Okay, I’m a bit late with this update. I had my second appointment with the physio last Thursday. I still had some bruising in the pectoral area from Monday’s visit and so the physio decided to work some of the rhomboid muscles, to use some dry needle acupuncture in the rear of my shoulder and to spend about half an hour doing some painful flexibility stretches and exercises. After this I did some stretching on my own, and then received some electro-stimulus and heat.

The stretching exercises that the physio did to me really worked the range of motion of my shoulder and at times were quite painful. While talking about pain, however, the dry needle acupuncture itself was not a cakewalk.

The dry needle acupuncture was done in the rear of my shoulder, I’m guessing down towards my infraspinosis. The physio was poking needles into my shoulder until he found a tender spot which he proceeded to torture. My arm would reflexively move when he poked one of these areas. At one point he poked a sopt several times in quick succession and I asked him jokingly to stop playing. Although painful (and it hurt the next day and my wife also said she could see hole marks on my arm) it definitely worked for me.

At the moment things are looking up, my range of motion has improved markedly, and I do not feel the pain that I used to feel at the limit of my range of motion. That’s it for now, off to do my stretching exercises!

In my last post I outlined that I had some issues with my diagnosis of frozen shoulder. Yesterday was Monday, and that meant it was the day for my first cortisone shot and my first physio treatment with the new physio.

While visiting my doctor he took the time to cover some of the questions I e-mailed him the previous day, the questions from my previous post. What he said was that back when I first came in, the very restricted range of motion immediately suggested frozen shoulder. The next step was to get an MRI, which we did. While the MRI did not provide any evidence of serious injury in the shoulder it was clear that something was wrong because of the limited range of motion. What he thinks is that it is possible that I am at an early stage of frozen shoulder, and if left untreated at some point in the future I will have full blown Frozen Shoulder.

The cortisone shot was fairly straightforward. He didn’t use any x-rays or ultrasound so the injection wasn’t into the joint itself but rather into the affected tendons which he did take the time to feel out and locate as the target for the injection.

The injection itself didn’t hurt any more than normal needle would hurt – a bit of a pinch as doctors like to say and a bit of burning but otherwise it was over rather quickly. After that it was often a physio.

My new physio, José, knows my doctor and knew about my history and injury, so we didn’t waste very much time talking. He had me lay down my back on the bed and proceeded to relax my shoulder. He made a point of indicating that my shoulder was quite limited. After he relaxed shoulder he started poking around and digging into some the muscles and tendons in my pectoral and my shoulder. One of the first things that he found was that the insertion points of the pectoral muscle near the shoulder were very contracted. To be honest I have been told about this by a massage therapist about 11 years ago and clearly I should have heeded her warnings.

He accessed the pectoral insertion points via my arm pit and worked both insertion points very hard. This was quite painful but I must say it wasn’t as painful as the massage sessions I had to recover a groin injury a few years ago. That pain was ridiculous, so ridiculous all I could do was laugh as I was getting a massage. Yesterday’s massage was painful however at the same time I could feel a renewed sense of blood flow in certain parts of my pectoral, my shoulder and my forearm as he gave me the massage. After working the pectoral insertion points we took a little rest at which point I noticed that my shoulder felt less tight and more mobile.

Next he worked a few other points – I can’t remember exactly what they were – and after that he pursued a spot in the back of my shoulder which has been tender for some time. I asked him what muscle it was and it turns out it was the infraspinosis, the very muscle that I have trouble with when doing my shoulder exercises.

After working a few more muscles he popped me onto a machine that provided heat to my shoulder, then hooked me up for some electro-stimulus after which we were done.

Two hours in total.

I have to say that as I write this post on the Tuesday after all of this work, I a’m quite satisfied with the physio. I not sure how much the cortisone shot affected the workout; I will have a chance to judge this as I am going to be receiving shots every second week, so for the physio sessions in between, well, my ability to endure the pain and range of motion should give me a good hint.

As for my shoulder the range of motion actually seems to have increased today and remarkably I do not have any pain when moving my arm to the extremes of my range of motion which has been the case for the last few months.

As for my injury as a whole, the physio agreed with the doctor in saying that if this wasn’t treated I would likely have worsened to the point where I would be experiencing proper adhesive capsulitis. It is quite likely that the muscle contractions that he encountered had worsened over time and then some event, most likely in the gym (I can think of at least two incidences in the last year), caused the onset of frozen shoulder, or to be accurate, my decreasing range of motion.

The next appointment is Thursday morning. Hopefully the pain from the massage has worn off by then so that the physio can begin for another productive session.

I thought it would be a good idea to post a little bit about what my arm has felt like it in the last few week or so, though to be honest I don’t really have very much pain except wondering my stretching and I reached the limit of mobility of my shoulder. I cannot say that things have gotten worse to be honest with stretching and some exercise my range of motion is the same if not a little bit better.

What I find disconcerting about my diagnosis of having a frozen shoulder is that unlike a lot of people, I do not have severe night pain, nor do I have muscle spasms, problems in my neck or in my arm. In fact I can even sleep on my left side – so long as I’m positioned in a certain way – as there is just one spot that feels awkward when I’m sleeping.

Yesterday was Saturday and when my wife and son went down for a little nap I decided to go to the gym. I did most of the usual rehab exercises that we frozen shoulder people have to do and also was able to do some of the exercises I would normally do when working out at the gym which included push-ups on a bosu trainer, bicep curls, side deltoid raises and some single arm cable pulls for my back.

Today more than anything my biceps are sore. One thing I’ve realized is that although I do not have all of the same symptoms as other sufferers of frozen shoulder my left bicep does have a problem near its insertion in my elbow. I am left wondering if maybe my frozen shoulder is the result of a smaller issue in my shoulder and an injury in my bicep tendon near my elbow.

I’ve informed my doctor by e-mail about all of this and tomorrow when I go into my cortisone shot hopefully will be able to discuss these issues. That’s it for now!

I haven’t updated this website in a while, but happily I had my MRI review last Monday. When I arrived at the appointment I was surprised by what my doctor told me. The results of the MRI came back without any indications of injury or signs of frozen shoulder.

He took the CD of my MRI and put it in his laptop, and we had a look at the images together. He pointed out some of the small injuries that the MRI technician found my shoulder, but overall was surprised not to see any other signs, or should I say any signs of frozen shoulder. In fact, when my doctor spoke with the technician and told him that I had a severe range of motion limitation, the technician was quite surprised.

At this point he decided to give me another review had me sit down on the bed in his office and proceeded to test my shoulder again. Although the range of motion had improved a little bit in the week since I’d seen him there were obviously still issues with my shoulder.

Seeing that I had this major range of motion issue that is common with frozen shoulder he decided to proceed with the usual aggressive treatment, which includes cortisone shots and physical therapy. My first shot is tomorrow, Monday, and he has me buying five ampules of cortisone shots, which will be used over five weeks of cortisone and physiotherapy.

I took some time to research cortisone because it does have a bad reputation, however in cases like frozen shoulder it seems pretty common. The main concern is usually how the injection is done, but I’m not too worried because my doctor is one of the better sports medicine doctors in our province and has worked with Olympic level athletes in the past, so I have a feeling that his injection techniques should be okay.

I think over the next few days we will have a better idea of what’s going on with my shoulder as the cortisone takes effect and hopefully allows the range of motion to improve. From what I have read the range of motion does not approve either the cortisone was ejected in the wrong place or isn’t going to have a positive effect with my injury.

More tomorrow!

There are plenty of definitions of Frozen Shoulder on the interwebs, but this is Mike’s Frozen Shoulder so more importantly, what does it mean to me?

1. My left elbow cannot move forwards and upward beyond the height of my shoulder. This makes it very hard to put on deodorant.
2. I can get around the flexibility issues from #1 by bending my elbow, which means that I can still lift my son above the horizontal plane defined by my shoulders.
3. I cannot sleep on my left shoulder.
4. My left hand cannot move (pain free) to a point behind me.
5. Taking a shirt off is always painful experience.
6. I cannot swim front crawl… properly.
7. I have to do painful exercises every day. Well, I tended to enjoy that before the shoulder injury, but at least I was able to choose which ones.

Okay, seven reasons is enough. So what is frozen shoulder technically speaking. Here are some definitions that I have found that accurately describe my situation:

Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by stiffness and pain in your shoulder joint.

Frozen shoulder, medically referred to as adhesive capsulitis, is a disorder in which the shoulder capsule, the connective tissue surrounding the glenohumeral joint of the shoulder, becomes inflamed and stiff, and grows together with abnormal bands of tissue, called adhesions, greatly restricting motion and causing chronic pain.

I have to admit that I prefer the first one; the second one sounds much worse. That whole the glenohumeral joint of the shoulder grows together with abnormal bands of tissue isn’t very attractive sounding to me. Happily, the Wikipedia entry (the second one above) goes on to state the following after providing some other dire facts about this issue:

There are a number of risk factors for frozen shoulder, including diabetes, stroke, accidents, lung disease, connective tissue disorders, and heart disease. The condition very rarely appears in people under 40.

Awesome. I’m part of an elite group of rare people who have this under 40 (I always liked being different.)

I’m going to read up some more about this. If I find out any other juicy facts I’ll be sure to update this post. With any luck I get the report back from my MRI this week.

Today I had the pleasure of my first MRI. I must say, the thumping air sounds were cool in a house-music discoteca sort of way, but who invited the guy with the air hammer?

There’s really not much more to say; they gave me a digital copy of my results so I’ll add some screen shots and commentary when I get a little more time. For now, I need to copy the CD and give it to my doctor. The report from the scan should be ready in a few days. Until then, I’ll try and figure out the scans on my own

So here I am on the 24th of August, 2009. I’ve just returned from a good 1 hour visit with a local sports med doctor. At the end of it all he tells me that I have Frozen Shoulder, aka adhesive capsulitis. For good measure he tells me that he has never seen a patient diagnosed with FS who didn’t have a direct incident to provoke it (or at least that is what I understood). So how did I get here?

The history

For as long as I can remember I have been leery of my left shoulder. I can remember doing pull downs at the local gym back in Vancouver – maybe 15 years ago now – and having to either start pull downs from the down position or start pull ups from the up position (in both cases more or less maximum concentric).

More recently we had our first child (he is heavy!) and I have been working out progressively harder over the last 12 months. In any case, I have been working the arm hard and had two incidents that are suspicious, one on a pull down where it felt as if the shoulder moved out and back in again, and another where the long head of the bicep seemed to pop from its groove (this was later sorted by a massage therapist I know).

So the gist is, its Monday night, the 24th of August, 2009 and I’ve just made an appointment for an MRI. This being Spain I had two choices: government plan or pay-my-way. This being my health, I have paid my way and have an appointment for tomorrow at 4pm. Should be fun.

And so starts my adventure with adhesive capsulitis.

Aside

Thanks to all of my friends on Facebook who have dealt with this issue either as care givers or injured patients. It helps to know people who have been there, and thanks for letting me know that I’m in for a lot of physio related pain and suffering!