Patrick Hobsbawn (not his real name) is a 73 year old gentleman, formerly an engineer at the BBC. When I first met him however, bent forward with pain and worry, you might have thought he was at least a decade older.
Patrick visited our clinic only on the strong recommendation of another patient, as he strongly doubted that we might be able to help. A few months’ back, an orthopaedic consultant had told him he was suffering from “frozen shoulder” in both arms. As a result of this, he had given up using his arms for most mundane tasks like reaching up for a cup or book on a shelf, and had to be helped into his clothes by his wife… and quite literally, the world was shrinking around him!
After taking a case history and examining Patrick briefly, I concluded that the diagnosis had probably been hasty. Frozen shoulder, or adhesive capsulitis, is a specific condition involving the progressive inflammation and scarification of the ligaments surrounding the shoulder joint (aka “articular capsule”). It is initially very painful, then dominated by marked restriction in the range of movement of the arm – specifically, both the active (performed by the patient) and passive (performed by the practitioner) ranges of movement of the shoulder joint match closely. But a little bit like IBS for digestive complaints, frozen shoulder tends to be a common shoulder default diagnosis, often reached over-hastily without the requisite tests and clinical reasoning.
In Patrick’s case, especially when coaxed to relax a little, his passive range of movement far outstripped his active range, and the profile of symptoms didn’t match those of frozen shoulder either. I concluded that he had an inflammation in the tendons of some of the rotator cuff muscles, brought on partly by poor postural habits, and informed Patrick that there would be a little treatment sequence ahead of us, and some real commitment and effort on his part to exercise and conform to lifestyle advice.
From the moment the “frozen shoulder” sentence was lifted, Patrick was a changed man. Over several weeks, I treated his shoulder tissues, but also his neck and mid back, and gave Patrick some exercises which he performed scrupulously. Within a few weeks, one arm was back to normal, the other was 70-80% improved, but most importantly, Patrick had shed 10-15 years and was positive and outgoing again, to his wife’s intense relief!
The moral of the tale is that clinical rigour is always required when issuing a diagnosis – something all of us practitioners can be humble about – but also that the diagnosis and “condition label” stuck on a patient’s forehead can powerfully and (often) negatively affect their outlook and behaviour. We are only human, after all!