FROZEN SHOUL­DER

It af­fects women more of­ten than men – usu­ally at midlife – and, in many cases, no one is quite sure why. Writer Lisa Kadane was one of those med­i­cal mys­ter­ies. She shares her jour­ney, along with a few tips on how to cope while wait­ing for the thaw.

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THE FIRST TIME AN ELEC­TRIC JOLT OF PAIN SHOT down my right arm from my shoul­der, I was reach­ing be­hind my back to tuck in my shirt. It felt like a light­ning bolt zap­ping me for 20 sec­onds. A few days later, it hap­pened again – this time, I slipped in ski boots and f lung my arm up to catch my­self. I im­me­di­ately dou­bled over from sear­ing pain caused by the sud­den move­ment. At the same time, my range of mo­tion was slowly de­creas­ing. Every­day tasks like styling hair, putting on a fit­ted shirt and reach­ing for top-shelf pantry items were be­com­ing more dif­fi­cult.

My shoul­der had been act­ing funny for months – weirdly loose, click­ing upon ro­ta­tion and sore at night if I slept on my right side. I could no longer ig­nore the fact that some­thing was wrong. X-rays and an ul­tra­sound came back with no sign of ob­vi­ous in­jury, yet the pain and stiff­en­ing still per­sisted. Even­tu­ally, my fam­ily doc­tor re­ferred me to a sports-medicine spe­cial­ist, who made a quick di­ag­no­sis after test­ing my range of mo­tion and strength: frozen shoul­der.

WHAT IS FROZEN SHOUL­DER?

Frozen shoul­der (FS), also called ad­he­sive cap­suli­tis, is a con­di­tion where the con­nec­tive tis­sues sur­round­ing the shoul­der joint be­come inf lamed and scar tis­sue forms in­side the cap­sule, caus­ing ex­treme pain and stiff­ness. It af­fects be­tween three and five per­cent of the pop­u­la­tion, most com­monly women be­tween the ages of 40 and 60, says Dr. Ryan Bick­nell, a shoul­der and el­bow sur­geon and an as­so­ciate pro­fes­sor of or­tho­pe­dic surgery and me­chan­i­cal and ma­te­ri­als engi­neer­ing at Queen’s Univer­sity in Kingston, ON.

It’s also more com­mon in peo­ple with di­a­betes and hy­pothy­roidism, pos­si­bly be­cause those con­di­tions in­volve ab­nor­mal­i­ties of the en­docrine sys­tem, which – among other du­ties, such as in­sulin pro­duc­tion and hor­monal bal­ance – works to reg­u­late in­flam­ma­tion in the body.

A MED­I­CAL MYS­TERY

Like any good story, med­i­cal or oth­er­wise, there’s some mys­tery sur­round­ing the con­di­tion when it hap­pens in oth­er­wise-healthy peo­ple like me. In some in­stances, frozen shoul­der is as­so­ci­ated with a trau­matic in­jury, such as dis­lo­ca­tion or a ro­ta­tor cuff tear, but in most cases it’s deemed “id­io­pathic,” mean­ing that it comes on for no par­tic­u­lar rea­son.

That’s what hap­pened to Jen­nifer Twyman, too. “I woke up one morn­ing and a tiny ache started in my shoul­der,” says Twyman, a 53-year-old pho­to­jour­nal­ist and mother of three. “I thought I had just slept on it funny, but then it got worse and worse un­til I couldn’t even lift my arm.”

I felt the same way about my shoul­der – it seem­ingly came out of nowhere. But the more I thought about it, the more I was cer­tain it was brought on by repet­i­tive strain from our dog – a birder who is prone to er­ratic lurch­ing (read: shoul­der pulling) if she sees any­thing with feath­ers while on a leash.

Leigh Garvie, a sports spe­cial­ist with the Cana­dian Phys­io­ther­apy As­so­ci­a­tion and a phys­io­ther­a­pist and owner of Coro­na­tion Phys­io­ther­apy in Ed­mon­ton, is also con­vinced that the con­di­tion is trig­gered by some­thing, even if it’s just an un­re­mark­able ac­ci­dent. “In prac­tice, I see a lot of peo­ple where I think [the frozen shoul­der] has come from a trauma, even if it’s a mi­nor trauma,” says Garvie. “It sets off in­flam­ma­tion in the area and then, de­pend­ing on the in­jury, the in­flam­ma­tion spreads or the im­mo­bil­ity al­lows it to stiffen up. You don’t want to move your arm be­cause it hurts, and that’s really why it gets stiff: be­cause you stop mov­ing your arm.”

The shoul­der is unique from other bend-and-ex­tend joints in that it has an ex­treme range of mo­tion – al­most 360 de­grees – that makes it more sus­cep­ti­ble to in­jury, says Dr. Bick­nell. “The shoul­der al­most dis­lo­cates or par­tially dis­lo­cates with nor­mal range of mo­tion, so it’s a joint that doesn’t stay per­fectly con­cen­tric in nor­mal dayto-day ac­tiv­i­ties,” says Dr. Bick­nell. “Is that part of what can lead to more trauma to that cap­sule on a daily ba­sis and pre­dis­pose you to frozen shoul­der? Pos­si­bly.”

HOW TO TREAT IT

The con­di­tion pro­gresses in three stages. First comes “freez­ing,” where your range of mo­tion grad­u­ally de­creases over sev­eral months and cer­tain move­ments – par­tic­u­larly ro­ta­tion – cause all-con­sum­ing pain. The next phase, “frozen,” lasts be­tween four and six months. This is when the shoul­der is stuck, though the pain dwin­dles to a dull ache, es­pe­cially at night. Fi­nally, the shoul­der be­gins “thaw­ing” and move­ment re­turns over a six- to 24-month pe­riod.

The time­line from on­set to re­cov­ery can span two or three years, which is par­tially what makes it so vex­ing – that and the pain. “I would reach be­hind to open the door and the pain would bring me to tears in­stantly,” re­calls Joanne Elves, a 57-year-old free­lance writer who re­cov­ered from the con­di­tion. Elves says that her doc­tor told her not to worry too much about her shoul­der – it’s up to the body when it wants to re­lease. “My doc­tor was very pos­i­tive in ap­proach­ing the prob­lem,” she says. “Cor­ti­sone and a nerve block re­duced my pain so that my range of mo­tion im­proved.”

Of course, you more bear­able while it is one of the most painful

Bick­nell. He sug­gests non­s­teroidal anti-inf lam­ma­tory drugs (NSAIDs), such as ibupro­fen, to man­age the pain. If those are in­ef­fec­tive, he sends pa­tients for a se­ries of cor­ti­sone shots in the gleno­humeral joint, which helps get the pain un­der con­trol by re­duc­ing inf lam­ma­tion. Once the shoul­der no longer hurts, those who are af­flicted grad­u­ally be­gin to re­gain mo­bil­ity and strength.

Suf­fer­ers can also ben­e­fit from phys­io­ther­apy. Garvie uses both ul­tra­sound and in­ter­fer­en­tial cur­rent stim­u­la­tion (IFC) or high-volt gal­vanic stim­u­la­tion to re­duce pain by in­duc­ing blood flow into the joint. She also man­u­ally mo­bi­lizes and stretches the cap­sule to keep the range of mo­tion and as­signs stretches for pa­tients to do at home. Dur­ing the thaw­ing stage, she starts them on a strength­en­ing pro­gram to re­ha­bil­i­tate the shoul­der’s sta­bi­liza­tion mus­cles, which may have at­ro­phied.

Since ad­join­ing arm and back mus­cles may be­come in­volved as the shoul­der stiff­ens up, ther­a­pies like mas­sage, ac­tive re­lease, acupunc­ture and in­tra­mus­cu­lar stim­u­la­tion (IMS) can also be ben­e­fi­cial for re­lax­ation and pain man­age­ment and to main­tain mo­bil­ity.

Un­for­tu­nately, no sin­gle ther­apy or treat­ment is proven to cure or speed up its res­o­lu­tion. “Some re­search stud­ies have shown that, no mat­ter what you do, the re­sult is the same two or three years later,” says Bick­nell.

The good news: 90 per­cent of suf­fer­ers can ex­pect to re­gain full use of their arms and re­solve their pain – though there is less suc­cess with di­a­betes and hy­pothy­roidism, adds Dr. Bick­nell.

Mine even­tu­ally re­solved, but it took a full three years. To pre­vent it from hap­pen­ing again, I’ve taken to walk­ing the dog hands-free by ty­ing the leash around my waist (as far as I know, there’s no such thing as frozen hip). “I WOULD REACH BE­HIND TO OPEN THE DOOR AND THE PAIN WOULD BRING ME TO TEARS IN­STANTLY.”

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