Thawing of painful frozen shoulder takes time
Most patients will get better, but the process will require patience, doctor warns
Nearly a decade has passed since Lynne Robson’s first encounter with frozen shoulder. But she remembers in exquisite detail the limitations it imposed and the pain it caused her.
Pulling on a winter coat was excruciating. Robson could only wear clothing with front closures, because reaching behind her back to hook a bra, for instance, required a range of movement she no longer had.
Blow-drying her hair, pretty much a requirement for a TV reporter, which Robson was at the time, was an impossibility.
During the worst of it, even the small tasks of daily life were too much to cope with as Robson struggled with constant pain and severely restricted mobility.
She’d work, then spend the evening icing her shoulder.
“I had quit cleaning my house. I had quit opening my mail . . . I just couldn’t deal with anything other than getting through the day. It was completely dominating my existence,” says Robson, 58, now a Montreal-based manager for the CBC.
“I didn’t even realize I wasn’t opening my mail. It was only when I started to feel better and my insurance company phoned and said ‘We’re about to cancel your coverage if you don’t pay,’ and I had warnings from hydro and the phone company,” she says, recalling what she describes as a difficult period in her life.
“It was just like one more thing to deal with and I was barely functioning by that point.”
Frozen shoulder, also known as adhesive capsulitis, is a condition in which the capsule of connective tissue that encases the shoulder thickens and tightens around the joint. The process is extremely painful and results in a virtual immobilization of the joint, leaving the sufferer with an arm that barely functions.
It’s neither very common nor extremely rare. On average, about two to three per cent of people will devel- op frozen shoulder at some point in their lives, says orthopedic surgeon Dr. Stephen Thompson.
Some people are more likely than others to develop the condition. Women are diagnosed more frequently then men. It is most commonly seen in those over 40. People with certain illnesses — diabetes, under- or overactive thyroid, tuberculosis and Parkinson’s disease — are more likely to develop frozen shoulder than the general public, according to information posted online by the Mayo Clinic, in Rochester, Minn.
About 15 per cent of frozen shoulder patients — and Robson was among them — will later develop a second case in the opposite joint. For Robson, the second bout was far less debilitating than the first.
In most cases, it is not known why the condition sets in.
Most people who develop frozen shoulder will get better eventually, though it can take a year or two to resolve, says Thompson, a sports medicine specialist who until earlier this month practiced at Oakville Trafalgar Hospital in Oakville, Ont. (Canada has an oversupply of orthopedic surgeons, so Thompson is moving to Bangor, Me.)
He says between five and15 per cent of frozen shoulder cases will retain some shoulder stiffness as well as ongoing pain or discomfort, but most will get back to their previous state of mobility within about two years.
Thompson, who has done research on frozen shoulder, refers sufferers to a scientific paper published in the journal Orthopedics in 1996 entitled: “Thawing the frozen shoulder: the ‘patient” patient.” While there are some orthopedic therapies that can be used, getting better is mostly about time and physiotherapy.
The condition is marked by three phases — the freezing, frozen and thawing stages.
The first, when the shoulder capsule is contracting around the joint, is the most painful. Sleep is often disrupted because movement that jostles the shoulder produces enough pain to wake the sleeper. As Robson recalls, any movement brings an electric shock of pain.
“Even breathing or coughing was
“It was just like one more thing to deal with and I was barely functioning by that point.” LYNNE ROBSON
enough to make it . . . not spasm, because it’s not muscular, but you would get this jolt of pain. You’d gasp in reaction,” she says. During the frozen phase, pain may subside, but movement is limited. When the joint begins to “thaw,” mobility slowly returns, but so can pain. For Robson, the process was a long and slow one. She first became aware she was having problems in early January 2004 and it wasn’t until October of that year when the acute pain began to subside, she says. She would walk around holding onto her collar with her left hand, immobilizing the affected arm across the front of her body. It was a coping mechanism designed to minimize the risk she’d bump the arm. The habit became so ingrained, though, that when her joint started to thaw Robson had to ask colleagues and friends to point out when she was doing it so that she would stop. Keeping her arm in the sling-like position was preventing her from regaining mobility. For Robson, the pain of frozen shoulder was exacerbated by the fact that many people weren’t aware of the condition and couldn’t really get why she was babying her arm. She admits there were days she wished she’d broken the arm, because a cast and a sling would have been a visible sign that people would have understood. “It doesn’t show. Unless they see you struggling to put on your coat or they see you crying because you’ve just had a jolt, unless they see the result of the pain, they can’t see the problem,” she explains. After months of trying to soldier on, Robson eventually went on sick leave and devoted herself to getting better. In addition to intensive physiotherapy she saw a massage therapist, tried acupuncture and attended aqua fitness classes. In some cases, therapeutic procedures are an option, Thompson explains. He will often administer a shot of cortisone into the joint for frozen shoulder sufferers, saying it helps reduce pain. An option sometimes used is a procedure called manipulation under anesthesia. Once the sufferer is unconscious, movement of the shoulder is forced in an attempt to cause the tightened capsule to tear, which opens up the joint. Thompson says this procedure can be risky and isn’t one he uses. Another approach is what’s called arthroscopic capsular release. After a patient is put under anesthesia, a surgeon will insert a scope into the joint and clean up scarred capsule tissue. Still another is called distension arthrography, where water is forced through a needle into the joint to make the capsule burst. The latter is not generally performed in North America, Thompson says.