Link between Shoulder Pain & Hashimoto’s – Its Surprising

It’s been my observation that so many women who have Hashimoto’s or hypothyroidism often report symptoms of random shoulder pain.  I’ve experienced the problem personally a few times and at one point started to wonder if there could be a link between shoulder pain and Hashimoto’s.

Guess what?  There is!

My Shoulder Pain Story

During the years of my long Hashimoto’s journey of being misdiagnosed there was a period of about 6 months when I struggled with excruciating shoulder pain.  It interrupted sleep, driving, travel and basically robbed my joy.  I saw several specialists including orthopedists, neurosurgeons and physical therapists.  I was prescribed oral steroids, antidepressants and trigger point injections (tossed the antidepressant prescription in the trash). I had a MRI and other tests which did not reveal anything structurally wrong.

Relief from the one round of trigger point injections (ouch!) was such a relief and I slept like a baby for the first time in quite a while.

But those benefits only lasted 24 hours and the smack-down pain returned with a vengeance, and I gained 20 pounds from the steroids.

Eventually the cycle of pain stopped, but it was sort of by accident.  After having surgery to remove fibroids, the pain that radiated from my shoulder and was about to drive me nuts somehow disappeared, literally the next day.  My doctors believed it was some sort of paradox that happened as a result of anesthesia.

Whatever it was, I was grateful!

Two years ago I started experiencing mystery shoulder pain again.  This time it was in the opposite shoulder and there wasn’t any obvious cause, no rhyme or reason as to why it was happening.   I’m in good shape and always do some form of exercise everyday and stretch afterwards.

The pain was so acute and disruptive that I decided to see an orthopedist right away.  The pain was a level 10+ and I wanted to rule out an injury or some other problem.  I was prepared and armed emotionally to be told it was “part of getting older,” or “part of being a woman.”  I heard all that nonsense in my 20s when no one could diagnose autoimmune thyroid disease.  Beware of those types of explanations for symptoms.

By the time I saw the doctor my shoulder was completely rigid and “locked up.”  I couldn’t raise my arm above shoulder level, I wasn’t sleeping AT ALL because the pain was worse at night or when lying down.  I couldn’t exercise either… blood flow pumping through the muscles of my shoulder triggered intense pain.

Without any testing to speak of other than an x-ray, the diagnosis was adhesive capsulitis, also known as primary frozen shoulder.  The doctor also said I must have surgery right awaybecause it wouldn’t heal otherwise.   In came the surgery scheduler, and out the door I went.

I left his office not believing a word he said.  Deep down I believed surgery was unnecessary and probably wouldn’t do any good.  I didn’t even believe I really had primary frozen shoulder!  I’m not saying he was looking for reasons to do surgery because in his best judgment based on my physical symptoms it was all he knew to offer.  After all, he is a surgeon…and surgeons are in the business of doing surgery.

My first inclination was that it was somehow autoimmune related but I wasn’t sure how.  Immediately I sought the help of a soft-tissue therapist and the work of a trainer in Valencia, California.  They both taught me exercises I could do at home and promised that if this was not true frozen shoulder, the exercises and soft tissue therapy would help.

Within six weeks my shoulder pain was cured and it has not returned, albeit I keep up the exercises for maintenance.  When I returned to the orthopedic doctor, he was in disbelief and wanted to know what I had done to heal.  He was particularly shocked in that I hadn’t lost any range of motion.  With typical frozen shoulder, there are limitations in range of motion even after recovery from surgery or physical therapy.

At the end of our appointment he commented that it was “probably due to inflammatory cytokines” despite there was no injury to my shoulder.  It was also during that appointment that he told me most women with thyroid disease have shoulder pain, but he had no idea why.

My last appointment with my doctor was as close as I could get to him discussing, recognizing or admitting to a possible thyroid or immune system connection.

I work with women all the time who also have a thyroid condition and have gone through something similar with their shoulder…many have experienced it in both or the pain goes from one to the other.  Several have accepted their surgeons advice and followed through with surgery only to recover and then continue to experience random acute to chronic shoulder pain episodes again.  Many say the pain returned with a vengeance…more painful than it was before surgery.

So, what’s the connection between thyroid disease, Hashimoto’s and shoulder pain?

Why would inflammatory immune system cells congregate at the shoulder joint when there is no injury, if that is what’s happening?

Research

One research study reviewed “calcific tendinitis” and found it to be a common condition in women who have abnormal function of the thyroid gland.  It was also found that people who have “diabetes or a genetic predisposition” may also be at risk for this type of mystery shoulder pain.

Below are symptoms of calcific tendinitis:

  • Severe, disabling pain in the shoulder which occurs without cause.
  • The pain often occurs in the morning, but not always.
  • Stiffness in the shoulder – which leads the physician to assume frozen shoulder based on the overall clinical picture.
  • Significant sleep disruption due to pain.
  • Reduced range of motion.
  • Limited activities of daily living due to pain.

Interestingly enough, the researchers in this study found that most cases resolve spontaneously without surgery.

This study done in Taiwan studied patients with hyperthyroidism as a risk factor for developing actual primary frozen shoulder.

I’ll never know if my case of healing was the result of soft tissue therapy and specific range or motion exercises or if it was spontaneous healing.  Maybe it was a coincidence.  I’m glad I did do therapy however, because it certainly relaxed me and gave be a sense of hope in that I felt I was on the right path in a positive proactive way, whereas surgery would have been the wrong way to go for me.

What You Can Do

If you are experiencing or have experienced sudden shoulder pain as described in this article, I do recommend that you see a doctor to rule out a structural problem with the joint itself and surrounding tissues.

Also, make sure your Free T3, Free T4 and vitamin D levels are optimal.  At the time of my last shoulder episode, my FT3 and vitamin D levels had dropped.  As I was going through therapy I also increased my thyroid hormone dose and vitamin D intake slightly.

From there, you can always try what I did…a conservative approach and seek the help of a soft tissue therapist and trainer skilled in working with women who have shoulder problems.  What you definitely want to avoid is “rigorous physical therapy,” the kind where they use aggressive and sometimes painful techniques.  If your pain is related to your thyroid, painful therapy is the wrong approach for you.

More than likely it isn’t true frozen shoulder and aggressive approaches will make you feel worse, and you’ll be very unhappy.

Give this some time before making the decision to have surgery because it may not help at all and if it does help it may only be temporary.

At Home Exercises

Try these at home with the approval of your therapist.  These are my personal favorites and they really helped me a lot.  You can also do them in the shower.

frozen-shoulder-rehabilitative-exercisesShoulder separation exercises

shoulder exercise 3

 

 

 

 

 

 

Let me just say that:

  • Standing close to a wall or inside the shower against the wall with your arm extended and using your fingers to “crawl up the wall” is incredible for relieving shoulder pain. Warm water helps you get through the discomfort of this exercise.
  • Also, try using a foam roller and lay on it so that the length runs with your spine and you can lay your neck and head comfortably on the roller.  Relax, and while holding your arms up, slowly (like tin soldiers) allow your elbows down toward the floor.  Your painful shoulder will resist but over time it will get better.  I used yoga blocks at first instead of trying to get my elbow to the floor.  Try deep breathing during this one because it helps the muscles relax.
  • Be sure to avoid using a pillow during sleep.  This was a challenge for me but is important.  Instead, use a rolled up towel placed down the length of your spine and between your shoulder blades will help more than you can imagine.
  • Essential oils like wintergreen, Frankincense, lemongrass, and peppermint do help a lot with inflammation, pain, and relaxation.

References:

  1. Carli, A. D. (2014). Calcific tendinitis of the shoulder. Joints Jts, doi:10.11138/jts/2014.2.3.130
  2. Huang, S., Lin, J., Wang, W., Wu, C., Liou, T., & Lin, H. (2014). Hyperthyroidism is a Risk Factor for Developing Adhesive Capsulitis of the Shoulder: A Nationwide Longitudinal Population-Based Study. Sci. Rep. Scientific Reports, 4 doi:10.1038/srep04183

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