How I Caught A Frozen Shoulder By accident
- Storm Baynes-Ryan
- Apr 22
- 5 min read
And what to look out for with shoulder pain
I've started with an in-person client who travels two hours to see me (so she has an excuse to come to town). She had a knee injury 15 months ago, and wasn't quite loaded heavily enough to return to full function.
She came to see me for her second appointment yesterday. She started telling me about her knee and how it was much improved (with 10 mins of work per day no less, she's now half way to her 30 minute walking with a pram on uneven surfaces goal).
Then, she "dropped in" (this is the by accident part) a little treat for me (mind you, this is a half hour follow up appointment AND, I was totally up for it.)
(sheepishly) "Stormie (she calls me Stormie) oh, um , I fell the day after I saw you last, and now my right shoulder is sore can you help me?"
She reported
Immediate pain (didn't think it was broken).
Restricted movement
Ongoing ache, down into the arm
Difficulties doing her hair
Problems with pulling her seatbelt down
Stiffness when tucking herself in at the back
Night pain**
In addition, I had just taken her history. We had discussed the impacts of the hormonal changes of perimenopause on how we feel and how our body reacts to life. Perimenopause and menopause is a risk factor for frozen shoulder.
For the past fortnight she had been cutting her sugar intake significantly as it was incredibly high (we know that diabetes (which comes secondary to high blood sugar (HbA1C and diabetes is a factor in frozen shoulder). After her first appointment, we discussed her sugar intake, and asked her to make one change for a start - no sugar in her fizzy drink. She could have fizzy (soda) but it had to be sugar free. She also decided to cut the sugar in her coffee and was so proud of herself. (High blood sugar and diabetes are risk factors for frozen shoulder).
In addition, we had been working on increasing her protein intake in one meal a day (it can be anti-inflammatory) - she hadn't been able to find many solutions to this, but is committed to starting to make some choices here. (Frozen shoulder is increased cytokines (inflammation) in the shoulder).In addition, we looked at increasing her 5 hours of sleep per day - she felt she could go to bed 15 mins earlier, so was also working on that (this is also known to impact inflammation and anxiety (which is also linked to adhesive capsulitis). (Inflammation and anxiety are impacted in frozen shoulder)
At the initial assessment, there were a lot of lifestyle factors to deal with, so we chose just a few which she thought she could address (and was keen to address) and get the hang of, and we decided to park the others until she was ready. I always try and work closely with my clients to allow them to make the best decisions for them - because it's actually their treatment, and their body, and their life...) Part of our decision making in what to choose was the low hanging fruit. Either the things that could change symptoms quickly (strength work, taping) or things which were easy(ish) to implement e.g. sugar and sleep.
That all said. My spidey senses pricked up when I saw her movement pattern, and remembered her history (and applied what I knew to her).
The relevant in this situation risk factors for Frozen Shoulder are
Perimenopause and Menopausal
Female
Trauma (like an accident not like "TrAumA")
(note, some come on independently, you don't have to bang it)
High blood sugar history (I didn't have her HbA1c or diabetes status but knowing her sugar intake, it could be an issue)
Lack of sleep
General aches (indicative of inflammation)
Other things I could also check for
autoimmune,
thyroid,
cardiovascular,
cerebrovascular, and
Dupuytrens disease
hyperlipidemia
Population:
Include "older" adults
More female than male
Symptoms
I noticed her affected shoulder was held lower than the other, and when she moved her arm, she had restricted range of motion especially with hand behind back and hand above shoulder. Other movements were limited too.
What I did:
I was working at radiology, and went next door to speak to the office manager with a request for an Xray (night pain) and Ultrasound Scan (for all the other reasons) as well as a cortisone asap if indicated. (I also wanted to check for a cuff tear, and bursitis, as the presentations overlap). I explained to the client the reasoning and clinical guidelines and best practice behind this, and she was in full agreement.
I wanted to schedule an appointment that worked for the client so she didn't need to travel down twice in one week.
We scheduled an appointment that worked for everyone, then an appointment space (magically!) appeared, and she was seen immediately. The sonographer then came to my door, told me the diagnosis and confirmed that my initial suspicions were correct - a severe adhesive capsulitis and bursitis.
Outcome:
She was immediately booked for a cortisone injection.
She has some home exercises to improve flexibility at the shoulder, without overloading it or hurting it in the interim.
After cortisone, we have a plan which I've set for my clients, (it'll be a blog post in the coming months), which she will follow.
Treatment plan:
The gold standard for treatment includes cortisone soon after diagnosis, then physiotherapy exercises for mobility. I add in strength work in comfortable and tolerated ranges after 2 weeks, and then progressive strengthening after that.We also do spiky ball work, and address all the concurrent factors discussed above. The programme is always comprehensive, and focused on the goals the client has, and easy for them to fit in - this may mean strength goals take a little bit longer, but that we do achieve them because they actually do the work - rather than it being too hard and they stop doing the work.
I use the current science to work with my clients, but also, work with the human in front of me - working with what they can tolerate and what works in their life.
If you want to book in with me - go to this link here. If you have shoulder pain and are desperate - here is a resource I created, it's aimed at improving shoulder function while you wait for physiotherapy - go to this page Shoulder Injury First Aid | That Farming Physio
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