Bursitis or frozen shoulders

Type 1 and LADA
1

I was diagnoses with bursitis and frozen shoulder recently.
My doctor told me that it is common for diabetics to have it especially if control is not great.
My control is very good. I have no other complications and I have been t1 for 26 years.

In any case it is majorly painful and limiting. I have a tough time lifting things over my head. Even playing ball with my kid is nearly impossible.

The thing is , it came on so fast. I have an appt with a PT next week.

Anyone else ever have this and have some insight on what to expect?

2

I had a wierd thing in my shoulder, I never got it dx'ed but I think I caused it doing behind the back shots with paper towels into the men's room garbage can at work. MrsAcidRock had been dx'ed w/ FS and I did her exercises that seemed to help but then I got back into lifting weights regularly and that seems to have made it go away. Chest presses, pull-downs and these sort of side lift things pulling lighter weights up to shoulder height (I have a gizmo w/ the pulleys...) all seemed to help.

3

I have had shoulder problems. Not frozen, but bursitis (inflammation) and shoulder impingement (pinching the nerve) I do have some permanent range of motion limitations. What helped me was performing careful exercises to increase my range of motion and increasing the strength of the tendons and muscles in my shoulders.

To help my range of motion, I used an exercise called the shoulder dislocate shown here. I don't have the range of motion of that guy, instead I used exercise bands, starting with the easiest and working up. For strength, I used a number of cable exercises at the gym, including internal and external rotations, slowly increasing the weight.

You will probably have to go through a bunch of stuff with PT to just get to the use of the above exercises, but those are probably some of the things you will have to do.

4

The frozen should is an inflammation in the subacromial space of the coracoacromial arch of the shoulder (not so easy to get that translated). Bad control can attribute to the inflammation. With good control it just shows that we are still prone to all the other conditions normal people can get. I know many healthy people with this condition. I my experience it will take one to two years to recover. The necessary excercise therapy will cause some pain to mobilize the shoulder again but it can be done.

5

Yes, I have had T1 for 30 years and had frozen shoulder starting a few months ago.

The good news I have been told and have read, is that between physical therapy and slow self-healing it almost always clears itself up. And that starting PT early seems to reduce the overall duration.

The bad news is that it takes time, and it still hurt me a lot, not so much during the day, but at night when I was trying to sleep. I'd find one good position and then roll over a little bit and wake up in pain. After I woke up crying a few times (a grown man crying in bed) I decided going to see the doc was the right thing. But you're right, for me during the day, not being able to play with the kids and the dog, with anything involving sudden movements of my arm or throwing things or lifting over my head with that arm, was a downer.

It also made it hard for me to dress myself. Putting on a T-shirt was nearly impossible. Putting on a button down shirt required some careful ordering to get my arms through the holes in an order that would work. For a while I couldn't pull my wallet out of my back pocket using the bad shoulder.

The therapists are pretty good but still breaking up the scar tissue requires moving the joint into places where it is kinda between sore and painful. It's not all bad, most of the exercises they have me do just puts it into sore, but there are a couple of oddball positions the therapist loves to put me into that make me wince. After most sessions there's a soreness but it's a good kind of soreness, meaning that I have stretched my arms into positions that I haven't been able to reach for a while.

I've been doing PT for only 6 weeks now, and they also gave me a steroid injection into the joint about 8 weeks ago. The improvement has been remarkable. By no means am I back to 100%, but the PT can show me the range of motion I've regained and it is really encouraging.

They warned me (and I'd read about) steroid effects on my bg, but I noticed no change in insulin needs. I actually boosted my basal in sort of a proactive way, expecting a bg rise, but I had to back it back down to my usual basal because I was going hypo all the time.

My personal theory is that a lot of the inflammatory part of frozen shoulder has little to do with bg control and is more closely related to the auto-immune aspects of diabetes. e.g. when my thyroid got swollen because I was hypothyroid and needed to take synthroid, nobody told me it was my fault because my bg's were out of high, although there are some here who think that high bg's cause thyroid problems. Similarly my pet theory is that frozen shoulder is also mostly an autoimmune thing. My A1C's have been in the 5's or very low 6's for most of the time I've been having A1C tests run (didn't have them for the first 5 or 6 years I had diabetes, or I didn't know the results back then.)

6

I actually believe that part of the issue with shoulders it that our high blood sugars thicken the tendons causing a decrease in the range of motion and a tightening in the joint. I also suffered terribly with sleep. The impingement can press on the nerves causing not only pain no matter what position you try, but I also ended up with spasms all down my arm.

7

In my case the doc and PT tell me that the impingement, which seems to have started before the frozen shoulder, probably set the stage for frozen shoulder.

I sometimes wonder if the impingement was actually an early symptom of frozen shoulder.

The doc and PT and many websites say that in frozen shoulder it's more than just tendons, that the shoulder joint actually has scar tissue in it.

8

Hi Tim- I have had a frozen shoulder for about 2-3 years. Sometimes it is better and sometimes worse. Exercise does help stretch the tendons and the scar tissue. My BG control is also good and my PT said she sees FS in as many non-D people as D. Sometimes it does hurt quite a bit and my range of motion is less than I would like. Watch out if steroid shots are recommended, I had them for a back problem a few years ago and my BG went up to 400. Most D do have an increase in BG with them. ( The BG does come down after a few days.) Good luck !!!!

9

As to steroids and bg's... me and my doc talked about that before the steroid shot, and he may have used some skill in exactly where the injection went into my shoulder, or in choice of dose or type of steroids used, that minimized any effects on my bg. So just because it worked out well for me doesn't mean that steroids automatically work OK for any diabetic with any steroids.

At the time I was very much in favor of doing something, anything, to help with the pain at night, rather than doing little to nothing. Without any "official" PT and just having the steroid shot I did see noticeable improvement, it marked the turn from "getting worse" to "getting better" and I feel very good about making that turn.

And certainly neither the doc nor the PT have promised an instant solution to my frozen shoulder. While I try to sound positive (and generally feel positive) I also know that it typically drags out for years and still there's no guarantee that everything comes back 100%, more typically they tell me it's like 90%.

Is the pain for you during the day, or at night? The PT has me trying to do more with my problem shoulder during the day and not favor me "good shoulder" like I had been doing for a while. This is over and above doing the exercises at home. It's not easy but for example I did put on a T-shirt last week. And changed an overhead light bulb with that arm too. That may not sound very impressive to someone who has never had frozen shoulder, but I see that as real progress.

10

I have had frozen shoulders on both sides--luckily not at the same time. My first one was about eight years ago. The doctor said there was really nothing he could do about it and that it would get better by itself but it was going to take two years. That's exactly what happened. It got better by itself, but it took two years. The other shoulder started to freeze about two years ago. It was never quite as bad as the first one, but it was still a pain in more ways than one. It is just starting to ease up now. I can lift my arm up over my head to reach for things and it just hurts a little bit. It's loosening up more and more all the time. In addition to the frozen shoulders, I have also had tendonitis in both elbows, wrists, thumbs, groin areas, knees. The worst of it now is tendonitis on both sides of my neck. It hurts to twist my head from side to side which is giving me a stiff-neck appearance. The good news is that it's going to go away all by itself, just like every other hurt tendon that I have had. It's just going to take two years to do it. As for control, I am currently in a time of very good control. I hope this session lasts for the rest of my life because I have been through times of terrible control and it has been horrible and done it's damage. The good control hasn't lessened the severity or likelihood of the tendonitis happening. Probably all the years of bad control set me up for it, but that's my story on frozen shoulders and tendonitis.

11

Well thanks for all that info. I'm no sure I'm glad I asked .
The trouble I have is in both shoulders and is diagnosable just in my right.
The pain is very weird horrible to sleep with and any quick movements during the day is excruciating. Like that punching bag thing they have at carnivals. I tried to punch it forgetting my shoulder and I thought I would pass out.
I still have good strength but range is limited and pain is terrible.
I'm quite afraid to take cortisone in my shoulder but my doc recommended it. He said I will come around after my first visit with the PT. He thinks the pain will persuade me.

As for the possibility of auto immune disease. It think it is likely. I have also developed eczema over the past 2 years, although not severe. And a new allergy to tree pollen, Both cam on suddenly and I believe it is an immune issue.

I also had my immunity checked for several of the usual childhood ailments and My bloodwork showed that I have no sign of immunity to Chickenpox or to Hep B.

I was immunized for both of those and that is suppose to be lifetime protection.
So I guess I will get another injection for each of those.

I'm not exactly sure what to make of it, but my endo tells me it is not common but also not uncommon for type 1 s to have this happen.

12

Are you taking supplements? I actually took (and still take) high doses of fish oil, which is claimed to be an anti inflammatory. I also took Glucosamine. At times I would take a NSAID, like Aleve, but I was always concerned about long-term use.

13

I've had frozen should in both shoulders now (not at the same time). The right one I had a cortizone shot and the shot hurt more than the shoulder pain - but it worked. The left one I used physical therapy and it took two years, but I was not good at doing the regular PT exercises. Although I don't think you get frozen shoulder again in the same shoulder, I would just get the cortizone shot. ps, my control is good, no complications; type 1 for 38 yrs.

14

Yes, I was diagnosed with frozen shoulder several years ago. Came on fast and I've also always been in good control. They say that it can run it's course; freeze up, be frozen and then unfreeze on its own over several years. I went in for therapy and after awhile it un froze so don't fret, there's hope.

15

I had "frozen shoulder" several years ago that turned out to be a muscular problem that I solved by seeing a trigger point therapist and doing lots of exercises and work on my own. I do a lot of yoga, so it was weird because I have way more range of motion in my shoulders than most people due to 18 years of avid yoga practice. Turns out it was a computer mouse problem! My trigger point therapist (I call her my torture therapist but never to her face) was a miracle worker, and I got an ergo eval for work and new equipment. I recommend "The Trigger Point Therapy Workbook" by Clair Davies or "The Frozen Shoulder Workbook" by Clair Davies.

16

Hi Tim. I too had a vicious frozen shoulder about a decade ago. I was uninsured at the time, so I just suffered with it for a couple years. It got progressively worse, till even riding in a car hurt with every bump in the road. After three unhelpful cortisone injections into the joint I was sent to a "shoulder specialist" in the nearest big city, a two hour drive. It took that guy exactly 5 minutes to diagnose my frozen shoulder. He said I could un-freeze it myself through physical therapy, or spend a few thousand $ to have a 10 minute Rx where they'd put me under general anesthesia, physically spin my arm/shoulder through it's proper range of motion, ripping loose the scar tissue. Then I'd be given pain killers and anti-inflammatory meds while I healed.

Well, I chose the physical therapy - Got the exercises for free from a friend of a friend who was a PT. He had me put a strong eye bolt with a pulley attached into a wall higher than I could reach. Then I ran a nylon rope through the pulley, made handles at ends by threading them through short sections of PVC, then tying them back to the rope.

The exercises involved 1) pulling the frozen arm straight up, backward, out to side or forward using the good arm - Pulling into the pain as far as I could handle then holding for a slow count of ten. Repeat 10 times in each of the 4 positions. 2) Hold a broom handle out front in hands, elbow of sore shoulder close to side, at 90 degree angle. The good arm pushes sore one so it pivots around to the side Keeping the elbow close to side - again 10 count, 10x. 3) Last I was to hold the broom handle over my head, straight arms, and walk through a door till the handle caught, move forward (pushes arms back over head) into pain and hold the same count/times as the others. Sounds delightful doesn't it? Arrrrrgh. I couldn't believe how much it hurt. But after 2 weeks of doing this daily the pain was 80% gone. A couple more weeks and it was pain free. There's hope!

17

It's called crispy tendon syndrome

18

I have had frozen shoulder on both sides in the last 4 years. Yes, it is extremely painful and most difficult to sleep. Months and months of PT and exercises with no improvement and actually worsening. If you decide to do injections i would definately seek out a shoulder specialist, and ask about getting the injection under flouroscopy xray to make sure that the needle is placed in the proper space. Yes blood sugars will be an issue with injections, I managed mine with temp basals, sometimes up to 140- 150%, knowing that there will be a spike. Eventually, I had surgery on both shoulders, the first being mostly successful eventho i still have some range of motion limitations. The second surgery, not so much, but i think my second shoulder was in a different phase of the process and that changed the outcome. Remember, a surgeons motto is "to cut is to cure". He will probably have little interest in the inflammatory process or the autoimmune aspect of frozen shoulder. My best advice to you would be, keep moving your arm, even though it hurts like hell.

19

Hey Tim:

I've got this. I had surgery about 12 years ago on the left and they removed the bursa sac. Really took care of it but I am loathe to get any more surgery so I've tried to fix the right with much stretching and a weight program designed to strengthen the shoulder. Also, many foods have anti-inflammatory properties (tumeric is one) and I think they are helpful too.

20

A google search on "crispy tendon" turned up some yummy looking restaurants and recipes :-)