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.
Saturday, May 22, 2010
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!
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.
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!
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."
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
zinc
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.
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
progress
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.
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.
Friday, March 26, 2010
insurance confusion
It turns out that my insurance company will probably allow more than 8 days of PT. I misunderstood the letter that I got. Apparently the physical therapy practice requests 8 days of treatment at a time, and it was the letter approving the first 8 days which confused me.
My eighth session was a couple of days ago, and it looks like I'll get more next week.
My eighth session was a couple of days ago, and it looks like I'll get more next week.
Saturday, March 20, 2010
stretching the coracohumeral ligament
This afternoon, I finished reading the article Positional Stretching of the Coracohumeral Ligament on a Patient with Adhesive Capsulitis: A Case Report, by Jose Orlando Ruiz. It sounded interesting and simple enough, so I decided to try it. The article can be summed up with one quote:
The article describes pretty clearly the stretching exercise, and also shows a photo of the action (Fig 2). I didn't want to lie down, so I tried to emulate this position while standing. I brought my left arm behind my back as shown in the figure, and used my right arm to help keep it pinned back, meanwhile extending my chest out and focusing on bringing my scapula together in the back. I could feel a decent stretch in the front of the shoulder, and only a very minor amount of pain.
Actually, there's a bodybuilding pose called the side triceps which is quite similar to this move. However, in my case, I kept my hand supinated as described in the article and shown in the figure.
In addition, the article says the stretch is done with ice applied ("cryotherapy"), but I did not try that. The idea is that the cold helps to "contract the tissues in the new lengthened position". Hm, I don't know about that, but I might try that later, if the stretching alone seems to help.
At the moment, though, I'm wondering if this didn't cause me some excess pain later in the evening.
I should probably mention that I'm not a doctor and should you try this yourself, don't blame me if something goes wrong! I encourage you to consult your own physical therapist or doctor before trying it.
The primary purpose of this single-patient case report is to describe outcomes of a positional stretching technique following the anatomical orientation of the two bands of the CHL and rotator interval capsule in a patient with [adhesive capsulitis].Of course, the case study was done on one person, so in some sense it's meaningless. On the other hand, I doubt it could hurt. In fact, my physical therapist has encouraged me to do general stretching exercises, even allowing weight-lifting, as long as I avoid painful movements (although in point of fact, the physical therapy exercises that were prescribed to me always cause the largest degree of pain). I've already been doing an exercise which is very similar to the one described, only I didn't go so far as to bring my affected arm behind my back for additional stretching.
The article describes pretty clearly the stretching exercise, and also shows a photo of the action (Fig 2). I didn't want to lie down, so I tried to emulate this position while standing. I brought my left arm behind my back as shown in the figure, and used my right arm to help keep it pinned back, meanwhile extending my chest out and focusing on bringing my scapula together in the back. I could feel a decent stretch in the front of the shoulder, and only a very minor amount of pain.
Actually, there's a bodybuilding pose called the side triceps which is quite similar to this move. However, in my case, I kept my hand supinated as described in the article and shown in the figure.
In addition, the article says the stretch is done with ice applied ("cryotherapy"), but I did not try that. The idea is that the cold helps to "contract the tissues in the new lengthened position". Hm, I don't know about that, but I might try that later, if the stretching alone seems to help.
At the moment, though, I'm wondering if this didn't cause me some excess pain later in the evening.
I should probably mention that I'm not a doctor and should you try this yourself, don't blame me if something goes wrong! I encourage you to consult your own physical therapist or doctor before trying it.
some improvement
I went for a little hike today. Adhesive capsulitis seems to get irritated by hiking, probably because of the way your arms swing when you walk.
The swing of my left arm is somewhat inhibited compared to my right. I'm not sure if that's an unconscious attempt at avoiding pain, or if the stiffness prevents it from swinging normally. I can force it to swing more if I try, and that does cause some pain.
In any case, the last time I went hiking, I was bothered by pain at the end of the hike, and a clicking feeling when the shoulder moved (bursitis?). Today, it went better. I was out for about 2 hours, and my arm didn't bother me much.
I can't tell if this was a fluke; this disease is quite tricky and sometimes gets worse when you don't expect it, or, on the other hand, the pain lessens for no discernible reason.
Everything was mostly okay today soon after I woke up, and I was feeling pretty good and optimistic, until after I did my physical therapy exercises this afternoon. A while after doing those, the shoulder began to feel clicky and aggravated. Maybe I didn't apply ice long enough after doing the exercises. Right now it's feeling sore, so the ice is back on.
The swing of my left arm is somewhat inhibited compared to my right. I'm not sure if that's an unconscious attempt at avoiding pain, or if the stiffness prevents it from swinging normally. I can force it to swing more if I try, and that does cause some pain.
In any case, the last time I went hiking, I was bothered by pain at the end of the hike, and a clicking feeling when the shoulder moved (bursitis?). Today, it went better. I was out for about 2 hours, and my arm didn't bother me much.
I can't tell if this was a fluke; this disease is quite tricky and sometimes gets worse when you don't expect it, or, on the other hand, the pain lessens for no discernible reason.
Everything was mostly okay today soon after I woke up, and I was feeling pretty good and optimistic, until after I did my physical therapy exercises this afternoon. A while after doing those, the shoulder began to feel clicky and aggravated. Maybe I didn't apply ice long enough after doing the exercises. Right now it's feeling sore, so the ice is back on.
another insurance snafu
I opened some mail from my insurance company today. Turns out they'll pay for no more than 8 physical therapy sessions (and according to the verbiage in the notice, they may not even pay for that - thanks for the warning, guys!). So my next one may be my last.
There's certainly been some progress, but it's a mixed bag. I might be willing to pay for a couple more sessions on my own, but it won't be more than one a week. If I'd known beforehand, I probably would have rationed out the sessions more slowly. Bummer.
The next time I hear someone complain about how the government will decide whether or not I get medical care under the public option, I'm going to bop them. There's already a large, bureaucratic, money-grubbing institution standing between me and my medical treatment - my insurance company.
There's certainly been some progress, but it's a mixed bag. I might be willing to pay for a couple more sessions on my own, but it won't be more than one a week. If I'd known beforehand, I probably would have rationed out the sessions more slowly. Bummer.
The next time I hear someone complain about how the government will decide whether or not I get medical care under the public option, I'm going to bop them. There's already a large, bureaucratic, money-grubbing institution standing between me and my medical treatment - my insurance company.
Friday, March 19, 2010
PNF
Today was my 7th physical therapy session for a total of 3 weeks. It was more of the usual: start by applying moist heat to the shoulder for about 10 minutes, then do some exercises, and finally the massage and mobilization techniques applied by the physical therapist himself.
Almost every time I go, they throw something new into the mix, though. This time, the physical therapist asked an assistant to work with me on some PNF. I was intrigued, because I had just seen this acronym in an article last night but hadn't had time to look into it.
In this particular case, it was a rather lame exercise. I lay down on my back, and moved my arm straight up in an arc as far past 90 degrees as possible (which is not much), with my thumb pointing in the direction of travel. Then I rotated my hand so the thumb was pointing towards my feet and moved my arm back down to my side. While doing this, the assistant applied a very small resistive force against the motion of my arm. This really felt completely useless, but in any case didn't go on for long.
It's a mixed bag in the area of pain. With so little sleep yesterday, I fell asleep pretty easily. I still woke up a couple of times with pain in the middle of the night, but fell back to sleep without much trouble.
When I awoke this morning, the pain was pretty bad, and I kept debating whether I should go to physical therapy, scheduled for midday. I went anyway. The mobilization techniques were still agonizing, but it was more bearable, similar to what was done last time. The therapist has been easing up a little, and I think that is helping.
Since I did 1.5 hours of physical therapy today, I opted to do my weight-lifting workout tonight. For any exercises involving my left shoulder, I use very light weights and try to stay away from anything that causes the least bit of pain... I feel pretty good right now, no pain at all. This disease is strange, the way you can be in fierce pain in the morning and then feel normal just hours later.
I still don't have any ibuprofen so I wonder how I'll sleep tonight.
Almost every time I go, they throw something new into the mix, though. This time, the physical therapist asked an assistant to work with me on some PNF. I was intrigued, because I had just seen this acronym in an article last night but hadn't had time to look into it.
In this particular case, it was a rather lame exercise. I lay down on my back, and moved my arm straight up in an arc as far past 90 degrees as possible (which is not much), with my thumb pointing in the direction of travel. Then I rotated my hand so the thumb was pointing towards my feet and moved my arm back down to my side. While doing this, the assistant applied a very small resistive force against the motion of my arm. This really felt completely useless, but in any case didn't go on for long.
It's a mixed bag in the area of pain. With so little sleep yesterday, I fell asleep pretty easily. I still woke up a couple of times with pain in the middle of the night, but fell back to sleep without much trouble.
When I awoke this morning, the pain was pretty bad, and I kept debating whether I should go to physical therapy, scheduled for midday. I went anyway. The mobilization techniques were still agonizing, but it was more bearable, similar to what was done last time. The therapist has been easing up a little, and I think that is helping.
Since I did 1.5 hours of physical therapy today, I opted to do my weight-lifting workout tonight. For any exercises involving my left shoulder, I use very light weights and try to stay away from anything that causes the least bit of pain... I feel pretty good right now, no pain at all. This disease is strange, the way you can be in fierce pain in the morning and then feel normal just hours later.
I still don't have any ibuprofen so I wonder how I'll sleep tonight.
Thursday, March 18, 2010
articles
I had asked my physical therapist for resources or articles to gain more insight into my condition. Yesterday, he gave me a couple of sites where I could look into frozen shoulder further. He pointed me to the article on adhesive capsulitis at the Professional Baseball Athletic Trainers Society. The article is okay, but it's mostly a rehash of the same information that I've found elsewhere online. There's quite a lot of discussion about surgical treatments, if you're into that kind of thing. The illustrations for the site are the best thing about it, although you wonder how correct they are. My preference is usually to go to wiki for general information like this.
In addition, he had told me to search PubMed for the terms "shoulder adhesive capsulitis". I'd actually already tried PubMed, but the first result I got was about shoulder pain in Nigerians, which didn't sound very relevant, and I had quickly decided to look elsewhere.
In fact, PubMed seems to be a good resource after all. Since he suggested I try it, I returned and immediately struck gold. I found a single case report1 and a more extensive study2.
I'm still in the process of reading the articles, and I'll write about them more if I find anything notable.
1 Positional Stretching of the Coracohumeral Ligament on a Patient with Adhesive Capsulitis: A Case Report, by Jose Orlando Ruiz
2 Comparison of High-Grade and Low-Grade Mobilization Techniques in the Management of Adhesive Capsulitis of the Shoulder: Randomized Controlled Trial, by Henricus M Vermeulen et al.
In addition, he had told me to search PubMed for the terms "shoulder adhesive capsulitis". I'd actually already tried PubMed, but the first result I got was about shoulder pain in Nigerians, which didn't sound very relevant, and I had quickly decided to look elsewhere.
In fact, PubMed seems to be a good resource after all. Since he suggested I try it, I returned and immediately struck gold. I found a single case report1 and a more extensive study2.
I'm still in the process of reading the articles, and I'll write about them more if I find anything notable.
1 Positional Stretching of the Coracohumeral Ligament on a Patient with Adhesive Capsulitis: A Case Report, by Jose Orlando Ruiz
2 Comparison of High-Grade and Low-Grade Mobilization Techniques in the Management of Adhesive Capsulitis of the Shoulder: Randomized Controlled Trial, by Henricus M Vermeulen et al.
more problems sleeping
I had a physical therapy session yesterday evening at 6. It lasted just a little over an hour. It was still plenty painful, but less so than usual. The physical therapist told me that he's trying to be more gentle, so as to avoid aggravating the tendinitis.
I woke up at 2:30 this morning, and felt too awake to get back to sleep. After lying in bed for an hour, I finally got up.
There was some pain in my shoulder that was bothering me, but I had pain in my forearm - extreme soreness - which was worse. This is new. I think it's due to the physical therapy. My elbow has been giving me trouble too.
I've been sleeping worse since I started PT. Previously, I might wake up at 5, but I'd be able to get back to sleep. Now I'm waking up at all hours between midnight and 7. Tonight I'm going to try some ibuprofen. The only thing I've tried so far is naproxen sodium, and that doesn't seem to help much.
Maybe I should avoid doing PT in the evening; that might help with the sleep.
I woke up at 2:30 this morning, and felt too awake to get back to sleep. After lying in bed for an hour, I finally got up.
There was some pain in my shoulder that was bothering me, but I had pain in my forearm - extreme soreness - which was worse. This is new. I think it's due to the physical therapy. My elbow has been giving me trouble too.
I've been sleeping worse since I started PT. Previously, I might wake up at 5, but I'd be able to get back to sleep. Now I'm waking up at all hours between midnight and 7. Tonight I'm going to try some ibuprofen. The only thing I've tried so far is naproxen sodium, and that doesn't seem to help much.
Maybe I should avoid doing PT in the evening; that might help with the sleep.
Wednesday, March 17, 2010
insurance snafu
My second physical therapy session was similar to the first. Prior to working on me, they had me warm up and do a few exercises. Then the physical therapist repeated his massage followed by the painful pulling and twisting manipulations. Then they showed me a couple more exercises.
I went to PT twice the next week. After my third session, I learned that the insurance company still did not have a referral from my PCP. Since it had been a week since I had asked for the referral, I thought there might be some problem, so I cancelled my next PT session. I called up my PCP and went through their bizarre automated phone service to request a referral again. I had to visit my PCP's office to pick up the MRI CDs, anyway. While I was there, I found that my referral had just come through, so I didn't have to cancel the next session.
I'm glad I have insurance, but I do think it's kind of ridiculous that insurance can be such a hassle. I spent about an hour on the phone trying to get information about the referral and making sure that the PT would be covered. If lots of people are having to do this, it seems to me a great waste of time in aggregate.
Throughout this process I've been annoyed by how few things you can do online. I'd like to be able to make medical appointments and find out about insurance issues online. My referral request would have been much more easily done via a form on the internet.
I went to PT twice the next week. After my third session, I learned that the insurance company still did not have a referral from my PCP. Since it had been a week since I had asked for the referral, I thought there might be some problem, so I cancelled my next PT session. I called up my PCP and went through their bizarre automated phone service to request a referral again. I had to visit my PCP's office to pick up the MRI CDs, anyway. While I was there, I found that my referral had just come through, so I didn't have to cancel the next session.
I'm glad I have insurance, but I do think it's kind of ridiculous that insurance can be such a hassle. I spent about an hour on the phone trying to get information about the referral and making sure that the PT would be covered. If lots of people are having to do this, it seems to me a great waste of time in aggregate.
Throughout this process I've been annoyed by how few things you can do online. I'd like to be able to make medical appointments and find out about insurance issues online. My referral request would have been much more easily done via a form on the internet.
Tuesday, March 16, 2010
initial physical therapy session
As soon as I left my orthopedist, I went looking for a physical therapist. The clinic recommended their own physical therapy center, but they were booked solid for a couple of weeks, and there was no way I was waiting. An assistant suggested a place located in a sports club close to work. I called them immediately, and found out that they had an opening for the following day. w00t! I booked it, first verifying that they would accept my insurance.
The physical therapy center was well-versed in the ways of insurance. They told me I'd need an external referral from my PCP in order for insurance to cover my tab. So I rang up my doctor, and had to navigate a bizarre automated phone response system in order to enter my referral request. I never actually spoke to a person, and the message said that there would be no confirmation that the referral was sent. Hm.
The next day, when I went to the center, I asked how much the session would cost if my insurance didn't cover it. The answer was $150 per session. At that rate, I would only attend a few sessions if it were not covered... I would probably be doing all exercises at home at this point, if not for the insurance. As it is, I only have a $10 co-pay.
During the first session, I showed my physical therapist the MRI report, and emphasized the other conditions I had in addition to adhesive capsulitis. He seemed reasonably attentive. He did a few tests of my shoulder (more than the orthopedist had done on my first visit to her). Then he had me lie down on a table and gave my left shoulder a really deep massage. It felt wonderful and didn't hurt at all. That was followed by some very painful manipulations of my arm and shoulder.
Finally, he printed out a sheet with six physical therapy exercises on it, and told me to do them at home each day.
The whole session took about 1 h 20 min. I was surprised that it ran over an hour, but I figured this was because it was the first session. In fact they regularly run over an hour (and sometimes start late). I can't really complain about this, since the physical therapist told me that the more PT I do, the faster I'll regain my range of motion. I'm able to do between 40 and 90 minutes of PT exercises at home, usually. I try to spread them out over the course of the day.
I asked the physical therapist what pro athletes do if they get this condition. Surely they can't afford to be out of action for months at a time? He told me that 1) they take any injection necessary (presumably meaning corticosteroids, which I have no intention using) and 2) they do PT 3-4 hours per day. I'm not confident that the therapist knew for sure of athletes who have adhesive capsulitis; he may have been speaking of pro sports injuries in general. I'd like to read more about how pro athletes deal with this condition.
The physical therapy center was well-versed in the ways of insurance. They told me I'd need an external referral from my PCP in order for insurance to cover my tab. So I rang up my doctor, and had to navigate a bizarre automated phone response system in order to enter my referral request. I never actually spoke to a person, and the message said that there would be no confirmation that the referral was sent. Hm.
The next day, when I went to the center, I asked how much the session would cost if my insurance didn't cover it. The answer was $150 per session. At that rate, I would only attend a few sessions if it were not covered... I would probably be doing all exercises at home at this point, if not for the insurance. As it is, I only have a $10 co-pay.
During the first session, I showed my physical therapist the MRI report, and emphasized the other conditions I had in addition to adhesive capsulitis. He seemed reasonably attentive. He did a few tests of my shoulder (more than the orthopedist had done on my first visit to her). Then he had me lie down on a table and gave my left shoulder a really deep massage. It felt wonderful and didn't hurt at all. That was followed by some very painful manipulations of my arm and shoulder.
Finally, he printed out a sheet with six physical therapy exercises on it, and told me to do them at home each day.
The whole session took about 1 h 20 min. I was surprised that it ran over an hour, but I figured this was because it was the first session. In fact they regularly run over an hour (and sometimes start late). I can't really complain about this, since the physical therapist told me that the more PT I do, the faster I'll regain my range of motion. I'm able to do between 40 and 90 minutes of PT exercises at home, usually. I try to spread them out over the course of the day.
I asked the physical therapist what pro athletes do if they get this condition. Surely they can't afford to be out of action for months at a time? He told me that 1) they take any injection necessary (presumably meaning corticosteroids, which I have no intention using) and 2) they do PT 3-4 hours per day. I'm not confident that the therapist knew for sure of athletes who have adhesive capsulitis; he may have been speaking of pro sports injuries in general. I'd like to read more about how pro athletes deal with this condition.
Monday, March 15, 2010
mri results
left shoulder coronal view
left shoulder sagittal view
left shoulder axial view
The next week, while I was cooling my heels in the doctor's office, I took a look at the MRI report which was open on a computer screen in the exam room. Here's what it said:
Examination: MRI study of the left shoulderThe MRI photos mostly looked okay to me, but what did I know? I had looked at some rotator cuff tears online already, and the bad ones had a lot of white areas. Mine only had some small white areas. So that was encouraging. But reading that I had a partial tear was alarming, and I feared the doctor would recommend surgery.
History: Left shoulder weakness and stiffness with history of earlier injury
Technique: Axial coronal and sagittal T1 and T2-weighted images of the left shoulder are reviewed.
Findings: Hypertrophic changes are seen around the acromioclavicular joint with small amount of fluid in the subdeltoid bursa consistent with bursitis and mild changes of tendinitis involving the most anterior portion of the supraspinatus tendon. There is a small partial articular surface tear involving leading edge of the infraspinatus tendon with adjacent synovial cysts seen at the base of the humeral head. The rotator cuff is intact and no abnormalities are seen in the biceps tendon which is located normally in the bicipital groove. Glenoid labrum is preserved. No fractures or bony contusion is seen. No bony destruction is identified. Normal study otherwise.
Conclusion: Mild degenerative changes acromioclavicular joint with subdeltoid bursitis and tendinitis in the supraspinatus region.
2. Partial articular surface tear of the leading edge of the infraspinatus tendon.
In fact, she did not. She told me that I almost certainly had adhesive capsulitis, and recommended physical therapy. I asked about the partial tear - wasn't that a concern? No, she said, it will eventually heal on its own. She also brushed aside the concerns I raised about the bursitis and tendinitis described in the report, saying that my main problem was adhesive capsulitis, end of story. At some point she also said something like "well you don't have any tendinitis" and I had to correct her, having read the report myself. (As you might imagine, my confidence in the doctor was not swelled by her remark.)
So two months after first seeing a doctor for the problem, I was on my way to PT. A good month of the delay was my own fault, and I wish I had not procrastinated so much.
I was able to obtain a copy of the MRI images free of charge, which was sweet. It's fun to run them as an animation, and I hope to create an animation for a blog post, but for now I've just posted one each from the different views. I wish the doctor had gone through all of the images with me. I'd like to know what parts of the image indicate the partial tear, bursitis and tendinitis.
Sunday, March 14, 2010
mri
A week after my visit to the orthopedist, I went in for my scheduled MRI. It was the first time I'd had an MRI. I had read up on them a little, so I would know what to expect. I was a little worried because I'd read that they're very loud, but I hadn't bothered to bring earplugs. Fortunately, they gave me earplugs before going in for the test.
I got a little alarmed when they had me sign some forms saying I wasn't allergic to the contrast dye used for MRIs. Nobody had said anything about injections! In the end, I was not given an injection, whew!
The MRI was pretty loud, but it's intermittent, so it didn't bother me too much. It's a weird experience. I'm not claustrophobic, but I did have the strong urge to sit up a few times, even though I knew I couldn't. The whole thing took about 30 or 40 minutes. By the end, my muscles were getting little spasms from lying still for so long. But the MRI technician said the images were fine.
I was scheduled to see the orthopedist again in another week. I hated having to wait that long for the verdict.
I got a little alarmed when they had me sign some forms saying I wasn't allergic to the contrast dye used for MRIs. Nobody had said anything about injections! In the end, I was not given an injection, whew!
The MRI was pretty loud, but it's intermittent, so it didn't bother me too much. It's a weird experience. I'm not claustrophobic, but I did have the strong urge to sit up a few times, even though I knew I couldn't. The whole thing took about 30 or 40 minutes. By the end, my muscles were getting little spasms from lying still for so long. But the MRI technician said the images were fine.
I was scheduled to see the orthopedist again in another week. I hated having to wait that long for the verdict.
Saturday, March 13, 2010
suddenly, feels better
This morning I woke up around 5 am again, with pain, but managed to get back to sleep till around 7. I wasn't very active today. My shoulder was sore all day, and I didn't feel like doing much. Instead I did a lot of reading and watched some TV. Around 5 pm, I decided I should take advantage of the extra time and attempt a weight-lifting workout.
My workout schedule has been in a shambles since I started physical therapy, which takes too many hours out of my day. So I'm trying to get in two workouts on the weekends, at least. I'm mostly having to lift with very light weights to get around the shoulder handicap.
After lifting, I went through about 40 minutes of PT exercises. The abduction exercises have been particularly difficult since I started. But after just a few tries, it suddenly seemed like things loosened up remarkably. Visually, it doesn't look like much of an improvement, but it is visible. The feeling is much better though. I'm still in mild pain, but I've noticed all evening that the pain has moderated quite a bit. In fact the most pain I feel right now is in my elbow, which I'm pretty sure is secondary, due to excessive twisting while doing PT.
External rotation is still just about zero though. That's where I want to see improvement, next.
Unfortunately, I can't tell whether the improvement is due to the ice that I applied yesterday, or the first few days of PT. The ice seemed to reduce the swelling, and I wonder if that did the trick. I'm going to pick up some ice packs tomorrow and apply them after PT for a while, to see if that helps some more.
My workout schedule has been in a shambles since I started physical therapy, which takes too many hours out of my day. So I'm trying to get in two workouts on the weekends, at least. I'm mostly having to lift with very light weights to get around the shoulder handicap.
After lifting, I went through about 40 minutes of PT exercises. The abduction exercises have been particularly difficult since I started. But after just a few tries, it suddenly seemed like things loosened up remarkably. Visually, it doesn't look like much of an improvement, but it is visible. The feeling is much better though. I'm still in mild pain, but I've noticed all evening that the pain has moderated quite a bit. In fact the most pain I feel right now is in my elbow, which I'm pretty sure is secondary, due to excessive twisting while doing PT.
External rotation is still just about zero though. That's where I want to see improvement, next.
Unfortunately, I can't tell whether the improvement is due to the ice that I applied yesterday, or the first few days of PT. The ice seemed to reduce the swelling, and I wonder if that did the trick. I'm going to pick up some ice packs tomorrow and apply them after PT for a while, to see if that helps some more.
physical therapy
I've been trying to create my blog posts in an orderly fashion, but I'm skipping ahead with this one.
Yesterday was my fourth physical therapy session. The whole session lasted about two hours.
By now they have me doing a regular series of exercises. In the first one, I spend eight minutes on the "hand cycle", which is essentially a stationary bike which you pedal with your hands. (The machine is way overbuilt for what it does, IMHO). I'm nearly convinced that it's doing more harm than good, since it's impossible to pedal without the feeling that pins are stabbing into my left shoulder.
Since that's first, it sets me up for pain and crackling during the entire session. I try to avoid crackling by easing into and out of positions slowly. Before I developed this condition, it was unusual for me to experience clicking or crackling in my shoulders, and I don't want to develop it in the long-term.
As is often the case with medical offices, my physical therapist was delayed, so I wound up doing all of my exercises, and more, before he could get to me. When he got to me, I was already in quite a lot of pain. Then, as usual, he started with a deep tissue massage, and ended by doing lots of extremely painful manipulations of the arm which are intended to get the shoulder rotating correctly again.
I've been concerned about the manipulations because, in addition to the frozen shoulder, I've also been diagnosed with tendinitis, bursitis, and a partial tear of the infraspinatus. I'm willing to put up with pain, but not if the pain is an indication that I'm doing excessive damage to the other constituents of my shoulder. I want my shoulder back to 100% when this whole episode is over. I fear that excessive pulling and tugging might worsen the existing tear, or produce new injuries in previously healthy tissue. This is speculation, based on a few points that are extremely painful.
I think of my frozen shoulder as if the joint is encased in a ball of cement. The tendons and muscles are coming out of that ball. Usually, they slide around efficiently and cleanly when the shoulder rotates, but my view is that now they are getting stretched with much more force than is natural, and probably in strange directions, too. Surely this is just aggravating the whole joint more?
I'm particularly concerned about the biceps tendon because it inserts into the shoulder capsule and can develop adhesions in frozen shoulder. If the biceps tendon is torn, it won't heal on its own, and I'll need surgery.
I brought up my concerns with the physical therapist once again - I've continued to mention them, because I feel the amount of pain I'm experiencing is unreasonable. Yesterday, he cautiously admitted that the pain I'm feeling may be due to stress on some tendons, in particular the biceps tendon, and suggested that I shouldn't push myself to the point of extreme pain. However, he still seems convinced that it will be necessary to go through a lot of pain to get my shoulder rotating again.
At the end of yesterday's session, he asked me to lift my arm in a couple of directions. He thought that my shoulder had improved marginally - that it was rotating just a little as opposed to being completely stuck. He didn't seem to be saying that to make me feel better, either.
He then offered some ice. I haven't used it so far, but I decided to try it. It seemed to help quite a lot. I kept it on for 30 minutes or so, and after that the pain had subsided quite a lot.
When I got a chance, I took a look in the mirror, and I think he's right. The shoulder does seem to be rotating very slightly now. But it has a lot further to go.
Yesterday was my fourth physical therapy session. The whole session lasted about two hours.
By now they have me doing a regular series of exercises. In the first one, I spend eight minutes on the "hand cycle", which is essentially a stationary bike which you pedal with your hands. (The machine is way overbuilt for what it does, IMHO). I'm nearly convinced that it's doing more harm than good, since it's impossible to pedal without the feeling that pins are stabbing into my left shoulder.
Since that's first, it sets me up for pain and crackling during the entire session. I try to avoid crackling by easing into and out of positions slowly. Before I developed this condition, it was unusual for me to experience clicking or crackling in my shoulders, and I don't want to develop it in the long-term.
As is often the case with medical offices, my physical therapist was delayed, so I wound up doing all of my exercises, and more, before he could get to me. When he got to me, I was already in quite a lot of pain. Then, as usual, he started with a deep tissue massage, and ended by doing lots of extremely painful manipulations of the arm which are intended to get the shoulder rotating correctly again.
I've been concerned about the manipulations because, in addition to the frozen shoulder, I've also been diagnosed with tendinitis, bursitis, and a partial tear of the infraspinatus. I'm willing to put up with pain, but not if the pain is an indication that I'm doing excessive damage to the other constituents of my shoulder. I want my shoulder back to 100% when this whole episode is over. I fear that excessive pulling and tugging might worsen the existing tear, or produce new injuries in previously healthy tissue. This is speculation, based on a few points that are extremely painful.
I think of my frozen shoulder as if the joint is encased in a ball of cement. The tendons and muscles are coming out of that ball. Usually, they slide around efficiently and cleanly when the shoulder rotates, but my view is that now they are getting stretched with much more force than is natural, and probably in strange directions, too. Surely this is just aggravating the whole joint more?
I'm particularly concerned about the biceps tendon because it inserts into the shoulder capsule and can develop adhesions in frozen shoulder. If the biceps tendon is torn, it won't heal on its own, and I'll need surgery.
I brought up my concerns with the physical therapist once again - I've continued to mention them, because I feel the amount of pain I'm experiencing is unreasonable. Yesterday, he cautiously admitted that the pain I'm feeling may be due to stress on some tendons, in particular the biceps tendon, and suggested that I shouldn't push myself to the point of extreme pain. However, he still seems convinced that it will be necessary to go through a lot of pain to get my shoulder rotating again.
At the end of yesterday's session, he asked me to lift my arm in a couple of directions. He thought that my shoulder had improved marginally - that it was rotating just a little as opposed to being completely stuck. He didn't seem to be saying that to make me feel better, either.
He then offered some ice. I haven't used it so far, but I decided to try it. It seemed to help quite a lot. I kept it on for 30 minutes or so, and after that the pain had subsided quite a lot.
When I got a chance, I took a look in the mirror, and I think he's right. The shoulder does seem to be rotating very slightly now. But it has a lot further to go.
Thursday, March 11, 2010
shouldn't I be in bed now?
I feel pretty tired.
However, I still have about an hour's worth of physical therapy exercises to get through.
The pain that I experienced this morning only began to subside during the afternoon. It has been coming and going, and seems a little worse now. I'll try some naproxen sodium (Aleve) before bed and see how that goes.
However, I still have about an hour's worth of physical therapy exercises to get through.
The pain that I experienced this morning only began to subside during the afternoon. It has been coming and going, and seems a little worse now. I'll try some naproxen sodium (Aleve) before bed and see how that goes.
up at five again
I woke up with shoulder pain at five again, same as yesterday. There's a burning sensation around my entire left shoulder, and a stinging pain at one particular point near the back and top of the shoulder.
Waking up with pain has been fairly frequent since January (that's about two months now!). However, it has changed from waking up at a normal hour, and feeling pain in the shoulder, to waking up really early or in the middle of the night due to the pain.
I had my third physical therapy session yesterday, which may have made things worse in that regard. The therapy was incredibly painful. It was difficult getting to sleep because of the lingering pain last night. I decided not to take any medication for it, just to see if the pain would subside overnight, on its own, but no luck.
After the first PT session, which was somewhat painful, I felt like I slept somewhat better. The second PT session was horribly painful, and I haven't slept well since then.
Usually, after waking, it takes anywhere from ten minutes to several hours till my arm stops aching. I find it very strange that lying down aggravates the condition. I mostly sleep on my back - why does that make things worse than sitting upright all day long?
Waking up with pain has been fairly frequent since January (that's about two months now!). However, it has changed from waking up at a normal hour, and feeling pain in the shoulder, to waking up really early or in the middle of the night due to the pain.
I had my third physical therapy session yesterday, which may have made things worse in that regard. The therapy was incredibly painful. It was difficult getting to sleep because of the lingering pain last night. I decided not to take any medication for it, just to see if the pain would subside overnight, on its own, but no luck.
After the first PT session, which was somewhat painful, I felt like I slept somewhat better. The second PT session was horribly painful, and I haven't slept well since then.
Usually, after waking, it takes anywhere from ten minutes to several hours till my arm stops aching. I find it very strange that lying down aggravates the condition. I mostly sleep on my back - why does that make things worse than sitting upright all day long?
Tuesday, March 9, 2010
first visit to the orthopedist
A few days before visiting the orthopedist, I did a little research into the shoulder to get an idea about what to expect. I tried memorizing the parts of the shoulder, learned the mnemonic for the rotator cuff muscles (SITS), and found some informative videos about the shoulder exam. The best were posted by bluetentorthop.
Finally, it was time to see the orthopedist. The doctor performed a very few tests, and declared with certainty that I had frozen shoulder. She prescribed an MRI to see if there was any underlying cause. That was scheduled for the following week.
I was disappointed because I had expected the whole battery of tests that I'd seen in the videos. In fact, she didn't even visually inspect the shoulder, something that was supposed to be part of every good exam, according to the videos I'd seen.
However, I was happy that she hadn't decided instantly that I had a rotator cuff tear, something that I had been a bit worried about. I didn't realize at the time how big a problem frozen shoulder is.
Finally, it was time to see the orthopedist. The doctor performed a very few tests, and declared with certainty that I had frozen shoulder. She prescribed an MRI to see if there was any underlying cause. That was scheduled for the following week.
I was disappointed because I had expected the whole battery of tests that I'd seen in the videos. In fact, she didn't even visually inspect the shoulder, something that was supposed to be part of every good exam, according to the videos I'd seen.
However, I was happy that she hadn't decided instantly that I had a rotator cuff tear, something that I had been a bit worried about. I didn't realize at the time how big a problem frozen shoulder is.
attempted physical therapy
After getting back from my ski trip, I had to wait three weeks before seeing the orthopedist.
I was sure that she would prescribe physical therapy (PT), so I decided to get a head start, and began doing some rotator cuff exercises that I had found at Yahoo! Health.
It didn't make sense to just do some exercises without testing to see if they were doing any good. So I marked a column of inches on a sheet of paper to use as a ruler, and hung it on the wall. After doing my exercises, I'd reach up against the sheet of paper to see how high I could get, and whether I had progressed at all. To start with, I could reach six inches further with my good side than with my bad.
I did exercises every day for about a week, but found there was basically no improvement in my reach. Further, I felt like the exercises were causing too much pain. I'd get a sharp pain in the front of my shoulder when reaching up. It would get worse the more I did the exercises. I feared I might be aggravating a tendon or doing some form of damage, possibly caused by impingement. I stopped doing any PT exercises, but continued doing weight-lifting pretty regularly, sticking to exercises that didn't hurt.
I was sure that she would prescribe physical therapy (PT), so I decided to get a head start, and began doing some rotator cuff exercises that I had found at Yahoo! Health.
It didn't make sense to just do some exercises without testing to see if they were doing any good. So I marked a column of inches on a sheet of paper to use as a ruler, and hung it on the wall. After doing my exercises, I'd reach up against the sheet of paper to see how high I could get, and whether I had progressed at all. To start with, I could reach six inches further with my good side than with my bad.
I did exercises every day for about a week, but found there was basically no improvement in my reach. Further, I felt like the exercises were causing too much pain. I'd get a sharp pain in the front of my shoulder when reaching up. It would get worse the more I did the exercises. I feared I might be aggravating a tendon or doing some form of damage, possibly caused by impingement. I stopped doing any PT exercises, but continued doing weight-lifting pretty regularly, sticking to exercises that didn't hurt.
Saturday, March 6, 2010
ski trip
I went skiing the second week in January, 2010. I had some trepidations, since I was fearful that I might worsen the problem were I to have a bad fall. However, this was an expensive trip which I was gleefully anticipating, so I decided to take the risk and try to be as careful as possible.
During the trip, I continued to experience moderate pain, on and off. I had some problems pushing myself along with the poles over flat spots. Generally the pain would reduce after I'd been doing it for a while, but then the next day it would feel a little worse.
I also fell a couple of times while skiing, which is quite usual for me. During the last fall on the last day, I twisted my left arm and felt a very bad stabbing pain! The pain eased up pretty soon. I'm glad this happened right at the end, otherwise I might not have enjoyed the trip so much.
It was probably really stupid to go skiing with this condition. OTOH I could easily fall and slip on the ice at home. So I took my chances, and I don't think I actually made things worse despite the fall. It's hard to tell.
increased pain
After visiting the doctor in mid-December, I began to experience more random pain in the shoulder.
Late in December 2009, I began waking up with shoulder pain during the early morning hours! My doctor had predictive powers on that one.
I began to notice it was getting harder to tie up my ponytail without a pinching pain in the front of my shoulder.
Nevertheless, I continued to use my rowing machine and lift weights. At some point in January, I had to stop doing squats and shoulder presses, since I couldn't get the bar overhead. Oddly, shoulder shrugs still felt fine.
In addition, I started getting shoulder pain when
Over time, I continued limiting what I'd do, since I thought resting my shoulder was the right thing for it.
Late in December 2009, I began waking up with shoulder pain during the early morning hours! My doctor had predictive powers on that one.
I began to notice it was getting harder to tie up my ponytail without a pinching pain in the front of my shoulder.
Nevertheless, I continued to use my rowing machine and lift weights. At some point in January, I had to stop doing squats and shoulder presses, since I couldn't get the bar overhead. Oddly, shoulder shrugs still felt fine.
In addition, I started getting shoulder pain when
- reaching my left hand under my right arm pit while bathing
- bending over and dangling my arms down in front of me (for example when tying shoelaces)
- reaching back to put on my seatbelt with my left hand - I switched to using my right hand
- reaching into my left back jeans pocket
Over time, I continued limiting what I'd do, since I thought resting my shoulder was the right thing for it.
first visit to a doctor
Meantime, on December 16, 2009, I saw my primary care physician (PCP) to ask for a referral to get some physical therapy for the shoulder. At this point, I didn't think it was too serious, but I felt it wasn't going to heal on its own.
Before visiting the doctor, I recall testing my range of motion with the left arm and being a little alarmed at how limited it had become. When I stretched my left arm out up in front of me, I could barely get it past 90 degrees. My right arm could easily go up all the way past my head, a little beyond 180 degrees.
The doctor gave me a quick look. She asked if I was waking up with any pain at night, and I said no (I thought "why on earth would I have pain at night when I'm not doing anything?" - there was some foreshadowing going on there). I was only having mild pain during some activities at that point.
Anyway, the doc decided I had a rotator cuff injury, and told me it would likely give me a lot of pain and would take a long time to heal. "Oh no!" was my reaction.
She referred me to an orthopedist. I figured, OK, the orthopedist will look at me, and refer me to physical therapy. It seemed like a waste of time, but ya gotta jump through the hoops. She also sent me to get x-rays immediately - they came back normal a few days later. (It was nice to confirm that I hadn't broken anything. In fact, if it had been up to me, I wouldn't have taken x-rays, since I was completely sure I hadn't broken anything. But later my orthopedist told me that you may not realize it when you have broken something in this area!)
Before leaving my PCP's office, I went to make an appointment with orthopedist. The computer systems were down! They told me to call for an appointment the next day. But it was just before Christmas, and I was very busy at work, and I was just coming down with a cold, so I procrastinated.
In fact I procrastinated until after my January ski trip. When I got back, the earliest I could see the orthopedist was in the middle of February. Bummer, I wanted to go immediately.
Before visiting the doctor, I recall testing my range of motion with the left arm and being a little alarmed at how limited it had become. When I stretched my left arm out up in front of me, I could barely get it past 90 degrees. My right arm could easily go up all the way past my head, a little beyond 180 degrees.
The doctor gave me a quick look. She asked if I was waking up with any pain at night, and I said no (I thought "why on earth would I have pain at night when I'm not doing anything?" - there was some foreshadowing going on there). I was only having mild pain during some activities at that point.
Anyway, the doc decided I had a rotator cuff injury, and told me it would likely give me a lot of pain and would take a long time to heal. "Oh no!" was my reaction.
She referred me to an orthopedist. I figured, OK, the orthopedist will look at me, and refer me to physical therapy. It seemed like a waste of time, but ya gotta jump through the hoops. She also sent me to get x-rays immediately - they came back normal a few days later. (It was nice to confirm that I hadn't broken anything. In fact, if it had been up to me, I wouldn't have taken x-rays, since I was completely sure I hadn't broken anything. But later my orthopedist told me that you may not realize it when you have broken something in this area!)
Before leaving my PCP's office, I went to make an appointment with orthopedist. The computer systems were down! They told me to call for an appointment the next day. But it was just before Christmas, and I was very busy at work, and I was just coming down with a cold, so I procrastinated.
In fact I procrastinated until after my January ski trip. When I got back, the earliest I could see the orthopedist was in the middle of February. Bummer, I wanted to go immediately.
December - the Holiday Challenge
Throughout December 2009, I rowed 200K meters on my Concept II indoor rower for their Holiday Challenge. For about the first half of the Challenge, I usually had some light pain in the shoulder, but it was not a big issue. Towards the end, I began to feel like I was adjusting my natural moment to compensate for shoulder pain, and I began to develop secondary issues in my left arm - pain between the shoulder and the elbow and some pain along the forearm too. But I managed to finish the Challenge before Christmas without too much trouble.
Despite the pain, I continued to do my weight-lifting and rowing workouts when possible. I was sick with a bad cold around Christmas and into January, so I wasn't working out as often as usual.
At some point in January 2010, I had to stop doing squats and shoulder presses, since I couldn't get the bar overhead without severe pain. This was worrisome.
Despite the pain, I continued to do my weight-lifting and rowing workouts when possible. I was sick with a bad cold around Christmas and into January, so I wasn't working out as often as usual.
At some point in January 2010, I had to stop doing squats and shoulder presses, since I couldn't get the bar overhead without severe pain. This was worrisome.
how it started
I believe the problem started late last October, during a backpacking trip. I was climbing up a steep section of the trail over some boulders, when my left foot slipped. I reached out with my left arm to break my fall, and felt a sharp pain in my shoulder. It didn't feel too bad, though, and I continued my hike without any other problems. Later I learned that the medical community calls this a "FOOSH" - a "fall on an outstretched hand".
Over the next few weeks, I began having some shoulder pain during my weight-lifting workouts. I keep an exercise journal, and the first time I mention the pain was on November 11, 2009 - "left shoulder hinky".
Also, I recall that moving my left arm behind me to slip on a backpack became painful in the weeks after the fall. I adapted by putting on the left side first, so I wouldn't have to reach back with my left arm.
Over the next few weeks, I began having some shoulder pain during my weight-lifting workouts. I keep an exercise journal, and the first time I mention the pain was on November 11, 2009 - "left shoulder hinky".
Also, I recall that moving my left arm behind me to slip on a backpack became painful in the weeks after the fall. I adapted by putting on the left side first, so I wouldn't have to reach back with my left arm.
purpose of this blog
I've created this blog to share my experiences with a problem in my left shoulder. I was "diagnosed" with frozen shoulder last week.
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