreds of hits per week for this problem. Reader response indicates a large number of people are suffering from shoulder pain and may not know why.
How do you know if you really have Frozen Shoulder?
Previously, the orthopedic team thought I had a slight tear in my rotator cuff with a dose of tendonosis after analyzing my MRI. We treated my pain as a sports injury. I was using physiotherapy to manage loss of movement and pain. I had suspended my training in swimming and quit the tennis team. This was all meant to be a temporary matter.
That was last February 2010. My range of motion has decreased by 50-60% since then. (In February it was about 20%). Now, the diagnosis is clear: I have Frozen Shoulder.
What is Frozen Shoulder?
My doctor, Dr. Benjamin Chow, a specialist in Orthopaedics & Traumatology, shared a publication he wrote for patients under the same title. Here are a few highlights.
Frozen Shoulder is known as “Adhesive Capsulitis” to the medical community. It is a poorly understood condition which is characterized by inflammation in the shoulder joint and a thickening of the joint capsule. It affects about 2% of the general population between the ages of 40 and 60. It is more common in people with diabetes and usually follows an injury. So far, I tick all these boxes. I am 45 and the problem started after a tennis injury in my rotator cuff; I am shocked by the 2% statistic. This leads me to believe many people are undiagnosed.
Frozen Shoulder Stages
Stage 1: This is the “freezing phase” where acute pain is the predominant symptom. As pain becomes more severe, the shoulder loses range of motion. This stage lasts up to 9 months.
Stage 2: Called the “frozen phase,” the pain of frozen shoulder lessens and stiffness becomes a more prominent symptom. This lasts up to nine months.
Stage 3: In this period, the “thawing” occurs. Pain and stiffness are reduced, but this phase may last up to two years.
Stage 3 does not include complete resolution; permanent loss of external rotation is common.
According to Dr. Chow, “The cardinal sign of frozen shoulder is loss of external rotation.” To understand what this means, stand with your back against the wall, bend your arms at the elbow and put them flush against the wall. This is called external rotation. If you cannot manage this with your pained shoulder/side – you have one of the most significant symptoms. What makes diagnosis so difficult? “Other diagnoses that may be confused, or co-exist, with true frozen shoulder include shoulder impingement syndrome, rotator cuff tear, osteoarthritis of the shoulder joint, infection and tumours and pain referred from the neck.” Even for me, it wasn’t clear until my range of motion externally started to disappear.
Next steps: Treatment
Frozen shoulder can be resolved on its own – but it can take years and it can permanently damage range of motion for life.
Treatment 1: Anti-inflammatory drugs and gentle physiotherapy.
Treatment 2: If treatment 1 offers no significant improvement, consider a steroid injection. If however, you use insulin to manage diabetes, be careful and discuss the risks with your doctor. Steroids often prevent the efficacy of exogenous insulin.
Treatment 3: Surgery. Arthroscopic Capsular Release is a scopic surgical procedure where the capsule is cut surgically allowing the shoulder to move freely again (as opposed to the old-style procedure where manipulation by the doctor causes a severe tear). Vigorous post-operative physiotherapy is required if the movement gained during the surgery is to be retained. If physiotherapy is not utilized, the capsule can quickly become stiff again.
It seems unfair that someone like me with an active lifestyle and an A1c hovering between 6.5 and 7.0 should be a part of the 2%! Poor “control” has nothing to do with a diagnosis. I have decided to take the more radical approach. I am scheduled for surgery very soon, and will let my readers know how it goes.