Tuesday, May 02, 2006

140 out of 145

After my fall in January, my left shoulder strength and mobility were very poor. At first I could barely raise my arm forward like you’d reach for a doorknob. Initially the orthopedist wanted to wait for the bone to heal before starting physical therapy. Obviously he didn’t want me using the arm for anything due to the risk for an additional fracture. However, he didn’t want to immobilize the arm in a sling or cast as that would increase the likelihood of a “frozen shoulder.” A frozen shoulder refers to limited muscle function caused by muscle adhesions that form during muscle healing. If the arm and shoulder aren’t being used, these adhesions limit the range of motion for the muscle.

Unfortunately due to a delay in PT approval, I was starting to stiffen up when I saw the orthopedist in March. He wanted me to focus on improving my range of motion by working through the pain associated with stretching the muscles. He gave me until the end of April to get my arm straight up above my head using a forward arc style windmill motion (like the first flexion pictures here except while standing). I was also limited in my ability to move my wrist outward while my arm was bent 90 degrees with my elbow staying at my side (like the shoulder external rotation picture here – but with your elbow at your side).

If traditional physical therapy doesn’t work, the alternative to restore motion in a frozen shoulder is manipulation under anesthesia (MUA). In short, they put you out and yank your arm around to break up the adhesions. Needless to say, it’s painful after you wake up. That was my motivation.

Some of the therapy sessions were painful when they were stretching those arm and shoulder muscles. Progress was slow, but I could sense improvement. They’d measure the range and see improvement, but it wasn’t close to expectations. Dianne was watching me stretch one night and I asked if my external rotation was improved. She looked puzzled and asked me to show her with my good arm. I could rotate out about 35 degrees whereas she had an almost 90 degree range! By the way, I now call her Mr. Fantastic when she shows off her shoulder movement. I shared this story with my physical therapist and she measured my “good” side and found I could only rotate my straight arm up forward about 145 degrees whereas 180 is standard. She said typically after injuries, people get within 10% of the range in their good arm. That gave me hope.

Besides intense stretching during physical therapy, my therapist also added exercises to start building strength. They were mild so as not to cause further fracture, but I think that helped stabilize the joint and aid the range of motion. Last Wednesday the therapist made measurements again for the orthopedic progress report. Raising my arm up I was 140 degrees compared to 145 on the right. An improvement from about 30 degrees when first measured. Rotating out, I was 25 degrees versus 35 on the right. Again, a big improvement from the -5 degrees I started with. Yes, the muscle was actually pulling my left arm in 5 degrees to the right so I couldn’t hold it straight ahead when the arm was bent 90 degrees (as if typing).

The question is would this be enough to satisfy the orthopedist? I was nervous about my follow-up last Friday. I really didn’t want to face a MUA. I got up early and got my shoulder warmed up and stretched out for my visit. Although he said I still have work to do, he was pleased with the range of motion. He also took x-rays which showed the bone is healing nicely – although there is still some remodeling that will take several weeks. Now that he’s sure the bone is getting stronger, he wants me to focus on building strength while still doing stretching.
A quick slip on the ice has caused a lot of difficulty. Looking back, I can’t help but wonder if some early but gentle, passive manipulation that wouldn’t have risked further fracture would have minimized the range of motion issues I’m working through. While the healing is slow, it’s amazing how your body can repair itself.

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