Finding Relief From Frozen Shoulder

Meagan Esler

| Dec 31, 2011

Frozen shoulder is more common in people with diabetes than you may realize.  My own painful experience with frozen shoulder, also known as adhesive capsulitis, happened a few years ago.  I slipped and fell down the stairs at home, hitting the wall and nearly every stair from top to bottom.  I injured an ankle and lost my big toenail in the accident.  As I began healing, I also noticed that my left arm wouldn't go above my head.

I was worried because the pain was intense at times and traveled down my arm from my left shoulder, so I visited my doctor. The doctor did some tests, including an x-ray, and I was sent to a physical therapist.  I visited the therapist regularly and did a variety of exercises at home, but no matter how many exercises I tried, my shoulder ached and refused to budge.

Simple things like styling my hair or putting on a coat or bra had me wincing and near tears.   My husband and I tried to dance together at a wedding, and I ended up bolting from the dance floor to nurse my aching arm and shoulder.  Unable to deal with it any longer, I went back to my doctor, begging for help.

My doctor referred me to an orthopedic surgeon, who confirmed that I had frozen shoulder and needed surgery.  He commented that the problem was probably caused in part by my diabetes.  I panicked at the idea of surgery, but, luckily, no cutting was necessary.  I was put under anesthesia, and the doctor broke up the adhesions by forcing my shoulder to move while I was sedated.  I was nauseous from the anesthesia and in some pain when I woke up, but by evening I was able to raise my arm for the first time in over a year.  I don't think I've ever felt such relief.

According to the American Academy of Orthopaedic Surgeons, frozen shoulder affects 10 to 20 percent of people with diabetes.  Nondiabetics account for only about two percent of frozen shoulder occurrences, and this risk group mainly comprises women aged 40 to 60 years.  

After my surgery, I attended physical therapy several times a week for months until we were sure I had regained my normal range of motion.  Thankfully, my shoulder continued to improve even more over time.  Frozen shoulder can reoccur, especially in people with diabetes.  To help prevent my shoulder from freezing up again, I make time to stretch every day.

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Categories: Adhesions, Adhesive Capsulitis, American Academy of Orthopedic Surgeons, Diabetes, Diabetes, Frozen Shoulder, Orthopedic Surgeon


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Comments

Posted by Anonymous on 1 January 2012

hi my name is steve and i to am a type 1 with complications. i know the pain of checking and injecting 5 times a day,and having the worry of sleeping at night. god bless us all and hope for some type of cure soon.

Posted by ntrubov on 5 January 2012

Meagen,

From the picture you included in your story I am sure you were NOT nauseous. You were NAUSEATED. There is a big difference.

Good luck with the shoulder and watch those stairs (that's why there are rails along the side)!

Posted by Colleen Fuller on 5 January 2012

Frozen shoulder may also be associated with biosynthetic insulin. An important 1992 study found that people using rDNA insulin and proinsulin developed what was described as "arthralgia/arthritis/myalgia syndrome", an allergic reaction to the drug. In every case, the allergy disappeared when the drug was withdrawn. [Galloway JA, DeShazo RD. Insulin Chemistry and Pharmacology; Insulin Allergy, Resistance and Lipodystrophy. Ellenberg and Rifken’s Diabetes Mellitus Theory and Practice: Fourth Edition.] In these cases, frozen shoulder is linked to the type of insulin used to treat diabetes, rather than to diabetes.

Posted by Green Lantern on 5 January 2012

I've had frozen shoulder twice and am not diabetic. The problem is very common--and VERY painful. Basically, after a bout of untreated tendonitis, the shoulder will take about a year to "freeze". Then it will take another year to "thaw." NOTHING helps this process but time and pain medications. No solution has been proven by science to have any benefit. Yanking the adhesions loose under anesthesia is a temporary solution, unfortunately. I had physical therapy for the first shoulder, which was horrifically painful (basically torture) and didn't help the main problem, which was the pain. The second time, I skipped the PD and just used pain pills to help me sleep at night. Both shoulders are now fully mobile--the PT made no difference at all. Doctors hate having a painful problem they can't help, so they try, but don't be fooled. Your best bet if you are stuck with this unfortunate condition is to do as little as possible with the affected arm. Put your shirt sleeve on that arm first and then move the other one to get dressed. Strap it to your side at night if you have to so you don't move it when you sleep. It WILL get better in time.

Posted by Anonymous on 5 January 2012

I'm working through my second frozen shoulder myself. You don't need to have the adhesions broken up under anesthesia in most cases, and in some cases the manipulation itself can make the situation worse-- it can be like falling down the stairs in the case of the article. The trauma from the manipulation can flair off an even worse bout of frozen shoulder in a statistically significant amount of cases. Also it is not unheard of to have permanent rotator cuff damage from manipulations. I'd use with care.

The bad news is that 5-6 years later it is really quite common to have your other arm become affected if you are Diabetic and have had adhesive capsulitis in the past. This is what happened in my case (I'm T2, 42, male, and have excellent control and am now normal weight, BTW) The first time (six years ago) I injured my left arm.. the second-- well if I did I never knew it. This time it's worse because it's in my dominant arm too.

Working though it is annoying, painful and takes at least a year to 100% success -- but can be done. I've done it once before and am 2/3 the way there again. I wanted to point out that the manipulation itself is fairly risky and you need to consider trying physical therapy first. If you gain more than 25% of your motion back in the first couple of months of PT, then I'd not even consider surgery. You'll get there eventually without it.

Some people can get away with a steroid shot to the capsule as a quick fix as well but but both T1 and T2's that in itself is pretty risky. I'd talk to a primary care doctor about all of these options before going straight to a surgeon. The surgeons will tell you that without the manipulation you will NEVER get rid of it. Doing nothing, they will typically go away by themselves in 2-3 years and about 1 year with PT, 6 months of PT and your motion will typically be good enough to do everyday tasks (80% ish in my case). The surgeon in my area needed his BMW fixed.. he told me so... I went to PT instead and I worked through it the first time... Never looked back and didn't even bother to talk with him again this time.

Posted by goozer on 5 January 2012

I have bilateral frozen shoulders and no amount of physio has helped. So I just live with it. It doesn't hurt anymore but it sure does limit mobility. I have had T1 for 63 years and developed it about 20 or 25 years ago.

Posted by Green Lantern on 5 January 2012

Arggh! I posted comments and they vanished. I hate when that happens.

Anyway, frozen shoulder is more common in diabetes, but is pretty common in the general public, too. It can start as a repetitive stress injury. I had 2 frozen shoulders due to non-ergometric office furniture that had my shoulders scrunched up over a computer all day long. Step 1 is biceps tendonitis. The tendon feels sore, and the insertion point (about 3" down from the top of the shoulder) is painful when you press on it. If the tendonitis is treated--with ice, NSAIDS (i.e., ibuprofen, naproxen...), the shoulder doesn't have to freeze.

If the tendonitis isn't treated, Step 2 is "freezing." Loss of motion occurs--it becomes impossible to raise your arm up behind you first, and then becomes hard to lift it at all. For reasons doctors don't understand AND CAN'T TREAT, the muscle fibers actually stick to your bone (adhesive capsulitis). The pain comes in when you tear them loose through rapid movement. I swatted a bee with my "bad" arm and screamed because it hurt so much. The pain from this condition spikes up to 10 points on the pain scale. Ripping the adhesions loose under anesthesia may help temporarily, but really the problem just has to run its course--over 12-24 months, unfortunately.

Some advice if you have this awful problem:
1. AVOID SUDDEN MOVEMENT OF THE AFFECTED ARM. Move slowly and gently. Put that arm in a sleeve first, then finish getting dressed.

2. SKIP PHYSICAL THERAPY (and "surgery"). It doesn't help and is HORRIFICALLY painful. As I said, I had TWO frozen shoulders. I did weeks of painful PT for the first and none for the second. Both shoulders ended up with 100% movement back--but the second one didn't involve voluntary torture.

3. SLEEP ON YOUR BACK OR ON THE SIDE WITH YOUR GOOD ARM. For some reason, even if you don't move the bad arm at night, it sends out painful twinges that make sleep difficult.Prop up the bad arm with pillows, strap it to your side so you can't move it at night, and ask the doctor about sleeping/pain meds.

4. TRY HEAT, ICE, OR GENTLE MASSAGE to help with the pain.

Once you've had a frozen shoulder, you are at risk for having it again. After I'd had mine, BOTH arms were starting to freeze at the same time. My fantastic doctor gave me a 6-week course of high-dose ibuprofen (with kidney function tests before and after to be sure there was no damage), and told me to ALWAYS KEEP MY ARMS DOWN (dependent). To this day, 15 years later, I don't paint, wallpaper, or do anything that puts my arms above my shoulders for any length of time. And it's never come back.

Posted by Anonymous on 5 January 2012

I'm reading your article w an ice pack on my shoulder bc out of the blue, for a week now, has been so painful I can hardly function. I had NO IDEA this could be diabetes related?! And I log into my email and bam, Frozen Shoulder is the first thing I see!!! How many other people reading this suffer from the frozen shoulder?

Posted by Trekker on 5 January 2012

I've had adhesive capsulitis in both of my shoulders, 4 years apart, so very well understand. These happened 25 and nearly 30 years ago and thankfully the problem hasn't occured again. I also had to go under anesthesia to have them broken loose.

Posted by Kathy on 7 January 2012

I've had a frozen shoulder in both shoulders now. Its awful and painful. I had to resort to cortisone shots both times which I really hated to do because it played havoc with my blood sugars. Its been over 3 years now since the second one and I can say that I made a full recovery from both. My golf game was actually better while my left shoulder was frozen!

Posted by Anonymous on 8 January 2012

I got over my frozen shoulder through swimming. At first, I could barely move my arms, but eventually they loosened up.

Posted by Anonymous on 9 January 2012

I am so thankful that someone has finally talked about this! Until I went through my own experiences with it (now in both shoulders), I had never heard of it, nor had I any clue that it might somehow be related to having type one diabetes! It sounds like in your case getting it diagnosed and having the manipulation and PT early on seemed to do the trick. I haven't been as fortunate, as mine recurs, and I was unsuccessful with the first one in finding anyone who was willing to try the manipulation without cutting. Did your blood glucose levels play any role in yours?

Posted by Anonymous on 10 January 2012

I am T1 for over 30 years and experienced frozen shoulder 8 years ago. At the time I did a lot of research on this condition and many articles suggested surgery. No way was I going to subject myself to a surgery. I choose to see a chiropractor along with physical therapy and my determination to work with it myself. It took about a year and a half before I could reach above my head and then another year to strenghen my arm/shoulder. Today I have full range of motion and sure hope it never comes back, as many have mentioned the reoccurrence of it.
Glad to hear discussion of the frozen shoulder because my internist at the time did not claim it to be frozen shoulder associated with diabetes.


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