RE: Frozen shoulder!!!!!!!

Irish,  

I would have it checked out .. may not and does not sound like FS, but it may be something. Mine did not start with a lump ... just couldn't raise my arms after a couple of weeks...

Why is it that my endo says he does not nor has he heard that FS occur more often to diabetics for no know reason?

Cause

The causes of frozen shoulder are not fully understood. There is no clear connection to arm dominance or occupation. A few factors may put you more at risk for developing frozen shoulder.

Diabetes. Frozen shoulder occurs much more often in people with diabetes, affecting 10% to 20% of these individuals. The reason for this is not known.

Other diseases. Some additional medical problems associated with frozen shoulder include hypothyroidism, hyperthyroidism, Parkinson's disease, and cardiac disease.

Immobilization. Frozen shoulder can develop after a shoulder has been immobilized for a period of time due to surgery, a fracture, or other injury. Having patients move their shoulders soon after injury or surgery is one measure prescribed to prevent frozen shoulder.

orthoinfo.aaos.org/topic.cfm

From the The American Academy of Orthopaedic Surgeons.

I have had issues with limited range of motion in both shoulders.  The first occurred after a shoulder injury (and after 28 years with diabetes).  The second occurred more spontaneously.  Both events were characterized by muscle and ligament adhesions, which were really painful when stretched.  The solution for me was laproscopic surgery, one in each shoulder.  The first surgery repaired a rotator cuff tear and provided an opportunity for the orthopedic surgeon to fully rotate my shoulder through a full range of motion to break up all the adhesions that came about when I was restricting the range of motion in the injured joint.  

After surgery, it was critical to be diligent with physical therapy (starting the day after the surgery!)  The PT allowed me to keep full range of motion while the formerly-adhered areas healed.  The PT was painful, but not as bad as the adhesions pain.  But once the joints fully healed (about 3 months for me), the pain fully dissipated.  Without consistency on the PT, the adhesions would have quickly reformed.  The second surgery involved just full joint rotation to break up adhesions and some work to "clean up" the joint.  For 19 years now since the surgeries, I've maintained good shoulder range of motion without pain through regular exercise and stretching.  In retrospect, the surgeries were really needed.  The pain of the adhesions was so great, I don't think I could have broken them loose with exercise and PT alone.  With the second surgery, I worked to strengthen the muscles around the joint as best I could in advance of the surgery.  The presurgery strengthening seemed to shorten the recovery time.

I CANNOT OVEREMPHASIZE THE IMPORTANCE OF REGULAR STRETCHING (DAILY, or AT LEAST EVERY OTHER DAY) OF ALL JOINTS FOR THOSE WITH TYPE 1 DIABETES!  IT IS THE SINGLE BEST PREVENTATIVE MEASURE AVAILABLE AFTER GOOD BG CONTROL.

As I understand, this problem occurs much more frequently in those with diabetes, likely because of hyperglycemia leading to more glycated proteins and advanced glycated endproducts in joint structures.  

This is VERY GOOD advice !  I had similar issues and similar results, no problems since and it has been several decades since then. I know the procedures are much better now than they were. Thanks Randy.

OK, my question on this is for Jeff and Randy.  Was the relief of pain the major reason you did the surgery or was it to improve the ROM.  I have had FS (bi-lateral) for almost 4 years.  I did NOT do surgery and spent about 3 years in pain (lots as every one has). I have probably 75 degrees of range on both arms now, but can't get a bar behind my neck.  I've restarted PT and since the pain has gone away, it has improved my range.

So would you do surgery to improve ROM only?  Or is that a really stupid idea?

I had frozen shoulder to the point I could not move it without it taking my breath away, and no pain meds helped. I tried PT and it only got worse, after the PT sessions it would keep pace with my heart beat. After having arthroscopic  surgery (this is where they make a hole in the front, side, and back sides of the shoulder, just to be clear) and use remote camera without actual opening the joint, about the size of a sharpie marker. It was outpatient procedure, and I was down about 24 hours, the wound healed nicely and I can't even see the scar anymore, the PT did help after the spurs and debris was removed and the socket cleaned, full range continues to this day and have zero issues with it. I have practiced martial arts for over 40 years, and I do know range of motion and pain is easy to find other places. I was dx in 1972 at 13 yrs old and I had this surgery 21 yrs ago. My ortho was someone who did extensive work on professional athletes and had patients from every sport, so be picky about who does this.  

Great comments from Jeff, and great description of arthroscopy.   If you need arthroscopy, I would not delay it or avoid it.  It is minimally invasive, not cuts to muscle.  So healing time is dramatically less of an ordeal than open joint surgery.  The key determination for me to go the surgery route was the adhesions pain (severe, dibilitating pain at range-of-motion limit).

I would suggest that if you are not having adhesions pain, the best course is a guided training regimen for stretching and strengthening the joint and surrounding muscles.  Expect stretching discomfort at the limits of your current range of motion.  A  PT can guide you on the rate of progression of stretching, and most of the work you can do on your own.  As long as you are not having adhesions pain, I would avoid the arthroscopy.  (In my first post, I inadvertently described "laparoscopic surgery".  I meant arthroscopy).

Don't expect to get great gains in 1 week.  The key is daily consistency, or at least every other day and working a bit beyond the comfort zone in each session.  

Thanks Jeff and Randy.  My pain stopped about 8 months ago ... after 3 + years of terrible pain with little hope except surgery.  I have been doing daily stretching and going to PT.  I do have pain at the outer limits of my range but keep working on it.  

I probably would be stupid to attempt surgery when there is no pain as I refused to do it when I was in pain.  I would like better ROM and I know that like bending over to touch your toes .. if you don't do it daily you'll probably not be able to do it.

Like Keith, several years ago, I wasdealing with frozen shoulder. An orthopedic surgeon gave me a special shot, directly into the shoulder that has fixed things for the most part. I too heard "Need to avoid surgery because of your diabetes" I had thought this treatment would only last for 12+ months, but it has made life so much better for over 3 years. Pain was significant, getting dressed very difficult, among other things as well. Site changes became hard, and choice of locations got limited. I would need to look up the specifics of the procedure, but it did take place in a hospitol. Best of luck Martha!

Jedski

Type 1 since 66