Thursday, October 11, 2012

Frozen Scapula

"I know you've been screaming this at everyone for months, but I think your scapula is stuck." said my physio.  This was established by various movement/ manipulation attempts, all of which I failed miserably - it seems the muscles under my scapula (particularly the subscapularis) are not really doing what they should be doing.  I've also been getting a lot of increased nerve-y type pains and strange symptoms like burning in my hands and, strangely, a sensation where it feels like ice cold water is 'leaking' out a specific spot in my hand/fingers - I check to see if something has dripped on me but it's always dry.  He now thinks that might all be coming from compressed nerves under the scapula.  The pain I am still getting wrapping round my side along certain ribs would also be explained by everything under my scapula being 'stuck' as the same ribs originate there.


Next step: "I'm trying to get my fingers under your scapula and pull it away from the thoracic cage." And yes, that hurt as much as you'd imagine!


I've heard of a frozen shoulder before this year, and I've heard (and learned) a lot about it this year.  Before, I always thought it just meant the joint was stiff but basically (my basic understanding now) it's when fluid gets into the joint and it literally freezes/ solidifies and makes it impossible to move.  Usually that refers to the actual ball-and-socket joint we think of as our shoulder (I have problems here too), but there is also such a thing as a frozen scapula.  My understanding of it is that basically when everything ripped apart when I fell, and then was unable to move properly for so long - before and after surgery - it has healed kind of stuck together.


A frozen scapula's a bit more unusual (of course it is.... I really should have realised by now there is not one aspect of this injury that is normal/ common) - I tried searching Google Scholar for "frozen shoulder" and got 8,910 hits and for "frozen scapula" I got 1 (yes ONE) hit - I wasn't expecting a lot, but this still really surprised me!!  On Science Direct I got 2,009 hits for "frozen shoulder" and 3 for "frozen scapula".  Even Google threw up 10,400,000 search results for "frozen shoulder" but only 671 for "frozen scapula".


I have been saying that's what it feels like for months.  It's like everything is glued together and I simply can't make my shoulder blade move.   That's pretty much what it looks like too.  I think probably a lack of movement was expected after my surgery so it's been hard to tell before now what has been within 'normal' range for after the surgery and what has been a real problem.  Now, given the amount of healing time I've had, it is very clearly not moving as it should be.


Sometimes for a frozen shoulder they will aggressively manipulate the shoulder under general anaesthetic.  We did discuss this but there is a risk that without me being aware of pain, the person doing the manipulation could torque the shoulder excessively and damage the repair.  I've been told that I can't do anything to damage it now (i.e. exercises), but it is still very weak and excessive force could damage it.


However, the solution is to stretch out the tissue and get some movement back in my shoulder blade again so this week I have taken Valium, along with my usual strong painkillers and muscle relaxants before physiotherapy and I have been able to tolerate a bit more movement and massage of the area.  I am not knocked out, or even dopey enough to not feel the pain - it still hurts! - it just means I am able to tolerate a little bit more, so gradually it should loosen up a bit and I should be able to move it a bit more.


I have a ridiculous tolerance to drugs - actually, I don't even think tolerance is the right word given that I've never taken Valium before in my life, my brain just seems to fight them (when I was 12 I got my tonsils out and they gave me a strong sedative pre-surgery that was supposed to knock me out and it did not... actually it was a really horrible experience and I vividly remember the entire, um... 'trip' I suppose is the word  - had I ever been inclined to take drugs, that experience would have put me off! So it's just the way I've always been!).  Anyway, I've required quite a strong dose, combined with other strong painkillers, and taken on an empty stomach to even get enough of an effect for this to work.  It doesn't last very long either - maybe 90 minutes, so I have to time it all very carefully to get the optimum dose working at the exact time the physio is working on me.    And to top it all off, my strange reaction to drugs means the Valium - often used as a sedative - is giving me insomnia on the day I take it, so it's been 5am before I've been falling asleep... however that has meant that I've pretty much slept all day the day after the therapy which has probably been the best way to deal with the horrible pain.


The extra movement and massage in the surgical area is making me feel like I've been beaten up.  It even hurts to breathe right now because my rib cage expanding is agony.  I've had to increase my pain meds again and feel like I'm permanently attached to my ice machine... But even in two sessions, my physio is amazed at the increased movement he is getting with my arm - OK, it's nowhere near even close to normal, and I still can't move it like that myself, but it has to start somewhere and this is the most improvement I've had in months.


The plan is to try this for a few more sessions, see how the movement increases and then I'm hoping to try some therapist-guided aquatic therapy in a heated pool.  The idea is the heat is good for the muscles/ blood flow/ healing etc. and the buoyancy effect reduces the weight of the arm and (hopefully) it will move more, so my movement should increase.  


I think it's a bit torturous right now, but I am feeling really positive about trying this - it makes sense to me based on how my shoulder feels and how it moves (or doesn't move actually) and I think the fact there seems to have been some improvement after just two sessions is really encouraging.  


And in between all that we have been trying to unpack and organise the new house.... I say "we".... really, I'm pretty useless right now and Mum's doing a fabulous job!  We still have quite a lot to do though.....


It seems the day for a feel-good positive, motivating quote!



"What lies behind us and what lies before us are tiny matters compared to what lies within us." 
            ~ Ralph Waldo Emerson


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