Episode 1569 - Frozen shoulder: helping your patients navigate no (hu)man's land

Dr. Lindsey Hughey // #ClinicalTuesday // www.ptonice.com In today's episode of the PT on ICE Daily Show, Extremity Division Leader Lindsey Hughey explains that patients with frozen shoulder often struggle to manage their condition and experience fear of the unknown, which can significantly impact their cognitive and emotional well-being. Lindsey emphasizes the importance of understanding the patient perspective and their emotional stories. She highlights that patients may fear the future and the unfamiliar territory of living with a frozen shoulder, which can have a profound effect on their psychological well-being. Lindsey also emphasizes the need for healthcare professionals to appreciate the expectations and experiences of patients with frozen shoulder, acknowledging that their pain is not an exaggeration. She suggests providing controllable solutions and empowering patients to advocate for themselves in order to receive timely care and diagnosis. Lindsey underscores the challenges faced by patients with frozen shoulder in managing their condition and the significance of addressing their emotional and cognitive well-being. Lindsey reinforces the importance of healthcare professionals assisting patients with frozen shoulder in finding ways to continue engaging in activities they love. This involves helping them adapt their activities or modify their movements so that they can still experience joy and maintain a sense of autonomy and independence. Take a listen or check out the episode transcription below. If you're looking to learn more about our Extremity Management course or our online physical therapy courses , check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION 00:00 LINDSEY HUGHEY Good morning PT on Ice Daily Show. How's it going? I am Dr. Lindsay Hughey. I will be your host today on Clinical Tuesday. It's so good to be with you all. It's been a little while. Today I am going to chat with you about frozen shoulder and helping your patients navigate no man's land. But before I unpack this episode, I'd love to tell you a little bit about courses that Mark, Cody, and I have coming up. Cody actually was just promoted to lead faculty. We are so excited. And he will be teaching his first class this weekend solo in Minnesota so Rochester and there are still tickets left if you want to join him he would love that and you're sure to have a blast with him this weekend so October 7th and 8th can you believe we're already in October so wild other courses coming up in November on November 11th 12th we'll be in Woodstock Georgia and then our final courses of the year are in December. So you have two opportunities on December 2nd, 3rd. Cody will be in California, Newark, California. And then December 9th, 10th, I will be at CrossFit Endure again. That's always a blast of a spot. So Fort Collins, Windsor, Colorado area would love you to join. Those are our last of 2023. And then we'll be in 2024, which is super wild. So please join us. Thanks for letting me share courses coming up. 03:37 LIVING WITH FROZEN SHOULDER So last week, if you tuned in to clinical Tuesday, Mark hopped on here and he chatted about frozen shoulder, just the challenges associated with treating folks with frozen shoulder. And he really highlighted not only best treatment as we know it, but the importance of coming alongside the patient. And we need to do that better because this is an area, and if you think about any patient you've ever seen with frozen shoulder, it's always challenging, right? Because they are suffering and there are just so many unknowns. But we do have more knowns in regards to the patient perspective that just came out this past May. William King and Claire Hebron out of the Physiotherapy Theory and Practice Journal published a qualitative review of frozen shoulder. So specifically giving us the vantage point from the patient. So this study involves six folks, two were females, four were males. Their age range between 35 and 66. So a varied mix of sexes and then age ranges. They all were British and there was a mix of right and left and even bilateral frozen shoulders. So these interviews were done with these six folks and the question that was asked of them was can you describe in as much detail as possible what was important and meaningful to you in your experience of living with frozen shoulder? They used hermeneutic feminology methodology for those research nerds that want to know and they found the following five themes And so today I'm going to tell you what those themes are, and then I want to unpack some of the participant details from each theme. And I'm sure you'll be able to relate with some of your patient care experiences. And then kind of end the show with suggesting a rewrite of the title, plus some key takeaways for us going forward in caring for these folks with frozen shoulder. So the five themes illuminated from this article, and again, that's title, and I'll drop the link, is Frozen Shoulder, Living with Uncertainty and Being in No Man's Land. The five themes that were found were, number one, patients felt an incredible pain experience that they described as dropping me to my knees. Two, a struggle for normality in life. Three, an emotional change of self four the challenges of traversing the health care journey and then five coping and adapting and learning how to do that. So I want to unpack each one of these just a couple examples to help you appreciate that patient perspective. So dropping me to my knees that incredible pain experience All of the patients that were interviewed described multiple experiences where if they move their shoulder quickly or hit up against an object unexpectedly or involuntarily kind of reached and forgot about their shoulder for a second, that this pain would literally drop them to their knees. That when they would go to like stretch in the morning, they would scream and writhe out of pain. And this not only affected their body and their discomfort but like their family. Some of the participants described kind of scaring their partner because of like sudden outbursts or yelled. So an experience that's not just personal but affecting those around them. 07:28 EMOTIONAL CHANGE OF SELF Number two, the struggle for normality. So a lot of the folks describe multiple daily activities just being very limited and I'm sure your patients have had the same right just getting dressed, just rolling over in bed, unable to sleep, just that constant ache that's with them always kind of being in their mind and then challenging just normal daily activities. Not just ADLs and IADLs, but starting to lose work function, missing work and or recreational function. So one participant actually had to sell their fishing boat or chose to because they said just transporting the boat became so cumbersome and a reminder of their shoulder limitation. One of the participants described being unable to throw the ball. They're at a family gathering and their kid is watching other people throw the ball with their parent and the parent that has frozen shoulders just sitting there thinking, oh I can't even like throw the ball with my kid so this normalcy doesn't only impact them personally again in their daily life but it's impacting their family relations around them their work right their ability to actually provide for their family and then the recreation like enjoyment in life people that love to fish that was my dad's like favorite pastime if there's an emotional psychological peace here that is huge then that is challenged when someone has frozen shoulder that they can't do that one activity that brings them peace or joy and they can't um help provide for their family because they're suffering Which leads us to that third theme found, an emotional change of self. So all of the participants described overall just low mood from being in constant pain, having low self-esteem and starting to feel less worth in their family unit. Just kind of feelings of uselessness because not being able to reach overhead or being limited in the ability to just help out with daily chores. this was a really challenging thing to read, but one of the patients described that emotional change as if you were an animal, you would be put down because you're miserable. So basically like lack of thriving and like that was heartbreaking to read, but like this is how low emotions get when you're in, when patients have that frozen shoulder state. And a lot of them said not just the emotional drain is challenging, but like you're physically drained because of that emotional taxation. So multiple participants reported poor sleep, which I already mentioned earlier from a normalcy perspective, but they linked that to how this led to fluctuating mood because you never know when you're gonna get a good night's sleep. And so overall mood was very cantankerous and unpredictable. which patients even again mention that they're not able to even sleep in the same bed as their partner because they're so disturbed and uncomfortable in their sleep. And so they're sleeping in a separate room, again, that's that intertwining like emotional change of self being affected. and when this happens right you start seeing sleep being affected it makes you want to prompt for health care help right and so this leads to that fourth theme where patients are traversing the challenge of the health care journey going to a health care professional hoping they can help them sleep better helping they can take away the pain. 09:28 IMPACT OF DELAYED DIAGNOSIS ON TREATMENT But what most of the participants really highlighted is that this delayed diagnosis happened consistently where they saw multiple healthcare professionals prior to actually getting a solid diagnosis that this is in fact frozen shoulder. And so there was this, there's this period of not knowing and switching back and forth, like what's wrong with my shoulder? And then you finally know. And, um, even the treatments they were getting were challenging because patients said they didn't actually see solid results. So they would ask for a pain medication and then some of the healthcare professionals would be afraid of addiction. So they wouldn't give them stronger medications to help. And so there was this balance of figuring out what's that pain medication that's right for the patient. A lot of the patients, said that injections were life-changing. So getting a corticosteroid injection was helpful, but it didn't always happen right away. And some of them had to really advocate for that to occur. And that some, even the patients that were finally recommended to get the injection mentioned they were afraid of the needle. So we have to understand it might be a delay to get to the treatment that's effective, And then they might even have a fear of actually using that treatment that's recommended from the healthcare provider. So they're dealing with a lot of challenges in the healthcare journal. And disappointingly enough, as for most of our audience that are PTs, a lot of the folks said that PT wasn't the greatest. They didn't have initial great experiences because the PT would give them stretches that were super painful and not working. And the patient would have to wait a whole week to tell the therapist that, and then the therapist would give them something new, and then the stretches would hurt and not really work, and they'd come back again. We can do better here, right? If you test, retest in that session, you'll know whether that's working. So some kind of disappointing healthcare journeys for most of these folks. But there was some hope along the journey. So the fifth theme found was coping and adapting. Once patients did finally get to the healthcare provider or the PT that started providing effective care, they did have hope. Once they saw it start working or when they got that injection and the pain started going away, they could move their shoulder a little bit more. So when pain's down and range is better, they were super jazzed about it and finally had some hope. Various participants did say that it requires that coping and adapting, it requires you to shift your mindset, that press on attitude in the face of adversity. So helping our patients get there quicker, I think is something that we have an opportunity for. Another part of that, some coping strategies was people just learning, some of the participants mentioning that learning to work around the disability, right? If they were right-handed, starting to use their left arm, to keep functioning in kind of a pushing through mentality. The final binding theme of all of these, so we've unpacked examples of dropping me to my knees, an incredible pain experience, the struggle for normality, three, an emotional change of self, four, the challenges of the healthcare journey, and then five, coping and adapting. That theme that they found binding them all together was uncertainty. Or as the authors of the study titled No Man's Land. One thing I said that I was going to unpack was a suggestion for a rewrite. So we are dealing with humans, not just men. So I'd love to suggest that we call this No Human's Land. But this does come from a phrase, right, that was used to describe unowned land or unoccupied land or land that's not officially owned or inhabited by someone. but we are dealing with multiple humans, right? Not just males. So that rewrite I think is important here. 13:58 FROZEN SHOULDER & THE FEAR OF THE UNKNOWN But ultimately the main thing I want you to appreciate is with the unknown of how this disease may progress or regress, we have to do better for our patients here. They will not be able to manage their present living with frozen shoulder if they're fearful of the future. They don't read it. Oh, hopefully you're all still there. Give me a wave or like a thumbs up. If you are a little alarm went off. Sorry about that. Um, but patients will not be able, um, to manage living with their frozen shoulder. If they don't know how to manage it in the present, if they're fearful of the future, sorry for the folks that had to hear this twice on YouTube, but That fear of the unknown, right, or no humans land territory, this affects cognitive and emotional well-being. So what can we do with these themes, knowing patient perspective a little bit more deeply here? And I know it was only from six folks, but I'm sure you can relate and think back and reflect on patients you've seen, and they've had similar tough experiences. There are powerful takeaways here. appreciate that expectations from your patient they're always tied to a real human with an emotional story and we have to know that and appreciate that. We have to know that this pain is not an exaggeration. We need to give stabilization to that human story. with some of the facts of the do's and don'ts about frozen shoulders. See Mark's podcast last clinical Tuesday because he dove into best treatment and about what we know, what we thought we knew, and where we are presently. We have to provide controllable solutions. Some solutions. Help your patients advocate for themselves early. and with tenacity with their specialist, right? Help them get to that corticosteroid injection. You don't usually hear us saying that, right? That medicalization, we try to avoid that here at ICE, but here's a condition where we see, especially in the United Kingdom, this being a helpful pathway in combination with physical therapy. So help them get to the proper care and diagnosis faster. Make it so they don't have to see three healthcare professionals before they start feeling better. USPTs test retest the value of your treatment in session. Don't send someone home in writhing pain that worsens their range. Send them home with something that is helpful, right? That's easing and know that before they leave so they don't have a whole week of time of ineffective self-care. Let's not forget the human behind the painful and stiff shoulder. Those with frozen shoulder, let's help them feel direction at a really destabilizing time in their life. Help them figure out a way to do what they love, to keep working, help them be autonomous, to navigate their pain, their setbacks, and then their interactions with the healthcare team. We have a really cool opportunity to make living with frozen shoulder a little bit more endurable and making the patient feel more known. Thank you for being with me this clinical Tuesday and sorry about that little blip in the middle. Happy Tuesday. Cheers. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to PTOnIce.com and scroll to the bottom of the page to sign up.