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9:21am on Monday, 7th August, 2006:

Unshouldered Burden


On Friday, I visited Trudy the physiotherapist again about my bad shoulder. She had a long look at it, made me go through all the motions, and pronounced my treatment complete.

That ought to be a good thing, except I still can't put my arm behind my back, I still can't support my own weight, and it still occasionally gives me hours of aching pain. It never feels natural — I'm always having to make myself aware of it so I can put it where it's supposed to go rather than where it goes on its own (ie. too far forward, which if I didn't correct it would eventually regress it so I again couldn't do simple things such as throw a ball). The physiotherapist acknowledges all this, so why has she taken me off her list?

Well, the answer is that she doesn't know what to do next.

Physiotherapists see people all the time with shoulder problems. Overwhelmingly, these people have a "frozen shoulder", which is a polite way of saying that no-one knows what the cause is, how to treat it, or indeed whether to treat it at all. Nevertheless, it's very common. Frozen shoulders often go of their own accord after a couple of years, although they can spread to the other shoulder in the meantime. Exercises can sometimes help, but it's hard to gauge whether they're working or whether the improvement would happen anyway. People get frozen shoulders all the time; as a consequence, whenever physiotherapists encounter a patient who can't move their shoulder, they automatically go with that diagnosis. If you haven't got a frozen shoulder, they're completely stumped.

I really don't think I have a frozen shoulder. To me, it feels as if I have a muscle or tendon in the wrong place, and if I could just move my arm in the right way then it would click into its correct slot. The physiotherapist humoured me over this, but never once veered from her opinion that I had a frozen shoulder. She called in the hospital's shoulder expert, Fiona the physiotherapist, who, for 2 minutes between patients, watched me move my arm about then authoritatively diagnosed me as having a frozen shoulder.

Well there's a surprise. I'm guessing that the encyclopoedia of shoulder physiotherapy starts and ends with the letter F.

Trying to be upbeat about dropping me from the treatment list, Trudy the physiotherapist told me I had "normal" mobility in my right shoulder and "hypermobility" in my left shoulder. What, so normal people can't put their arms behind their back? She said that if I were a professional athlete she'd maybe send me to a surgeon for investigative surgery, but as I'm not then the surgeon would just laugh if she proposed it. Yes, although I wonder if she'd have that attitude if it were her own shoulder that was playing up — or if she were being operated on by a surgeon whose shoulder was like mine? She also tried to put a positive spin on things, asking me what there was about my daily life that I couldn't do because of the shoulder. I can't put my arm behind my back! Ah, but when do I really ever need to do that? What the hell? This is like trying to tell someone that they shouldn't be worried about going blind in one eye because they can do everything with the other eye except that unimportant stereoscopic vision thing. Yes, I can reach high places, I can scratch my spine, I can carry a heavy suitcase — but only with my left arm. I'm not exactly left-handed, either. I wonder if she tells patients who can't move one of their legs that it's OK, they have another one?

She was quite up front about her lack of expertise in shoulder problems, and said I was welcome to ask for a second opinion. However, that would involve going for private treatment, in which case the expert in this part of Essex is none other than Fiona the physiotherapist, who moonlights in the private sector because the NHS doesn't pay enough. In other words, I'd be paying money to be told once more that I had a frozen shoulder.

I was assured, though, that my problem would be gone in 6 months anyway. When I asked what to do if I still had it in 6 months, she said I wouldn't have it. When I asked what I would do in some strange alternate reality were I to still have it in 6 months there, she said I should come back and hopefully get on someone else's patient list.

Great. 6 months from now is February. The waiting list is so long that if I want to come back in February, I'll have to ask my GP to put my name down by October, which he's hardly likely to do given that I've only just finished treatment.

I know it sounds as if I'm trashing Trudy the physiotherapist here, but actually she's pretty good. My shoulder is way, way better than it was when I first visited, and if I'd been offered what I have now at the start then I'd have taken it with glee. I'd certainly be happy for her to do physiotherapy on me again. It's just that the core problem with my shoulder is still there, and unless it gets fixed then everything is going to go back to how it was before treatment began. I'm also not looking forward to spending the rest of my days dismissing pain interrupts from the muscles (which will surely only get worse as I get older). Other than having teeth removed, this is the first "you've got this for the rest of your life" medical thing I've had.


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Copyright © 2006 Richard Bartle (richard@mud.co.uk).