Stopped Physical Therapy and rapid decline in ROM

Bones, joints and muscles
1

Hi all!

I'm new here, but had the luck of recently finding this forum. It is so helpful to read about others' experiences and know that I am not alone, and am NOT crazy!

A bit of my story before I get to my question... I cannot pinpoint exactly when I started having issues with my shoulder - my best guess is that it started June 2013, but could have been earlier than that. Like many people here, it was a gradual worsening of an annoying ache/pain in my right (dominant) shoulder. In October, I was walking a dog at an animal shelter where I volunteer, and I slight tug on the leash sent me to the moon. The pain in my arm about dropped me to my knees, and was then followed by numbness.

I saw an orthopedic doctor who specializes in shoulder issues November 25. ( I live in the US) He did xrays and an exam and diagnosed frozen shoulder. He recommended physical therapy for 3 weeks, and wanted to see me again in three weeks time. He advised me to take one vicodin 30 minutes prior to therapy so that I could tolerate more. I followed the prescribed course of treatment - PT 3 times a week and followed my home program twice daily. At the end of those 3 weeks, I had great improvement - 40 degrees improvement in moving my arm straight forward. I measured 165 degrees ( normal is 180). He was happy with the results (as was I) and prescribed 4 more weeks of physical therapy.

This is where everything went wrong. That following week ( Dec.16), I could tell that my arm was getting more and more stiff. It took more and more reps to stretch my arm to get to the same ROM I had been before. It also started causing more pain. This is when my physical therapist started to increase the intensity of mobilizations she was doing. Beginning the week of Dec 30, I was in tears during/following almost every physical therapy session. I was making no more gains in ROM , and had started to actually lose ROM. I discussed my concern with the pain and stiffening and loss of ROM motion repeatedly with my therapist. She assured me that this is just part of the condition, and that you have to push through the pain to gain ROM.

This did not seem right to me, but I have no experience with this condition and i was relying on the "experts". I should have listened to my body!!! At the next appointment with my doctor, I expressed all of this to him, and he offered me a cortisone shot - I declined this because I have Type 1 diabetes and know that this can cause problems with blood sugars for weeks. The only other option he gave was to continue physical therapy for 3 more weeks. I agreed to do this - asked if she should cut back on the intensity of stretches/mobilizations. He said not to cut back on intensity - "she needs to push you until you grimace - and then push some more."

I went one more week, and by the end of that week, I had reached an absolute low and breaking point. I feel that all of this over aggressive therapy caused more inflammation, and in turn excruciating pain and a drastic decrease in ROM. My last physical therapy session was 10 days ago, and while the pain has lessened (some) in that time, my ROM has decreased significantly. While I had 165 degrees 4 weeks ago, now I can barely raise my arm in the front to shoulder height. I have been attempting to do non painful stretches because I am frightened as to how limited my ROM will get.

My question for all of those experienced with this - is this rapid of a decline ( I'm guessing 50 degrees ) in 10 days time completely out of line? I am wondering if I may have some additional injury/issue resulting from the over aggressive therapy. I have not been offered an MRI, and do not intend to see my original doctor, as I feel he is part of what got me in this current situation. I am pondering seeing another orthopedic surgeon to get a second opinion, but suspect he will push the same mantra as the original : physical therapy, cortisone and/or MUA.

My desire is to get the pain under control and attempt to work through this on my own with stretches. I am not interested in MUA or arthroscopic surgery - these do not have great outcomes in insulin dependent diabetics. I saw an orthopedic pain management specialist last week. I do not want to stay on narcotics long term, and had read about some doctors using a nerve block for frozen shoulder pain. This "professional" actually laughed at my suggestion and told me that the only way to "cure" a frozen shoulder is through physical therapy. My primary doctor is pushing cortisone ( regardless of the issues with blood sugar control). I have gotten to the point where I am completely disgusted with the medical community ( and I am actually a nurse!). None of them understand or acknowledge the way the pain with this condition completely alter your life.

Any insight is welcome!

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Hi aly204, I have had frozen shoulder since early Nov. 2013. Had X-ray, ultrasound, physio, massage therapy, cortisone shot and 3 sessions with a Chinese acupuncturist. I am now waiting for an appt. for an MRI. Nothing seems to be working. Not getting worse but not getting better. However, when I go to physio, the therapist tells me as soon as it starts hurting to stop. It's not like the gym where you push yourself for another 5 lbs. or a few more reps. They say if you push yourself till and after it hurts, it is only making things worse. Why can't there be consistency in physiotherapists? I hope your shoulder gets better.

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Thanks for your quick reply Wendy. I am sorry to hear that you are suffering through this. It is so difficult when the pain and limitations are so overwhelming, and there is no end in sight! I too wish there was more consistency with physical therapists. I firmly believe that my therapists' grade 4 mobilizations aggravated my condition. Right now I am just feeling so discouraged. Hope that your MRI provides some insight that can help your recovery!

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Aly I feel for you. I saw a physio guy who tried to push too. I stopped him. My specialist said rest is the only "cure" for FS. That and physio. The key to physio is just like Wendy said, you go to pain and not into it. This is just to keep the ROM you have. I am also booked for hydro dilation on Friday. I am nervous but excited. I have read lots about it and feel I have nothing to lose. I am still on the fence about the cortisone so have lots to think about in 4days. I have been dealing with this since Aug 2013. The worst hit in Nov. thanks to a drug called Zopiclone I can sleep at night. I take Vomivo for inflammation and it helps a lot. It is basically Naproxen with stomach protection. I have also used Lyrica for the shooting pains in my shoulder but you have to be careful as it can be trouble (constipation issues if you are not careful). It sounds to me like you have got lots of inflammation in your arm. You really need to rest it. I had to take a month and half off work to rest it and it made all the difference. Now I am back to work, not supposed to use the arm, and my employer has failed to accommodate this. That us why I am going for hydro dilation. I need to get this thing going fast. I will still need physio for a while after but the adhesions should be severed so most of the pain will be gone.

I wish you luck and I agree, listen to your body. You are the one who has to live with it. Take care and rest please.

5

Aly I am in a similar situation. I have had FS since at least June of last year. I have had four cortisone shots (even if they work, they only last a couple of weeks) arthroscopic capsular release along with MAU and a pack of Medril. Nothing has cured me! I am better off pain wise since the surgery, but I quit physical therapy about three weeks ago because it was causing me severe pain also. I would go and do the excersizes and the PT would stretch my arm in different positions and by that night my arm was killing me with sharp constant pains going up and down my arm and shoulder. I have a lot of trigger point pain also. I literally could not go hardly anywhere or do much of anything for the next four days. I had to stay home with my heating pad and ice packs. I decided that I was getting nowhere with PT and I needed to do something else. I have continued doing the few stretching overhead excersizes that I was doing in PT, but I only do them to the point of pain, no further. I am feeling much better. Can go places and am much happier. However, I will hear other people tell me about their experience with PT, none have had FS, and they say that I have to work through the pain to retrain my muscles, stretch the tendons, etc. I struggle to know what's right for me. If someone that had had FS and also pretty severe tendonitis and went through PT and came out finally cured, told me to push through the pain, I would listen. I don't have any other physical problems. Just still seem to have a considerable amount of inflammation. I just feel liked I'm treading water right now, but with a lot less pain.

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Hi Aly,

I so sympathise with your predicament. I cringe thinking how painful it must have been to over-do the stretching...definitely a no no in my view! With two FS at the same time...my dominant shoulder the worst, I was in a fine quandary and had to have help dressing etc. With GENTLE physio began to progress well, but then further injured my lesser affected arm. Now the left arm is worse than the right, and has been for some time. It seems to me that whilst there is inflammation, ALL the affected tissue should be rested, with to the point of pain exercises. My main problem was trying to sleep at night. It was only on reading 'Frosty's' message that I appreciated the overall approach necessary for improvement. It is not only the shoulder that needs tending...attitude also needs to change. On returning to physio sessions after a three week break, I immediately noticed that this made my shoulders MORE stiff...four days before I could even do the exercises I'd done well before. Progress is a wobbly line! I wear shoulder warmers at home, and have now managed to do without analgesia. Nights are still a problem, BUT, I take a couple of 'KALMS' (herbal relaxant) a couple of hours before sleeping, and for the past five nights, have managed to get 7 consecutive hours of uninterrupted sleep (even my habit of getting up to pee seems to have stopped!) So PLEASE do not give up, just read all and try everything that makes sense to you...most of all, trust your knowledge about treatment of inflammation, as far as I can see, the rules have not changed! This will stand you in good stead. Someone gave me a visual to consider...imagining a fiber-optic cable with a certain amount of fiber strands snapped inside the cable. More of these strands can snap with over stretching, but the fimbriating ends can heal given the chance to reattached themselves. This picture gives me comfort, so am not about to over-do the stretching!

You are on my prayer list,

Blessings

Chickabee

7

Thanks to all for the replies and for sharing your stories with me. I have found this forum to be such a wealth of information and sadly comforting to know that others have experienced/are experiencing the same things that I am.

Browner - I wish you all the best and will hope for a great outcome for you from the hydro dilation. My orthopedic doctor never mentioned this as an option - the only options he gave me outside of cortisone and physical therapy were eventually MUA and possibly arthroscopic release - he said that I am not a candidate for either at this time - which is irrelevant because I do not want to pursue either. I am sorry that your employer is not accommodating your situation. I consider myself lucky, in that, I am not employed outside the home.

Jana - Our situation does sound very similar withe the exception that you have attempted MUCH more than I have ( cortisone, MUA w/capsular release). Your experience with physical therapy sounds exactly like mine. I had gotten to the point that it was causing so much pain that i was non- functional and in tears multiple times each day . Two days after my last session, I could barely get myself together to attend a birthday dinner for my sister, and was in agonizing pain the entire evening. I could not even use a knife to cut my food without sever pain. That is when I decided no more physical therapy. Since discontinuing that almost 2 weeks ago, the pain has decreased, but in my case, so has my range of motion- dramatically. I too struggle with what the right decision is.

Chickabee - I simply cannot imagine how agonizing and difficult it is to deal with 2 FS at the same time!! I am continuing to move my arm as much as I possibly can with household chores, etc... I am also just now beginning to try gentle stretches again, and stop at the point of pain. I am shocked at how little I am able to stretch before pain arises. My mood is better since the pain has subsided some, and I am trying my best to keep a positive outlook. I am just frightened at with the prospect of losing more range of motion. I feel as though I made a trade off - less pain and ability to function traded for range of motion. I suppose time will tell if I am making the right decisions. Right now, my body is telling me that I am. Will keep you in my thoughts as well!

8

Well, the hydro dilation was a joke here. The tech did not even know what I was talking about. The Dr only put in about 25cc's and stopped. No explanation. Only one slight cramp in shoulder during procedure even though they said they would go till I could not stand the pain. Even the cortisone was useless. Had more pain after the procedure and now have pains in upper arm and forearm. Found out a week later that the Dr stopped because he suspects a full thickness tear in rotator cuff so fluid was just going through the tear. That is why he stopped. Now I am told that I have to wait for shoulder to unfreeze before they can fix the tear. This sucks! Does anyone know if it is possible to tear rotator cuff from repeated strain to the muscle? I have no idea of any specific incident when I tore it. Workers Comp says it must have happened outside of work but it didn't! I think the constant strain from my bad mouse position caused the eventual tear but don't know how I can prove it. Any ideas out there?

I feel very helpless as I am almost out of sick time. Only back working 4 hrs a day. I did get my boss to buy Dragon Speak voice to text software so am looking forward to training my dragon next week. I need to do something because I am starting to get tendinitis in my left arm from over using it. What a viscous circle! Ugh!

Don't get me wrong I could be a lot worse I guess. Just sucks that I can't even hug my husband for valentines day.

Best wishes to you all and hang in there ok? We will get through this. Thanks for listening

Sandy

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I am new here and have been reading everyone's post, through each experience you all have had some great advice and I'm a little concerned about my shoulder now...I'm actually in the US but stumbled upon this page and I'm open to any and all help..

I tore my left shoulder tendon back in Feb 2013 at work, we have a try everything before trying surgery policy, so I did the physical therapy, shots, medication, stim, everything till they decided to perform my surgery and repair the torn tendon. I had surgery in august 2013. very fast after my orthopedic surgeon noticed I was having a lot of pain and swelling, loss of motion and stiffness. This was nothing I had experienced before, and I know all about it because I tore the right one and had surgery in 2012.

Two months after my surgery I was diagnosed with frozen shoulder and went under for a second surgery on the left shoulder in January 2014. its now been 5 weeks, I'm strong into Physical therapy, pain pills, and ant-inflamation pills and I cant lift my arm. I can bend at the elbow but no matter how hard I try I can't to lift it. My orthopedic and Physical therapy both say its muscle, however before the second surgery I could lift my arm to almost 90 degrees so I have haard time believing I lost muscle to lift my arm waist height over night?? someone has mentioned Shoulder Chondrolysis which scares me even more. Any advice??

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I forgot to mention I am 31 but I (used) to do lots of physical work as I am a supervisor and run a 7 story apartment building in san francisco, ca...so lots of painting, electrical, plumbing etc.

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Hi everyone, I posted a couple of months ago when I was in full blow out pain, the freezing stage I guess, my injury occurred in July 2013 and I've had two cortisone shots but regret getting them because they really caused me more pain and I personally think that it escalated things. The first six month have been total hell, with as we all know the unbearable pain, Jan and now Feb. have been so much better I have rounded the bend and I think that I'm in the thawing stage, my pain level has dropped and I don't need pain meds, I'm only getting a slight improvement but to where I can put my hair in a pony tail!!! Although it hurts I can at least do it.

I was also told to do PT and did it for a couple of months but was in so much pain decided for myself was not worth it, was also told do my exercises until it hurt, the no pain no gain attitude.

I'm going to wait for a couple of more months then going to go see the orthopedist to talk about surgery if there has been no major improvement

I wish you all the best of luck , for we need it

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Hi Heidi,

Can totally appreciate where you are coming from. I guess I must be more or less at the same phase as you, now not needing pain relief. Every day I remind myself, 'small steps', for this is what it means. There is no hurrying along this predicament! The worst thing that now bothers me is when laying down at night...when I simply cannot relax my neck. It feels like my head is wobbling about on a pivot. The only thing that helps is blotting out consciousness with Kalms (herbal relaxant)

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sorry...hit the wrong key! ...otherwise the movement keeps me awake. During the day, I try to count my blessings in cms...today I managed to fully pull up my drawers! Today I managed to reach up and hang up my bath towel over the shower frame (which has taken me months to accomplish etc. Absolutely no point in getting impatient...this leads to depression. This is why I like 'Frosty's' comments, her input reaches the psyche...which is the area I most needed help. Pain is a mechanical thing, but sorting out ones thoughts and fears needs a deeper understanding.

Do hang on in there, and try to be patient. Things will improve and time will become your friend.

Chickabee.

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Seems the reports from people having had surgery only prove more to what I had stated in my previous post, that surgery will leave a person sometimes worse off, plus leave them with a nice scar. And also what I have learned in my research, is that the pain is even worse after! Healing time may be speeded up, but not always. My doctor, an orthopedic surgeon told me to wait it out. I did, and I am glad. But yes, Phys. Therapy is needed and a must, but as I mentioned, much can be done on one's own, but you will need initial help.

Also to Mariah, if you are doing this manual labor, or anybody else, you Must stop it and put it in rest mode, or you will only worsen your condition. No lifting whatsoever! Rest mode, for maybe 2-4 months. My underarms would get itchy because of lack of air, but I would put cream to avoid the itch. I work out with an elastic band almost every day, or I use the pool to make safe resistance movements, and get my exercise done as well.

I learned all this from my first FS. Now my other FS, other shoulder, I am thawing after 4 months, and I have seen good recovery from 20% to now 60% in last 3 weeks. And of course I have set backs, sleeping bad, a bump from somebody, or just doing something my brain reacts to naturally, that causes a reflex that I shouldnt do.

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Hi all. Hope you are feeling some relief since my last post. On my last physio visit I asked them to take measurements again to see my range of motion (ROM). Lifting up to the front and side it had decreased and in and out it had increased. Don't know why. PT said that ROM will get worse before it gets better but pain should go away a bit. I am going away to a warm climate for a bit so I hope that the warm air and some swimming (breast stroke only) will help. I will still do the exercises that the kinesiologist has given me. I bought some stretchy bands so can do quite a few of them with just that. I have a question for all of you who have "thawed" out. Does that mean you got more ROM or less pain? Hope to hear from you soon. Regards.

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Yervand, surgery does sometimes leave a patient worse off but this is true of all surgery. MUA and capsular release are usually only recommended for those patients where PT has not worked and the literature for both these procedures reports positive outcomes for the majority of patients that have had them.

You can "wait it out" but again this does not work for everyone, not all people with FS who take this path fully recover range of movement. For others, those with physical jobs or who play regular sport for example, it is not an option.

Aly204, why is capsular release not an option? It's day surgery, arthroscopic (not scars to speak of) and is entirely compatible with diabetes; the outcomes for diabetics are fine (nearly as good for non-diabetics).

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Hi I've had FS since Dec 2013 so I think I've a fair way to go ,I cannot believe how it effects daily life

showering drying hair getting dressed driving etc and while I have come to terms with it being a long haul tp

Recovery I really don't know wether to have PT or just push on doing daily chores etc,one of annoying things

Is the skin under my arm is starting to get sore I can't lift my arm up enough and I think it's lack of air ?

Has anyone got any tips on what to put onto the skin ?

18

Hi Katie

Yes it is a very frustrating process. I have been struggling since last Aug but frozen

Since Nov. While PT helps some, others have found it made it worse. I have found it

Quite painful but have managed to keep my range of motion because of it. Unfortunately

I have so much referred pain in biceps and elbow that I am in more agony from that

Than the actual shoulder. I also likely have a tear so I am going to be many months.

I am being forced into going on long term disability and people can't see why that makes

Me so angry. But it's like you said your daily life is impacted. I can't sit and read or knit or

Even clean my house because it is so painful. So what makes LTD so appealing I would

Like to know. Especially when I live my job. Oh well.

As for armpit. I have used deodorant sticks although it is hard to get it in there. Lady Speed

Stick does not irritate. You might also try Gold Bond medicated powder. The irritation is def

Due to lack of air.

I wish you all the best. They say the only cure for FS is rest so try not to use it too

Much or it will just get worse

Take care

Sandy

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Hi Aly204-

I've just recently been diagnosed with Frozen Shoulder and I've actually been told the complete opposite of you...DO NOT push through the pain, but instead stretch until the point where you feel a little resistance and stop. I'm trying to keep my treatment pretty conservative at this point - free of shots and lots of drugs and pushing through pain, though I've only been dealing with it for a month so far...so we'll see! Good luck!

~Shaina

20

Hi ,I have had FS for 4 months now ,dreadful to say the least but I have had very conflicting advice,I think because you are only 20 your blood supply to your shoulder will be very good ,I don't think it will take as long to heal as in an older person.

My Consultant told me to push through the pain, my Physio told me just to go as far with excersise without pushing through pain so there we are .

I just keep trying to do normal things and some days are much better than others,I have had to buy an automatic car as I can't change gear yet however I can drive !

You have to compromise but bear with it ! I have been told it will get better wether with treatment or not ,good luck .