Diagnosis Diary: An alternative to shoulder surgery

After several months of shoulder pain, Sandy Jackson knew something was seriously wrong when she reached down to lift her grandchild. The Glenwood Springs native, a rancher, educator and outdoorswoman, was used to being active, but on that day, her right shoulder was so painful she could hardly move it.

Sandy, age 66, was always hiking, backpacking or working on her ranch, opening and closing gates, working the irrigation, but the pain of trying to reach overhead or behind her back became too much to bear. “I couldn’t even put my hand in my front pocket,” she says.

Sandy was referred to Dr. Tito Liotta at ValleyOrtho. “Dr. Liotta was just so reassuring,” Sandy says. “He did all kinds of tests and an X-ray. My husband and I had tons of questions and Dr. Liotta answered every one very calmly. There was no rush to move us along.”

Dr. Liotta diagnosed Sandy with Frozen Shoulder Syndrome, or adhesive capsulitis. This condition, which presents just as the name indicates, causes pain and stiffness in the shoulder, and over time the shoulder becomes very hard to move. There are typically three stages to frozen shoulder – freezing, which causes pain; frozen, where motion is lost and there is ample pain; and thawing, when the patient regains motion and feels less pain. This whole cycle can take anywhere between six and 18 months.

Dr. Liotta recommended occupational therapy, and believed that with this approach, along with chiropractic work and therapeutic massage, Sandy could avoid surgery. “I really liked that Dr. Liotta wasn’t saying ‘Just do the surgery.’ Instead he said, ‘Let’s try a whole bunch of other things first.”

Sandy met with Valley View occupational therapist, Scott Kitchener, who began at Valley View in 2016. “With frozen shoulder, at first, we work to get things calmed down, so that patients are comfortable enough to sleep through the night and be functional,” he says. “Throughout the process we use a lot of manual work, including instrument assist (scraping with tool along the muscle), deep tissue massage, cupping, anything to calm the pain.”

Sandy combined her biweekly therapy work at Valley View with an active release technique at a chiropractor and therapeutic massage. After experiencing progress after a few months, she returned to Dr. Liotta who provided an expansion injection into her shoulder. This process injects fluid into the joint to force the joint to open and allow for extra movement. After the injection, Sandy immediately went into OT with Scott moving her arm, further gaining mobility.

It only took about six months of therapy for Sandy to regain movement and eliminate any associated pain. Today, not only can Sandy put her hand in her pocket, she can reach overhead and pick up her great nieces, twins born last September.

“In occupational therapy we try to focus on improving activities of daily living for our patients,” Scott says. “We want them to be able to cook and clean, enjoy leisure activities – all the things they enjoy. To me, a good outcome is that the patient is happy. That is what it comes down to.”