Scott Johnson’s left shoulder has been bothering him. Truly bothering him.
“I could not remember a particular incident, but was certain it was just a stubborn basketball injury,” explained Johnson, a Minnesota-based type 1 for more than three decades that sites at Scott’s Diabetes and functions for the app company mySugr. However, after months of physical therapy free of advancement, as well as what he describes as “unwanted improvement,” Johnson was diagnosed using adhesive capsulitis, better known in the vernacular as frozen shoulder.
This is one of those lesser-known diabetes complications, one which doesn’t get discussed much compared to nerve damage, vision loss, and a host of other very scary ones. Nonetheless, it’s a complication which can be debilitating and life-altering, and is not always easy to recognize when we could just equate it to “the miracles of getting old” DiabetesMine coated it several decades back within our 411 Complications Series, but overall it’s not really on the radar unless you’re personally experiencing it.
For those inquiring minds, here’s the scoop on shoulder.
What’s Frozen Shoulder?
In Summary, it occurs in three stages:
- Freezing: Pain slowly becomes worse until array of motion is lost (lasts 6 weeks to 9 months)
- Frozen: Pain improves, but the shoulder remains stiff (lasts 4 to 6 months)
- Thawing: Ability to maneuver the shoulder improves until returning to normal or close to normal (lasts 6 months to two years)
Digging deeper into the medical side of the disorder impacts your entire body, we discovered that enclosing your shoulder joint is a bundle of heavy-duty connective issue known as the shoulder capsule. For reasons which aren’t apparent, in some individuals the tissue thickens and becomes more tight, then stiff bands of tissue called adhesions grow, which makes movement of the joint debilitating and even obstructing the shoulder joint’s normal range of motion.
It is a progressive illness, starting with intermittent pain, and then the joint to move. At first hitting the bottle of whisky on the upper shelf gets hard. Then not possible. Finally, it can become so painful (the suspended shoulder, not the whisky) you can’t even dress yourself.
And it’s not just that you can’t increase your arm; the arm can’t be raised, period. Frozen shoulder is characterized by that which is known as “loss of passive range of motion” Passive range of motion is how much a joint can move. Somebody else could easily transfer the joint farther, although in different varieties of circumstances, someone might not be able to move her or his own shoulder beyond a certain stage. However, with frozen shoulder, the shoulder is, well… suspended. Physically stuck.
It can’t be moved farther.
And then what? Just if it gets worst, the process often begins to reverse itself. Like the seasons of the year, the progression of adhesive capsulitis is often described in stages of freezing, thawing , freezing.
Who Gets Frozen Shoulder?
Each year in the US, 200,000 people are diagnosed with frozen shoulder. It is most frequent between the ages of 60 and 40, and much more common in women than men. And I am convinced it’ll come as no surprise to you that individuals with diabetes are more likely to get it than anyone else.
The American Diabetes Association accounts, via the Academy of Orthopaedic Surgeons, that 10-20 percent of PWDs have suspended shoulder. Meanwhile, the consumer literature frequently reports that PWDs are three times more likely to get suspended shoulder over sugar-normals (non-diabetics), and also the actual risk might even be much higher than what the stats show.
A 2016 meta-analysis lead by Nasri Hani Zreik of their Blackpool Victoria Hospital in the united kingdom, found that individuals with diabetes are five times more likely than non-diabetics to have suspended shoulder, with an overall prevalence of suspended shoulder in individuals with diabetes in a whopping 13.4 percent. We D-folk make up 30% of all frozen shoulder instances.
That last set of numbers led the investigators to call for screening in any individual diagnosed with shoulder for diabetes!
And this is 1 time in which we share equivalent danger with our T2 cousins. There was no significant difference in prevalence between T1s and T2s, nor between T2s on insulin T2s on oral agents.
Fixing Frozen Shoulder
Adhesive capsulitis is just one. Frozen shoulder does thaw on its own as noted, but it might take up to three decades, and during that moment, the pain can be staggering.
Johnson stated, “Every once in a while, both on the court and around the house, I’d jar my own body in such a way as to hurt my shoulder. It was a knee-weakening, breath-taking, seeing-stars type of pain”
And that breath-taking pain got more and more common as time went by for Johnson. His ice was not thawing, so to speak, and it turned out so debilitating that it was interfering with his life.
“I was avoiding basketball instead of looking forward to every chance,” he stated, noting that new lack of action trashed his diabetes management and he says, his psychological health.
A jumpshot is taken by Scott Johnson during a basketball game in the Friends For Life diabetes conference.
It was time to do it.
The treatments for frozen shoulder are physical treatment to attempt to extend some flexibility back into the joint capsule, kind of like stretching out a pair of pants a day. Steroid shots are also generally used, but Johnson was wary of the notorious impact on blood sugar. Anti-inflammatory meds are sometimes used, along with the “nuclear” treatment alternative is a primitive form of surgery in which physicians knock you over the head with a skillet, and while your lights are out, force the shoulder via a standard range of motion to break the ice of the frozen shoulder.
Oh, I am told pans aren’t used by them any more. A general anesthetic can be used.
However, it sounds brutal.
Getting to Know Hydroplasty
A relatively new treatment that Johnson learned about and decided to experience is known as a Shoulder Joint Capsule Distension (a.k.a. hydroplasty). Under a local anesthesia, the joint capsule is filled with mixture of anesthetics saline, along with a little dose of steroids to extend it out, much like blowing a balloon up. This process is followed up by “intense” physical treatment to break down the adhesions.
Johnson explained the process was “fast, simple, relatively painless, and could not have taken longer than 10 minutes” He explained that the physical treatment began immediately following the injection, and continued for one hour daily for the following two weeks, followed by half an hour every other day for another week, with additional “trainings”
Or, as Johnson explains it:
“That was one significance of intense when my orthopedic doctor explained the physical treatment requirements — it required a real commitment and the ability to manage numerous appointments. Another meaning of intense was the therapy sessions. I listened to my shoulder make unnatural sounds,” while the therapist moved his arm around, said Johnson, including, ” all I could do was breathe through the pain”
Following the first intense physical therapy treatment he’d signed up for. But two days into the therapy, he was back to the court, playing basketball again with, “very little pain and striking range of movement” Johnson said the most challenging part was “compelling my brain to utilize my left arm again!”
Well over a year in the future, Johnson says his shoulder feels good, and he wonders why the hydroplasty is not “a better-known option for treating shoulder”
However, now his left shoulder is back into the game, he’s beginning to be worried about his shoulder, which is starting to show some signs of adhesive capsulitis. Sorry to say that frozen shoulder jumps from 1 side of their human body to the other. In doctor-speak in Medscape, “bilateral shoulder involvement is seldom simultaneous and rather occurs.” A blessing to be certain. It would suck to have both shoulders.
Would he sign up for another form of hydroplasty with physical treatment if Johnson’s right shoulder gets worse?
“I’d do it again in a heartbeat, when my doctor feels it’s an appropriate therapy,” he stated, adding that he would push his doctor to move faster on his arm. “That is my shooting arm so that I would not want to wait long”
Thanks to our correspondent Wil Dubois for digging into this topic for us, and of course to our friend Scott Johnson to be open and willing to talk about his story!
Perhaps you have ever experienced frozen shoulder? If so, please discuss your POV from the comments section below.
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