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 to ..) and thawing
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 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
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.
Mike Freeman, 5 June 2005
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.