Diabetes and Adhesive Capsulitis

[nancy1399]

I am a 55-year old female that has been diagnosed by an orthopedist as having adhesive capsulitis of the left shoulder complicated by diabetes. I am also left-hand dominant. My problem began a year ago, but I neglected it for 10 months before seeking treatment, thinking it would just go away. During the 10 months of my neglect, it progressively worsened, and the worse it got, the less I used my arm, and by the time I decided to get medical treatment, I had pretty much lost the entire use of my left arm. I have had X-Rays and an MRI. The MRI confirms RC tendonditis and suggests the adhesive capsulitis is "probable", although the orthopedist says I definitely have it. I have had one injection in early November of this year that did not give me much relief at all, and I have been in PT for 2 months now. Through PT, I have gotten back a lot of ROM, but I have made no progress at all in restoring internal rotation, and I have no ability to reach behind my back at all. The therapist says that I need aggressive treatment to restore the internal rotation, and he has tried it, but I am not able to tolerate the pain. When he was trying it, I would come home from therapy 3 times a week and just crawl into the bed and cry myself to sleep. At a recent visit to the orthopedist, when he found out about my intolerance to this type of therapy, he ordered that all aggressive therapy be stopped, and since then, my therapy sessions have been okay, but progress has now slowed to a crawl. The therapist is in disagreement with the orthopedist over what type of treatment I should be getting and says that I will not recover if I can't have the aggressive treatment. The orthopedist says that it may take another year for internal rotation to return, but it will return on its own when it is ready. I can't wait another year, and use of my left arm is still somewhat limited, and many actions are very painful. My sleep is VERY disturbed to the point that I really get very minimal sleep during the week, and then on the weekends I take Ultracet combined with 2 Tylenol PM at bedtime and get a good night's sleep. I can't do this during the week, or I don't wake up to go to work, so I only do it on the weekends. I can't continue doing this for another year waiting for my arm to get better. My question is: Should I try to "toughen up" and learn to tolerate the aggressive physical therapy, or should I just wait it out like the orthopedist suggests? I am scheduled for a second injection on 1/2/2008.

[JainMD]

Hi Nancy,
I don’t think that you should be doing aggressive therapy especially if when you are not comfortable with it.
Your ROM will eventually improve over a period of time if you do little physiotherapy and for longer time.
I am sorry to say but I don’t think they should be putting you through aggressive therapy.
What I mean by warm steam fomentation is that after the water has boiled and steam is formed, dry cotton towels are placed over steam till they get warm. Warm towels are then placed over the area of injury daily for 30 minutes till your Range Of Motion around the joint has improved.
Yes the steroid injections are known to increase sugar levels.
How is your pain now?
Did we discuss about your pain meds?
Keep me updated.
Bye.

[nancy1399]

Thank you, JainMD! I am 55 years old. By aggressive therapy, I mean that they are forcing my left arm in directions that it just won't go right now, mostly behind my back, and it is extremely painful. The other move they are forcing is to touch my right shoulder with my left hand which I cannot do. They try to force it, and the pain is so bad that I am screaming while they try to do it. I do not know what warm steam fomentation is, but I know that I am not getting it. I am there for one hour, and I spend the first 30 minutes doing all of my exercises, then 15 minutes of passive aggressive ROM, then 15 minutes of ice. I was getting stim, but it didn't seem to help, so they stopped it. I believe the injection I am getting is a steroid because the doctor is concerned about my sugar levels and says that it will raise my sugar level.

[JainMD]

Hi Nancy,
How old are you?
What do you mean when you say aggressive therapy session? What all is included in it? Do they do warm steam fomentation?
I have known couple of patients who had similar problem, after physiotherapy and warm steam fomentation; the ROM had improved by close to 90%.
I would like to know what is included in aggressive physical therapy.
What type of injection are you talking about?
Is it steroid injection?
They would help you a lot and pain will reduce gradually. It will 24-72 hours for pain to get better.
I would be interested to know about disease progression and healing.
Keep me informed.
Bye.