I had just got into the car and put on my seatbelt when I was hit by a sudden and breathtaking pain in my left arm.
t took 60 seconds for it to fade and as my sons looked at me in alarm, I assured them that all was fine. I must have just hit something as I got into the car. The pain passed, and away we went.
That episode happened last July and occurred again a number of times as the weeks went by. On the first occasion, I didn’t think too much about it, but on the second or third, I got a bit alarmed. And given that both my maternal grandmother and uncle died suddenly at a young age from heart-related conditions, I thought I had better get it checked out.
After an initial phone consultation (due to Covid restrictions) I was asked to come into the doctor’s surgery the next day where I underwent an ECG and various other tests and was then referred to the local hospital for a stress test and to be fitted with a 24-hour monitor.
The process was very efficient. I was told that my heart seemed fine, but due to my family history, I should remain vigilant.
But while it wasn’t constant, the sporadic sharp pain continued. It was decided that I must have pulled a muscle. So I carried on, slightly perturbed as I couldn’t remember any incident which could have caused such a painful injury.
Over the following weeks, the pain intensified, and any sudden movement would cause pain strong enough to take my breath away. I went to see a physiotherapist in a bid to relieve what was thought to be either a strain or an internal tear.
As the weeks went on, the movement in my left arm got worse rather than better, so I was put on anti-inflammatory medication, (which had little effect), while waiting on an appointment for an investigative MRI.
Due to the Covid situation, waiting lists were longer than normal so it took a couple of months to receive a date for the scan, which revealed several issues including a tear in my tendon, inflammation and a touch of arthritis and bursitis.
With a better picture as to what was going on, I was referred to an orthopaedic surgeon for further treatment. By this point, I was having difficulty sleeping and performing everyday tasks such as getting dressed or even putting up my hair as my arm was locked at a certain position.
I counted down the days to the appointment when I would finally find out what had been causing the constant pain and reduced mobility for the past nine months — and, more importantly, what could be done to solve the problem.
The consultant knew after a few moments of conversation and examination exactly what was wrong.
He diagnosed a frozen shoulder and said I would need manipulation under anaesthetic to unlock the joint, followed by intense physio for weeks afterward to restore mobility.
According to Ruth Delaney, a consultant orthopaedic surgeon, a frozen shoulder, which is also called adhesive caps ulitis, is a term which is often misused to describe any stiff or painful shoulder, but it is a very specific diagnosis.
“In frozen shoulder, the capsule, or lining, of the main ball and socket joint of the shoulder (the glenohumeral joint) becomes inflamed, often for no good reason but may happen after minor trauma or after surgery or immobilisation of the shoulder,” she says.
“As the capsule becomes inflamed, it is very painful and as the capsulitis progresses, the capsule becomes thickened, leading to restriction of motion of the shoulder, which can be very limiting.”
I was glad to finally know what was wrong, even though the procedure didn’t sound altogether pleasant. But thankfully I would be having a general anaesthetic as without it, the surgeon said I would ‘pass out from the pain’.
He advised me to stop going to physio and avoid doing any stretching exercises in the meantime as it would do little to help the problem and would just cause more pain.
I took his advice and for the next few weeks, tried to limit my movements even further to prevent jerking or over stretching and took painkillers when I awoke during the night. I was still getting up every morning by 5.30am as it was just too uncomfortable to stay in bed so I was looking forward to getting the procedure over and done with. And finally, two days after undergoing a Covid test and receiving a negative result, I was up bright and early as usual, having fasted since the night before, and ready to get the show on the road.
After the necessary preparations in the day ward, I was waiting less than 40 minutes before I was taken through to theatre, introduced to the various staff, one of whom was the anaesthetist administering a shot. The next thing I knew I was in the recovery room with no idea what had just happened.
The procedure was over and all that remained now was to wait for the anaesthetic to wear off, ensure the painkillers were doing their job and undergo some instruction from the physio, before being allowed to go home with my designated driver.
In the days that followed there was considerable pain due to the forceful nature of the procedure, but certain movements had returned. I am told, that with the five-times daily short exercise routine and weekly visits to my own physio, full movement will return over the coming months.
Ms Delaney, who is an associate clinical professor in UCD, says frozen shoulder isn’t as common as people think, but, interestingly, there has been a rise in cases since the start of the pandemic.
“The lifetime prevalence is 2-5% of the general population,” she says.
“We have recently reviewed our data for frozen shoulder here at the Dublin Shoulder Institute (DSI) both before and during the Covid-19 pandemic. Prior to the pandemic, 21.1% of patients who presented to DSI in one year had frozen shoulder, while during it, 28.8% of new presentations to DSI were frozen shoulder.
“This increase has been anecdotally reported by many of our international colleagues and has been hypothesized to be due to stress levels during the pandemic leading to upregulation of pro-inflammatory factors, but an exact causative association is not yet clear.”
She says that a condition like mine would right itself in time, but could take several years to do so.
“The natural history of frozen shoulder, if we were to do nothing, is for it to eventually burn itself out, but this can take up to two or even three years to happen,” she says. “For most patients, the pain and stiffness are too difficult to tolerate in order to wait it out for that long. And because capsulitis is an inflammatory problem, it often responds very well to a strong anti-inflammatory like a steroid.
“The mainstay of treatment is gentle stretching and injections (corticosteroid and local anaesthetic) into both the shoulder joint space itself (glenohumeral) as well as above the shoulder joint around the tendons (subacromial) for any secondary inflammation in that space.
“We often supplement this with non-steroidal anti-inflammatories and sometimes a short course of oral steroids. We then use a gentle stretching programme which the patient follows at home from online videos.
“In addition, doing some gentle stretching in a swimming pool and walking in the water while moving the arms can also be very helpful.
“We typically do not use formal physiotherapy for frozen shoulder, as most patients find that this aggravates the capsulitis and pain. The majority of patients do not end up needing surgery for this condition, but in persistent cases, an arthroscopic (keyhole) surgery to release the thickened, inflamed, tight joint capsule may be recommended.”
Ms Delaney says that recovery depends on the severity of the problem and how an individual shoulder responds to treatment, which in some cases can be a short as six to eight weeks from initial treatment.
And although the problem is unlikely to happen again in the same location, it can present elsewhere.
“It is unusual for frozen shoulder to reoccur in the same shoulder,” she says. “But it can happen in the other shoulder because the same factors which exist in an individual person that predisposed them to frozen shoulder on the one side still exist after that has been resolved and can play a role in it developing on the other side.”
These factors can include being female, aged between 40 to 60, being perimenopausal, having an underactive thyroid, diabetes, or other unidentified pro-inflammatory factors.
Two months on from my procedure, I am slowly, but hopefully surely, getting back to full, pain-free movement.
However, given that I tick the first three factors, I need to be aware of the problem reoccurring.
In the meantime, I’m still enjoying being able to put my hair up for the first time in a year.