Shoulder Update

I’ve been internally debating whether to give an update on my shoulder, for a couple of reasons. First of all, the whole “sharing medical information” thing. Secondly, who cares? And thirdly, it seems that recently so many people have run up against some very large and serious medical issues, and I don’t want to sound like I’m complaining, because I’m certainly very thankful that my own problems pale in comparison.

On the other hand, I’ve had the itch to blog again, but I need a break from the high school swimming series I’ve been working on. They say you should write what you know, so I guess I’ll lean on my recent first-hand experiences, and the thing that’s been nagging at me for months.

Early in 2015 I was struggling a little bit with a sore right shoulder. Near the end of 2014 I’d decided to get into the pool for the first time in years, and ended my first workout with a set of 200’s. My ego may have gotten the better of me. The 200 free was my main race throughout high school and it’s possible that I pushed it a little too hard for a first workout. I wanted to prove to myself that I could still swim it. I started noticing the soreness soon after, and haven’t returned to the pool since. In the spring of 2015, I went to the wellness center where Sara works and had one of the trainers do a quick evaluation. He thought it seemed like I’d pulled my upper bicep, way up by my shoulder, while swimming. I was told to go easy on it for a while. During the summer of 2015, I noticed the pain worsening a bit, especially when doing things like pull-starting the lawn mower. But, by the end of 2015, the pain in my right shoulder was going away and I was starting to notice it on the left side, instead.

The left-side pain was more constant and sporadically intense than the right side had been. So much so, that I finally gave up and called an orthopedic doctor towards the beginning of 2016. I talked about the result of this visit in my post “Shouldering a Burden”. In short, neither the X-Ray nor the MRI showed anything obviously wrong, so the diagnosis at the time was degenerative cartilage. I went to PT for a couple of months, felt much better, and then continued strength-building at home on both shoulders after my PT was complete.

After some time using the resistance bands, I decided I was ready to start using some free weights, at least for a couple of exercises. I started using my neglected bench press for shoulder shrugs, and some light dumbells for curls. By this time, my knee had started to hurt after running, so I was hoping to get a bit more of a workout with the weights in lieu of running. During the third free-weights workout, I was lifting the barbell off the rack in preparation for shrugs, and my left shoulder fell down. It felt like the ball of the joint had literally pulled out of the socket, and a searing pain shot up through my neck. After throwing the weights back on the rack and cradling my arm like a baby for a few minutes, I was able to move my shoulder in a way to prove that I had not actually dislocated anything. I decided that I must not be ready for weights yet. So, I continued with the bands while the pain continued to grow.

It continued like this for a while. As the pain got worse, I worked harder, trying to strengthen it up. At some point I became unable to raise my arm up and lie on it in bed. Still, I just figured this was a part of the degenerative process, and something I would have to live with and work through. Eventually, as I would work with the bands, I started to notice certain movements had become limited. One night, I noticed when pulling the bands across my body using an external rotation, my right arm had nearly 180 degrees of motion from my stomach out, but my left arm was barely going past 90, and that only after a considerable amount of pain. Amazed, I turned towards a huge hallway mirror in our entryway, and mimicked the motion of a butterfly stroke. Not only could I not lift my left arm nearly as high as my right, but when I lifted it, it looked different. Instead of my shoulder rotating within the socket, my entire scapula (shoulder blade) and clavicle (collarbone) was lifting high up in order to pull my arm up. No matter how hard I tried, I couldn’t make my left arm do a normal butterfly motion. Something was definitely wrong.

So, I made an appointment with a different orthopedic doctor, just to get another opinion, and I stopped all strength work. My appointment was a few months ago in September. My new doctor listened to my story, which at this point had started to get kind of long, and then he asked me to make a few movements. After only a couple of failed attempts to move my arm in different directions, he said “Ah, it looks like the old frozen shoulder!” I’d never heard of such a thing. But everything I’ve read since that conversation does seem to add up. Apparently adhesive capsulitis is a thickening/hardening of the soft connective tissue surrounding the ball-and-socket joint in the shoulder, resulting in limited range of motion and fairly intense pain. This would explain why my scapula was compensating so much whenever I tried to move my arm in certain directions. It was trying to make up for the fact that the ball no longer moves freely within the shoulder socket. They don’t really know what causes it, but it does seem that certain people are more likely to get it, like women (not me), diabetics (not me), someone who’s recently had surgery (not me) and someone who has kept the shoulder immobile (still not me). So, either I’m just extremely lucky, or something else is in play.

I actually asked my doctor about the risk of swimmers developing shoulder problems later in life. I’ve tried to do some Google research on this, and there are plenty of posts about incorrect technique causing shoulder pain in current swimmers, but nothing about the long-term effects of high-level competitive swimming on the body later in life. My doctor told me that he was unaware that any study had been performed with regards to this, but did concede that the pounding a swimmer puts on his/her shoulders could certainly leave them predisposed to various ailments down the line. I’ve reached out to the other three members of our state-ranked 200 freestyle relay team, and each of us has had shoulder issues in the last few years (aged late 30’s/early 40’s). Though this is a tiny sample, it’s still a pretty telling statistic. Not that I’d change anything, mind you, I just find it interesting. I also wonder if the pain I had in this shoulder originally was the early stages of adhesive capsulitis and not a degenerative condition. Perhaps it was too early to show up in the MRI. If so, that’s a good news, because unlike degenerating cartilage, frozen shoulder actually gets better.

The doctor presented me with three potential treatments. Option one, we could do nothing, and the shoulder should get better in about two years, maybe three. Option two, we should try physical therapy. Option three, he could give me a MUA (manipulation under anesthesia). With the third option, they would put me under for about 15 minutes while the doctor would crank my arm around like pulling a leg off of a turkey on Thanksgiving, “breaking through” the stiff connective tissue and loosening everything up. As much as I disliked the idea of waiting another two years for this to clear up, option three just sounded….horrible. I mean, it’s 2016, what kind of fake doctor grabs the part that’s in excruciating pain and pushes around it until it moves again? We have robots that can perform micro-surgery for pete’s sake! But, it’s a real thing, and it’s used in many cases of adhesive capsulitis when the risk of breaking the patient’s arm bone is low. My age and general health would make the risk of breakage relatively low. That’s comforting, I guess. But then again, my risk of getting adhesive capsulitis in the first place was fairly low and I still managed to get it. Can’t you just zap it with a tricorder or something? (I know, Star Trek fans, the tricorder is not for medical use, it’s just a joke).

I decided to try Physical Therapy first to see how well we could progress with a less horrifying option. During the last two months, I’ve been visiting my physical therapist twice a week, squeezing in the time between meetings, and performing nightly stretching at home. I’ve learned a couple of things: As much as it hurts to move my arm in certain directions, it hurts even more when someone else moves it for me. Also, I’ve finally gotten my physical therapist and PT assistant to open up about my case. They seemed reluctant to talk about it at first, because they’re not doctors, and also I think they didn’t want to discourage me. Dianne, my PT assistant was the first to admit that in over 30 years she’s never seen anybody with adhesive capsulitis as bad as mine who hadn’t been through some kind of trauma or surgery. Tricia, my physical therapist, concurred with that observation. So, yay, me! Still breaking records with my shoulders!

I have made some progress in PT. In fact, I’m now able to go through my normal day without any pain at all. That is a welcome change! But, the fact remains that my range of motion is still considered severely limited. I can’t even put on a jacket like I used to, because my left arm will not reach behind me. I look like a little kid learning how to get dressed every time I pick up my jacket and try to figure out the best way to put it on. So, I’m trying to get comfortable with the idea of the manipulation. I certainly don’t want to be in Physical Therapy for the next two years. If the analogy of tearing the band-aid off fast or slow applies (and I’m spending more money the longer the band-aid is on), the logical move would be to tear it off as fast as possible. But that option still scares me a little. I’d hate for a tendon or muscle to tear during the procedure and cause even more issues.

They (the anonymous experts) say it’s good to have a goal when you’re working through something like this. Prior to late 2014 (when I first noticed shoulder pain), it had literally been years since I’d done a swimming workout. I never really had the desire. Then, when I thought that I had degenerative cartilage, it hit me harder than I thought it would, the realization that I was officially done swimming – forever. I suddenly wished I’d have the chance to get back in the water again. Now that the diagnosis has changed, I feel like I’ve been given that chance. I’ll never be competitive again, but I do want to start swimming, even if it’s only a thousand yards a few times a week. That’s my goal. I want to be able to swim for exercise, especially since running is now officially off the table (my doctor told me that I needed to find another type of workout if my knee hurt after running). My ultimate stretch goal is to swim a 100 butterfly again. Not to win a plaque, or to beat someone, or even for time. I just want to do it again.  But that may still be a ways off, yet.

I’ll meet with my Doctor again in a couple of weeks. Hopefully, we’ll be able to gauge my progress and determine the best option going forward.

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