This case study shows the development of my frozen shoulders from a patient's point of view. Living in the UK I have access to a wide variety of medicines, doctors, health practitioners and other resources, but nothing seemed to make a huge difference, nor to change the predictable evolution through the 3 stages of freezing, frozen and thawing:
Right shoulder: freezing (January - April 2003), frozen (May - August 2003) and thawing (September 2003 - February 2004...)
Left shoulder: freezing (June to September 2006), frozen (October 2006 to January 2007) and thawing (February to July 2007...)
One wet day in the December, I was riding along on my bike and I had the misfortune to skid and fall off. I tried to break my fall with my outstetched right arm. As I was riding along at about 15 kilometres an hour, the full force of the fall was considerable. The shock was absorbed by my right shoulder and that hurt a lot for several days. I took some aspirin and put cold ice packs on the shoulder. After a couple of weeks the shoulder started to heal and it became much less painful. Unfortunately, during mid-January the shoulder started to hurt again, so I went to see my GP.
My GP prescribed some painkillers and anti-inflammatory tablets. He also suggested that I have a short course of physiotherapy. None of these measures seem to help, as my condition gradually got worse.
I was given a series of exercises to carry out at home. I did my exercises religiously twice a day for about 20 minutes each time. These exercises became more and more painful. As the pain became worse I took more and more painkillers. To start with, large quantities of ibuprofen seemed to help, but as I took more and more the effect seemed to be less and less. The worst time was at night.
The pain was now excruciating. When the pain was at its worst I was up five or six times each night. I would walk around, massage my arm and take hot drinks. I was unable to sleep on my right side and it became increasingly difficult to become comfortable in bed. Because I was not sleeping well at night, I became irritable and frustrated. Towards the end of March the pain also started to affect my work.
At this point I was feeling desperate and willing to try anything. My GP gave me some strong painkillers and a steroid injection. This injection into the shoulder probably had no effect at all. My physiotherapist told me that she could not help me any more and just told me to get on with my exercises. At this point my shoulder started to become stiff and slightly restricted.
I was running out of options. I had a short course of treatment by an osteopath. This consisted of deep massage and gentle manipulation of the shoulder. I'm not sure that this did any good at all. There was a slight decrease in the pain, but my range of motion was also considerably worse. I only had about 50% of my normal range of motion in my right arm. I now had pains in my hand, lower arm, upper arm, shoulder, neck and temples. I went to see my GP, but he was unable to do anything.
As the weeks passed it became easier to sleep at night and the condition became generally less painful. The range of motion, however, became worse. At its worst I only had about 30% of my normal range of motion. This was very depressing and I felt considerably handicapped. It was at this point that I saw the shoulder specialist at a local hospital. He said that my frozen shoulder was one of the worst he had ever seen. As it was so severely restricted he strongly recommended that I have a manipulation of the joint under anaesthetic, followed by arthroscopic capsular release. I was not very keen on an operation, but this was arranged for the month of September 03.
During July I went back to the physiotherapy department of my local hospital and requested some exercises to help the joint move a little. I saw the consultant physiotherapist and he reluctantly told me that I had a debilitating condition that he could not help with at all. At this point I was suffering from pains in that top of my back and lower neck. The physiotherapist told me to stop my exercises as he thought that these were making the muscles in the top of my back ache. Fortunately, the pain became slightly easier during July, although the range of movement was still very severely restricted.
Despite my condition we left for three weeks' holiday during August. I spent most of the time relaxing, swimming gently and going on short bike rides. Fortunately, there was considerable improvement during this month. The pain decreased further, the joint became looser and my range of motion increased to about 45%. I'm not sure if it was the relaxation or the natural healing process, but the whole thing seemed to be on the mend. It occurred to me during this period that a natural recovery would be preferable to an operation. I decided to ask the shoulder specialist for a second opinion. This was partly a delaying tactic. I wanted to give my shoulder the chance to heal naturally before going ahead with a rather brutal operation.
After discussions with two fellow sufferers, I decided to have a course of acupuncture to stimulate the natural healing process. The results were dramatic. It seemed to do just that. After the first session my shoulder felt much easier and looser. By the end of September I had no pain at all and my range of motion had increased to about 55%. Around this time my shoulder started to get back some of the strength that it had previously. Most of the muscles around my shoulder had wasted away. I was able to exercise sufficiently to be able to get back about half of my normal strength. It may have been a coincidence that my arm started to improve at this time, but my gut feeling is that the acupuncture did have a postive effect.
I was having weekly sessions of acupuncture and swimming about three times a week. There was no pain now and I could sleep on my right side again.
During November I saw another shoulder specialist and had a second opinion. I was very pleased when he told me that he would not recommend an operation. He suggested that we should allow the natural healing process to continue as long as possible. He did say that if there was no progress for three consecutive months then I should go back to see him. I had no pain and my range of motion was up to about 60% now.
During December my acupuncturist suggested that I start lifting some weights. These were only small weights, but they did help to build up the strength in my arms. I was very pleased with the progress. My shoulder continued to improve. I suppose my range of motion was now about 70% of its normal value and I could do most things that I normally do. Strength in my arm muscles increased up to about 75% of its normal value.
I don't think I would contemplate an operation now. The improvement continued through January with the range of motion about 80% now. I could swim about 15 lengths and do about 10 press-ups. This is about 75% of my normal performance. One day, when I was using a pulley attached to the ceiling, exercising quite strongly, there was a popping sound in my shoulder and a sharp pain. I was frightened at first, but immediately noticed an improvement in my range of motion. The pain and discomfort continued for a couple of days and then went away.
Apart from the occasional twinge, I had almost forgotten about my frozen shoulder. I could do most things that I wanted to do by then. My range of motion was probably around 80 to 90% then. And that's good enough for most things. As always the danger with an operation is that it can do more harm than good. There is also the danger that it may provoke another frozen shoulder. During February I saw the shoulder specialist again. He told me that my increased range of motion was partly due to compensation by the muscles around the shoulder. He suggested that I needed to move my arm to the limit of its range of motion. He said that this was likely to hurt, but it was the only way to get back full movement. He gave me one year to make these improvements.
I kept doing my exercises and swimming for the whole year and had about 90% range of movement in most directions. I regularly swam ~40 lengths and at about the same speed as before. I could do press ups and other exercises without any problem. My arm still felt a bit stiff from time to time and probably didn’t have quite the same strength as before, but it didn’t really bother me. I was just pleased to have normal use of my arm again and no pain – just 2.5 years after my accident!
What worked (or seemed to work for me):
1. Exercises
2. Acupuncture
3. Swimming
4. Pain killers (only for the first week)
5. A pulley attached to the ceiling
6. Sleeping with a pillow in my arms
What didn't work (or didn't seem to work):
1. Anti-inflammatories
2. Cortisone injection
3. Physiotherapy
4. Massage and manipulation by an osteopath
To my horror, I started getting odd pains in both arms, neck and shoulders. I thought I had been doing too much rowing at the gym at first, but one day I went for a swim in the sea and the sudden jolt produced a sharp and numbing pain in my left shoulder. After a visit to my GP my worst fears were confirmed; it seems like the onset of another frozen shoulder in the left shoulder.
What should I do? How could I prevent the same painful scenario? My GP suggested a strong dose of ibuprofen (400 mg x 3 per day) and 2 weeks rest to calm things down. I knew this had not worked last time so I went back to my acupunturist for advice. She told me to take the ibuprofen, but also start a course of acupuncture and have some gentle exercise (using regular swinging movements of the arms). I followed her advice. At first, there was no pain at night, but I did notice a clicking sound in my shoulder when I did my exercises (windmill movements). There was also discomfort and tightness in my arm muscles; things were not quite normal. It started to become uncomfortable to sleep on my left side. Suddenly, I had a trapped nerve in my neck. I went back to see my GP and he wanted to inject the shoulder with cortisone. I resisted the idea as it did not seem to help the last time. Instead, I had a session of acupuncture. My acupuncturist said the muscles were all very tight, but they felt more relaxed after the treatment. I had my first bad night, but the progression was irregular, as some nights were better than others. The aches and pains gradually got worse during the month; there was more tightness in the muscles and I felt a slightly restricted range of motion during my morning exercises. Occasionally, a jolt or rapid movement would cause horrible pain in my left shoulder. I also noticed a slight discomfort in the mornings; gentle exercise and light massage seemed to help. My acupuncturist persuaded me to wait one more week before having the cortisone injection, to give the acupuncture a chance to work.
During July, the pain generally got worse and my range of motion decreased. I was swimming regularly, having weekly acupuncture, and taking quite heavy doses of ibuprofen. The progression was not regular: one night there was a strange tingling sensation in my left shoulder, one day my left arm ached on and off and one night the pain was quite bad. Towards the end of the month the pain during the night started to wake me up. As the situation seemed to be getting worse, and the acupuncture seemed to have little effect, I decided to go ahead with the cortisone injection and stop the acupuncture. I couldn't notice any difference after the cortisone injection.
At the beginning of August, I was feeling a bit depressed, as I felt powerless and had no way of stopping the progression of this debilitating disease. I even started having pain in my right shoulder; this was scary. I had nightmares of having a frozen shoulder in both shoulders at the same time. It was quite clear to me that the pain was getting worse, my range of movement in the left shoulder was decreasing, and I was starting to wake up in the middle of the night because of the pain. In fact, I was woken up two or three times a night, nearly every night of the week towards the end of August. The occasional pain, clicking noises and tightness in my right shoulder continued. It felt like my right arm was stuck to my ribs. The pain levels increased in my left shoulder and the duration of the pain became longer: it would last three or four hours at a time.
The level of pain in September got really bad, especially at night. I just couldn't get comfortable and spent most nights tossing and turning. I didn't know what to do, so I went back to my GP in desperation. He thought it was a good idea to try the acupuncture again, to use an anti-inflammatory cream and some mild massage, and wanted to give me another cortisone injection. He also gave me a blood test to check my cholesterol level. Nothing seemed to help. I was sleeping with two very large pillows in my arms and still couldn't get comfortable. One day I had a really low point, while going out for a bike ride. I went over a big bump, and that produced an excruciating pain in my left shoulder. This pain, made me fall suddenly onto my saddle and squash my testicles! I was suddenly swimming in a sea of pain! The accumulation of many sleepless nights, lots of pain and mild depression made me feel very unhappy. The tendons in my arms felt like they were on fire. Around the 25th of September was a definite turning point. My acupuncturist showed me how to insert the needle myself into the pressure point called GB 34 , just below the knee. As soon as I tried this, the movement in my shoulder seemed a bit looser. It suited me to do the acupuncture myself as I could relax more and apply the needle when I wanted to. After only two insertions of the needle, the pain levels seem to decrease. I noted in my diary " the best night for a long time as I only woke up twice, and with much less pain". The following night, I only woke once, and with even less pain. There was, however, a loud crunching noise in my left shoulder when I did my exercises in the morning.
During October the pain levels decreased, but my range of motion became more restricted. I was still waking up at night, but less frequently and with less pain. My shoulder was gradually freezing solid and my left arm was becoming weaker. Towards the end of the month I had one or two good night's with almost no pain; my arm was stiff, but it didn't hurt much at all. I continued with the acupuncture, inserting the needle every other day, but stopped taking all medication.
I read about the Neil Asher technique on the Internet, and decided to visit his London clinic to give his trigger point therapy a try. The first treatment hurt quite a lot, but the pain didn't last. I couldn't see any real improvement, but I was told I got an extra 5° of movement in my range of motion. I purchased his exercise manual and asked my wife to do the trigger point therapy; now I had seen it in action, I had a better idea of what was required. My shoulder was starting to feel a bit looser, and I could feel that the range of motion had improved slightly. Towards the end of the month I saw a shoulder specialist at the hospital; he told me that I had a severe case of frozen shoulder; this is something that I could have told him! To my relief, he told me that the inflammation was very unlikely to return to the same shoulder, but there could be the occasional flare-up. He asked me if I wanted an operation, and in the same breath, told me that there was about 70% chance of it being successful, 20% chance of no change, and 10% chance that it would get worse. He also told me that it was a waste of time injecting cortisone into the muscles and tendons; he offered to inject cortisone directly into the joint at the hospital, if it flared up again. It is a pity that I didn't try that much earlier. He also recommended that I avoid prolonged or severe stress to either shoulder. I told the specialist that anti-inflammatory drugs did not seem to work for me, and that I prefer a more natural alternative: using foods that seem to have anti-inflammatory properties, such as garlic and ginger. He thought this was a very good idea.
At the beginning of December, I was so pleased to spend my first night without holding a pillow in my arms. I was able to sleep better, and that made a big difference to the way I felt in my recovery. There was almost no pain during December so there was no need to take any painkillers. I was still having some gentle exercise in the form of swimming, a little yoga to help stretch the muscles and tendons, and the trigger point therapy once a week. There was some small improvement in my range of motion, but movement was still very restricted.
I found it easier to swim during January and manage to do around 12 lengths, and even a little backstroke. I was able to do exercises, but due to the restricted range of motion, the exercise nearly always produced some sort of discomfort. There was some discomfort under my arms in the armpits on both the left and right sides all through January.
The under-arm discomfort went away in February, and I started going to the gym to the first-time. There was a noticeable improvement every week; each week I got a bit of my movement back stop. I noted on the 22nd of February, that I did 12 lengths of the pool and swam at about three quarters of my normal speed, using front crawl. I also tried the sun salute for the first time, and it was a bit tight, but there were no after-effects. It's a wonderful feeling to get back to normal after so much pain and discomfort.
I had no pain and very little discomfort, so I was able to exercise more and start rebuilding the muscles in both my arms. I went to the gym regularly, and was able to do a few ladies press ups in addition to the sun salute.
I was getting better every week and my range of motion was improving; I suppose it was about 80% now. I was building up my muscles and feeling stronger all the time. I lifted some heavy boxes and moved to a filing cabinet without any problems yesterday. During this month, I decided to add turmeric to my diet as this is supposed to be a natural anti-inflammatory agent. I now swimming about 26 lengths of the pool at about 75% of my normal speed. It seems like the thawing process is well under way and, fingers crossed, I am well on my way to complete recovery.
It's more than one year
now since this restarted, and everything is more or less back to normal. I can
now swim about 40 lengths at nearly normal speed
, I'm going to the gym regularly and can row about 1 km in about five minutes
on level 2. I have no pain, and very rarely any discomfort. My range of motion
is about 90% of what it was.
For the last few weeks I have noticed a cracking sound in my left shoulder, especially each morning when I do my exercises. This seems to have got a bit worse and the joint seems a bit sticky from time to time, but especially early in the morning. This problem did not last, and gradually got back to normal.
The range of motion still seems at about 90% of what it was; I'm not sure that this is going to get any better, but at least there is no pain or discomfort now.
All last year I went to the gym and tried to build up my shoulder muscles as much as I could. I had my first game of badminton last week, and it was fine. I wanted to update this case study at an earlier date, but was too busy.
What helped (or seemed to help) for my second frozen shoulder:
1. Gentle exercise and
yoga
2. Acupuncture (during the frozen stage) using pressure point called GB 34
3. Swimming
4. Pain killers (only for the first week)
5. A pulley attached to the ceiling
6. Sleeping with a pillow in my arms
7. Light massage
8. Trigger point therapy
1. Anti-inflammatory drugs
2. Cortisone injection in the muscles around the joint
3. An anti-inflammatory cream
4 . Acupuncture (during the freezing stage)
If you can get it, I'd advise asking a shoulder specialist to inject cortisone directly into the joint. I'm not sure what effect the garlic, ginger and turmeric had, but I don't think they can do much harm and may have been beneficial.
I suppose if you are reading this case study you are likely to be somebody who has been recently diagnosed with a frozen shoulder. I'm afraid this case study is likely to be depressing reading. However, you should bear in mind that your frozen shoulder is likely to be less severe than mine. A shoulder specialist told me that my case was particularly severe; it is also unusual to have two frozen shoulders. In any case, I hope that you find it useful. Please remember that there is light at the end of the tunnel, and it is not a permanent condition.
This case study is on the web for the benefit of fellow sufferers and anybody else who may be interested. I do not wish to enter into discussions concerning this page unless there are exceptional circumstances.