Saturday, May 22, 2010

mixed improvement

After a few weeks of progress, I really cut back on doing any of the physical therapy exercises that had been given to me to try at home. I wanted to see if the shoulder would continue improving on its own. I also began lifting weights more regularly, and I've been doing more hiking too. I was surprised at how much the shoulder moves while hiking. When I first started, going for a hike resulted in some pain, especially after the hike. Now it hardly bothers me at all. I'm able to do most of my weightlifting exercises again, but in most cases with reduced weights. I still can't get do shoulder presses or squats with a bar behind my neck.

External rotation continues to improve, about an inch per week. Flexion stopped improving, and actually got slightly worse over the last week. This is a hint that I should work on the stretching exercises more than I've been doing.

Sunday, April 18, 2010

leaps and bounds

I have been continuing to do light stretching exercises on my own every day. I do the ones that were prescribed by my physical therapist, and also just try to stretch the shoulder in all directions. For example, I'll reach over to my right shoulder and try to get my hand as far around to my back as possible without causing too much pain. Or I make an effort to reach into my left back pocket and see how much I can stretch while doing that.

My biggest effort has been towards getting more external rotation back, and it seems to be working. I have two exercises for that. I hold a wooden dowel in front of me with my elbows at right angles, as if I were holding a tray in front of me. Then I use my right hand to push at the left hand. I try to keep my left elbow moderately a bit close to my body, and feel the stretch in my shoulder. Another variation of that is just to try to externally rotate my shoulder by keeping my elbow pinned at my side, bent at 90 degrees as if I'm holding a mug in front of me, and then moving my hand out to the side in an arc parallel to the floor, as far out as it will go. It hurts and doesn't get very far. But I've noticed in the last two weeks that it is actually moving more and more over time.

I went away last weekend, and while I was away, my shoulder was kind of acting up. It got a bit painful and weirdly sore. There was a strange pulling sensation somewhere, as if I had a thread coming loose in there. Hard to describe.

Anyway, this evening I was shampooing and suddenly thought "hey, my hand just went farther over my head than it has in a while, I'm sure of it!" So I took another measurement. My last measurement was last Friday. My hand can move an inch farther up the wall, and over an inch more out in external rotation than it could last Friday! Wow, I am very impressed. I have no idea whether this is because I stopped going to the fairly brutal PT sessions, or whether this is just the natural course of the disease. What good progress!

Saturday, April 17, 2010

another visit to the doctor

I visited the doctor on Tuesday; she had wanted to see how things were going after I'd been doing physical therapy for a while.

I explained that I'd initially had quite a lot of pain with the PT, but that the condition seemed to be slowly improving now. She repeated all the stuff she had told me earlier - it can take two years, etc. But she also said that she didn't think I needed any more physical therapy sessions per se, and that doing the exercises at home should be enough to help. She said that since I'm an active person, she expects that I will challenge the shoulder enough with my usual activities, which will help to reduce the stiffness.

She didn't seem thrilled that the physical therapist had been causing so much pain. She said the condition is associated with inflammation, and forcing the shoulder into painful positions is likely to produce more inflammation. However, she admitted that there's so little known about the condition that you can't really make any absolute statements.

Well, I think I pretty much agree with her. I can't actually tell whether the PT is helping, hurting, or indifferent at this point. I don't know what state I'd be in now without the PT. I'm inclined to think it helped me over the worst of the problem, but it's so hard to tell. But at this point, I have a feeling I'm just as well off doing exercises at home.

I had my 12th PT session on Monday, the day before visiting the doctor. I'd decided to cut back to once a week on the sessions, to see if things continue to improve without so many visits. PT consumes such large chunks of time, and seems to make things so much worse for a couple of days. I want to see what happens if I continue on my own. The visit to the doctor influenced me though, so that I now think I'll stop PT and see how things go. If the improvement slows, I can always go back for more sessions, so far as I know.

In fact there's a perverse incentive for me to continue PT even though it's not clear to me that I need it. There's only a $10 co-pay. I might think "let me just keep going to as many sessions as I can get insurance to pay for. Why not? It's not that expensive and I get more treatment!" The insurance company should give me a reward for saving them money, no? Well, no, I guess that would be asking too much from an insurance company.

Sunday, April 11, 2010

more progress

I went for a hike today. I took a trail which involved some arm work; reaching out to balance, climb, and support my weight in a few places. There wasn't much of that, but enough to test the arm a little.

I had taken this same trail at the beginning of March, and my shoulder bothered me a lot after doing that. Today, it was a pretty big contrast. The shoulder still hurt some, but it felt much more flexible. That's very encouraging!

Saturday, April 10, 2010

mri cost

I just got a bill for the MRI that was done back in Feb, over a month ago. Apparently, the cost was about $1700. But insurance covered all but $25 of it.

It's really weird that we aren't told up-front how much a treatment will cost. I "knew" that my insurance would cover the bulk of the cost, so I didn't put any effort into finding out. I wonder if I would have gone for the MRI if I didn't have insurance, though. I'd probably have thought "I'll take the risk and skip it, I'd better save my money for a potential catastrophic incident."

Saturday, April 3, 2010


Early on, I asked both my doctor and my physical therapist if there was anything I could do nutritionally to improve my condition. It's unfortunate, but still very typical, that medical professionals appear to know next to nothing about nutrition. In any case, nobody had a suggestion.

I went snooping around the internet to see if I could find anything. Nutritional supplements are one of those things that snake oil salesmen like to latch onto, and searching the internet turns up a ton of dubious claims.

As for the science, you can find suggestive, but not definitive, research that zinc is important to production of collagen. In rats, anyway.

A few years ago, I kept tabs on my diet. At the time, I appeared to be deficient in zinc. However, I hadn't noticed any issues caused by it, and I've always been reluctant to take supplements without reason, so I didn't do anything to correct the situation.

Is it possible that my zinc deficiency led to frozen shoulder? I suppose so, although I guess there's no way to know for sure. In any case, I decided to start taking a zinc supplement soon after I started physical therapy.

I'm taking chelated zinc (50 mg of zinc amino acid chelate, 333% of the RDA) since it's supposed to be one of the more bioavailable forms of zinc. In addition, since zinc interferes with copper absorption, I'm taking a copper supplement (2 mg of copper gluconate, 100% of the RDA). I take the zinc mid-morning on an empty stomach, since that's supposed to be better for absorption. That typically gives it a couple of hours to float around without a lot of competition. I take the copper later in the day, but not on an empty stomach, since I haven't read anything that indicates that would be useful.

Recall that I had noticed an article about shoulder pain in Nigerians at PubMed. When I first thought about zinc being a possible factor in frozen shoulder, I immediately wondered whether the Nigerian diet might be deficient in zinc, leading to more cases of frozen shoulder in that area of the world. However, it doesn't appear to be the case. Some research by Onianwa, et al, says that "the estimated weighted average dietary intakes for the entire adult population [of Nigeria] were calculated to be 2.64 mg Cu/day and 15.8 mg Zn/day" which is quite near the US RDA for those minerals. So, there are no helpful clues from that research.

Sunday, March 28, 2010


As I mentioned previously, I've been checking my progress a few times each week by testing my range of motion using a few simple measurements. The last mark I made was on March 22, a week ago, although I did make a few measurements over the course of the week and found no gains.

This evening, I clasped my fingers around the back of my head and felt like my left arm was moving a little more freely, with less pain. I went to my "measuring stick" taped up to the wall, and sure enough, the tips of my fingers could go about 3 inches higher than on March 22. I'm pretty sure this improvement happened in the last day or two.

It's really amazing and feels incredibly good to make such progress all of a sudden, even if it is just a few degrees change.

On the downside, I tested external rotation and there's still no change in that.