Frozen shoulder - choices of treatment

In reply to the discussion about the causes of FS I find myself with a foot in both camps. I have definitely suffered from neck problems over the years and with both my FSs I suspected that I had a trapped nerve in that region because of a feeling of numbness and/or very unpleasant tingling down my arm. However, leading up to a proper frozen shoulder I had symptoms which presented as a rotator cuff/instability/impingement problem and also feelings of tendonitis in my wrist and in my elbow. I have ended up seeking treatment for these symptoms in the fear that the shoulder will freeze if I do nothing but if this ever happens to me again I'm not sure I will be so quick to seek help, I might try and rest it more as a first resort. Problems with the arm could be due to compensating for the shoulder discomfort by using the arm more. Also, it isn't surprising that the neck becomes problematic when you have a bad shoulder because you come to rely totally on the trapezius muscle to lift the arm because you simply can't lift it any other way.

I don't think we'll ever know the real reason why FS develops in some people - after all the medical profession don't seem to understand it. I do wonder, though, whether an old whiplash injury could contribute to my problem. Also, in the past, I have suffered with mild frozen shoulder symptoms upon falling on my shoulder while ski-ing and, although on that occasion I didn't have anywhere near the FS pain we've all discussed, I couldn't raise my arm properly for around three months.

Ho hum, we will probably go round in circles forever on this basis. All I know is that I NEED to include lots of gentle exercise to keep my neck and shoulders comfortable. Lack of use seems to leave me feeling more uncomfortable.

That's my twopennorth!!

Ok. I could send you a copy of the MRI i had on my neck 3 years ago.....but that wouldn't prove anything. In the same way that an MRI of the rotator cuff wouldn't prove that it causes FS. My opinion on FS is obviously based on an across the board appreciation of all the factors which seem to occur, and are common to most sufferers.To be honest, I've been opinionating on FS for quite some time, not just on this site, and the reasoning has evolved gradually. So I wouldn't expect anybody to just say "Yes, that makes sense" straight off. I think when it comes to disputing recommended practices, I need to put forward an intelligent argument, and, for anyone, especially someone in the middle of the trauma of FS, it takes time to come to terms with new ideas. My suggestions are probably more acceptable after the event, in retrospection, when the FS has maybe resolved itself, by itself. What I'd really like to get across is ......don't discount this common outcome when it comes to choosing treatments. My experience of FS is one where a 'wait and see'' policy has paid dividends. I wouldn't recommend a 'wait and see' policy for a broken fingernail !

Gerry

Reply to Judyb..........I think you ought to have an MRI of neck area to determine whether you have C/S (cervical spondylosis) or not. Your arm symptoms and numbness sensations suggest a possibility. And the FS adds to that. Your GP should refer you to a Physio and they can refer you for MRI. One way or the other it won't affect the outcome of the FS.

Gerry - I really think if you are making factual statements on here like the one I quoted, you need to back them up with evidence. Not evidence like MRI results on your neck...but evidence that what you are saying has some basis. Otherwise it is simply your opinion, and you need to make it clear!

best

Lesley

PS....I love my afterthoughts ( I'm just a bit slow !). A question for Lesley........Is anything I've suggested likely to prolong or exacerbate the condition ? Or , for that matter, to leave any scars ? Or, for that matter, to create a vulnerability for the future ? These are important things to consider when making a choice for treatment. I haven't got any links to hand, but if you search "Frozen Shoulder Non Intervention" , or "Frozen Shoulder Trapped Nerve" on net I'm sure you'll see there is a school of thought out there, even amongst professionals.

Gerry

Hi Gerry

I don't disagree with your reasoning. On both occasions I had treatment - and physic - for my FS and I did then make progress. However, I will never know whether I would have made that progress without that treatment. Also, when my shoulder was 'going bad' I made no concessions but determinedly gardened, played golf and so on until the pain got so bad I just couldn't do things any more. Perhaps this wasn't really wise and maybe it wouldn't have been so bad, or lasted so long, if given an easier life.

Whatever, I am now pretty much OK now so, given NHS resources, further investigation isn't on the cards. Fingers crossed I can escape another episode of FS but I won't forget the discussions of other people read here, you never know it may just help in the future.

Thanks for your contribution.

Judy

Here's just one link I;ve just looked at www.ncbi.nlm.nih.gov/pubmedhealth/PMH0047024/. And here's a quote from it

"in brief, a lack of clinical evidence and consensus regarding treatment options made the structuring and populating of a model unachievable." Says it all, really.

I think my last post is delayed because of link awaiting approval. And the sequence of posts here can go a bit loopy ! However, I'll try and respond to Lesley. I think what you're really asking is whether you should trust the opinion of someone who is trained, or the opinion of an unqualified poster like me. Ok. If I said that that trained person trained for 5 years, of which about 0.001% of that time was dedicated to studying FS, and with no actual experience of the dynamics of the condition, just how much confidence are you going to place in their hands ? It's a no-brainer. They have to follow whatever second hand theories they learn. They know no different. Medical science is continually improving, supposedly, mostly by sheer chance or by patient involvement. Very little is actually figured out in textbooks. I will always reserve the right to trust my intuition over these textbook bound, unwilling to change, institutionalised practices. That's my perogative...in fact, its my protection against being mistreated. A bit strong, perhaps, but in my opinion very necessary, especially when you consider the confusion experienced by the posters here who have all been through the recommended processes. Where does all that leave them....it leaves them vulnerable to all sorts of advice. Including mine, as it happens. But I'm trying to settle that confusion and put some reasoning back into the processes. The less we understand about our own condition, the easier it is for them to advise anything, and, especially here in the UK, that is something that needs urgent attention.

I'll get off the soap box now

G

I will like to share my experience, not to tell anyone to do exactly what it should. I am not from UK, in Singapore but working in Thailand. During the last year Flood in Thailand in Oct 2011 which affected the Company I work in badly, I returned to Singapore temporary. During then I played basketball almost daily, which I did not do for very long time. Then after 2 month when I return to Thailand where my company start re-building, I help plenty of moving work, on damaged machines etc. Then after about 2 months, my right arm start to get painful and eventually I discover I was unable to lift my right arm above shoulder.I struggle to write on the white board during a meeting session, it was just terrible, although it did not affect much of my work on the computer. I went to the doctor in a Thailand Hospital, after describing my sympton, the doctor instead of examine my shoulder, ask me to take X-ray on my Neck ( This I suppose do proof some doctor did consider Neck as a issue which what Gerry The Neck was talking about). After examining the X-ray, he did not think it proof much it affect my shoulder, so he start telling me about frozen shoulder, and give me some inflammable medicine and pain killer and told me it take time to heal, and tought me to do "climb wall" exercise.That was on March.

I did what I was told, but the "climb wall" thing don't seem to have any progress, I just could'nt go any further above 120 deg. I suffer many sleepliness night fighting the pain.

Then when I went back to Singapore on home leave, I seek specialist back home. I mention about my condition, I did X-Ray and MRI for my shoulder to see any damage to the rotary cuf or any other injury I suppose. I was told to be confirm as Frozen Shoulder or ahesive capsulitis and advise for MUA which do not require any open wound operation. My result and progress I have post here in this same topic in this Forum before.

To update further, it have been 3 month now since my MUA procedure, it did manage to help me get my ROM back rather quickly, but sad to say, my shoulder still painful. I now can reach my back pocket, wipe myself up rather effortless but pain during sleep still a problem.

I think eveyone condition is unique at some point. Neck can be a problem for sure, I did come across a youtube relating neck to frozen shoulder.

The problem can be also from the Shoulder alone, I saw a clip about a procedure when a tiny cutter was insert into the shoulder area and cut away those so call adhesived tissues which was say to prevent our ROM.

I think I should say, it could be the Neck issue, but it could be the shoulder issue itself, and agree which some say that it could be the shoulder problem that indirectly affect the neck where we use our muscle differently due to our shoulder pain, or vice versa.

Any way, alot of info and experience shared here, judge for yourself. The best part here in this forum for me is that, DON"T WORRY, YOU ARE NOT ALONE.

Hi steadyang

I think your description helps to highlight the confusions we all experience with FS. We suspect its the neck cause, and then we're told it might just be the shoulder. It feels like we should just leave it alone, and then we're told to exercise it even when its painful, etc etc. With so many differing opinions, it really all comes down to making what we think might be the best decision ourselves. This is where the safer options would seem to be the better choice. If that, for some reason, doesn't work, then it may be time to consider other, more aggressive, options. Even with the recommended treatments, it is unlikely there will be any improvement for first 3/4 months, so doesn't it make some sense to hold back on those treatments and just see how it evolves by itself. It can do no harm to try out some sleeping posture changes, during those early stages, just to see if it affects anything for the better....it won't get any worse, which is something I couldn't say for using aggressive therapies.

Yes, we are not alone and that helps in its own way. But maybe its time we started telling our advisors to get their act together and stop giving us contradictory advice. Seems to me that they are just as confused as us, and if they were prepared to admit that fact, then we would see that there is really no option here but to try and figure it out for ourselves, and hopefully empower ourselves to make better decisions. The equation for me is really quite simple......."Unless a professional can tell me with certainty exactly what the cause of my FS is, why should I trust their recommendations for treatment " ? Statistics prove that the condition is very likely to self resolve, given time. That's the best therapy, right there.

Gerry

Gerry - like Judy, I don't disagree with your reasoning - BUT, I think we ALL have to be very careful on forums like this when making statement s which are pupported to be fact , when they are simply opinions we have formed from our own experience and are not backed up with medical evidence.

My FR definitely did not stem from neck problems or trapped nerves. In my OPINION my FS is linked to tendonitis, which in turn is linked to hormonal changes and there is a lot of medical evidence out there to support that. I think the advice you give is great, and you obviously have a real interest in the subject and are trying to help as many people as possible....but we all have very different shoulders and very different reasons for being here...and will all probably need different treatment!

Hi Lesley

Its probably all down to how we react. I , luckilly, haven't had FS for 10 years, but I read some posts and I think...No No No....stop and think! You helpfully pointed out on another post the prevalence amongst 50+ women due to changes, and I think that was good because it gave the issue context. It's obvious from the postings that that's the main demographic affected. It all helps others to make good decisions. I'm not saying my suggestions are the only answer, but if they aren't successful there's always the other stuff to fall back on.

I posted some suggestions earlier on these pages about sleeping on a sofa, don't know if you saw them. Give it a try for a few days, and if you don't notice any changes, you have my permission to say what you like about my opinions ! Just imagine if something as simple as altering sleeping or napping arrangements can make a difference. No appointments needed, and no fee charged !

Gerry

Thanks Gerry. I am having a hell of a time at night - waking every half an hour in severe pain. Unfortunately I have it in both shoulders - albeit the left is FAR worse...and no matter what I do I cannot get comfortable..

I can get to sleep initially - with two cocodamol and a diclofenac - propped up slightly , with both arms on raised pillows. (Husband hanging off the edge by his fingernails) I wake an hour or two later on my side which is my usual sleeping position. Moving is agony - I have stiffened up and get 'stoons' of pain in both shoulders. After that, no matter what I do I cannot get rid of the severe ache. Lying on my back again doesn't work, this time. Lying on either side doesn't work, as my shoulder drops forward - I have tried pillow along the length of the body to raise the shoulder but seldom get comfort. Then ..ah bliss - I find a position that works...and either get an itchy back or can't get to sleep for hubbie snoring!! It's just HELL.

I tried the sofa position you recomend the other day for a nap, but I genuinely cannot get my arm into the position you describe. I have very limited movement still with severe pain (which phase is that then, Mr GP??) every movement of my left arm is complete excrutiating agony.

However, the good news is today I found a Costco shiatsu heating pad which my mother gave my husband three Christmasses ago, and was consigned to the understairs cupboard...if I lean back against it is itis complete bliss for the upper neck muscles which are rock solid (I guess I am hunching my shoulders in defence to the pain)

thanks

Lesley

Lying down can be a real problem....I know. Another method I used was to nap in an armchair, pushed up against some higher furniture, and with pillows to support the head more upright. There's a tendency to slip down once sleep happens, but I also found this position helpful. Finding a sleeping position with the least painful effects is important, i think, because that's what allows the shoulder to rest and start recovering. It might be a slow process, and a little different for everyone, but I think its worth persevering over a few days just to see what happens. I wouldn't begin to think to advise this if it hadn't worked for the better for me. And I'd sooner have the old FS back than waste anybody's time......well, on second thoughts, maybe not.

Gerry

Well I'm home. Today I had a theraputic arthogram. The procedure was awful. It was an awful sensation when he was injecting the joint and awful when he was poking it trying to get in. The doc said he had never seen a joint as tight as mine... he made 5 separate punctures (instead of one) trying to get the needle into the joint before succeeding. It took alot of freezing, cortesone, air and pain to finally pop it. That was something - I actually felt it break away and move out.. at first it kind of hurt, but then it felt good in way. My range of motion has only increased very slightly.. he couldn't release the other areas. Pain is manageable right now... we'll see when the freezing comes out.. not that it really felt like it was ever there.