He reports that his pain started gradually, about nine months ago, getting worse over time until he had to start limiting his exercise and began having pain with dressing, grooming, and sleeping. He saw an orthopedist and underwent MRI which showed that he had fraying of his labrum and supraspinatus tendonosis. He was treated for frozen shoulder with subacromial and intra-articular injections, with gave him significant pain relief, but did not improve his ability to move.
Examination
His shoulder motion was significantly limited, consistent with frozen shoulder. Because he is active, relatively young, male, and not diabetic, his condition was not expected. He also appeared to have mildly limited motion in the other shoulder.
Treatment
We started his care with aggressive range of motion and stretching, to improve and normalize his shoulder motion. During the course of his treatment, he was traveling for business intermittently, so he was given basic, yet very effective exercises, that he could perform from any hotel room, or even during the day. He attended 6 visits over 6 weeks, and was able to improve his motion and start strength training relatively quickly.
From strength training, we moved into a final set of exercises that are designed to challenge his stiffness and build integrated shoulder strength at the same time. During one of his appointments, it was noted that he had unexplained swelling of his small finger, causing it to stiffen in a bent position of the PIP joint. He was not sure what caused it, and told me that it had happened a time or two in the past, and resolved after only a day or two – before he was able to seek medical attention. I encouraged him to take a picture of it, and talk to his orthopedic surgeon about it.
Outcome
By his last appointment, he had returned to weightlifting, and had minimal pain, other than when he was challenging his motion with his home exercises.
He also let me know that his orthopedic surgeon had drawn blood and found that his ANA (Antinuclear Antibody) was high. It can be a possible sign of lupus or other autoimmune disease, and may ultimately explain why an active, young, and otherwise healthy male, would appear with a frozen shoulder, despite his other MRI findings. they could be found in many males who were athletic in the past.
