From “frozen shoulder” to “rolling in the water”
Lara Christy is living her dream life. A nurse practitioner, Christy spends much of her free time kayaking the rivers that crisscross North Carolina. For her, whitewater kayaking is not so much a hobby; it’s a passion. “Within an hour and a half of my home, there are a half a dozen class 3 and 4 rivers to kayak,” says Christy. “I moved here completely for the water and kayaking available.”
Christy’s dream almost didn’t happen. While living in St. Louis and working as an ICU nurse at a local hospital, she slipped and fell while walking her dog. The fall resulted in a dislocated shoulder. Over time, the inability to move her shoulder while it was healing atrophied her muscles and created adhesive capsulitis, or “frozen shoulder,” a condition in which the shoulder becomes stiff and painful to move. “I couldn’t lift patients, I couldn’t reach my hand behind my back or raise it to braid my hair,” says Christy. “It was a career-ending problem.”
Christy had to switch jobs away from direct patient care to sitting behind a desk as a case manager. She also couldn’t enjoy many leisure activities, including kayaking, a recreational sport she picked up in the 1990s.
Adhesive capsulitis can occur after an injury or as a complication of diseases such as hypothyroidism, hyperthyroidism, Parkinson’s disease, and diabetes. It can immobilize the shoulder for weeks or even months.
“Her range of motion was 45 degrees for both external and internal rotation,” says Christy’s doctor, sports medicine specialist Matthew Matava, MD, Washington University orthopedic surgeon at Barnes-Jewish Hospital. “Both should be at least 90 degrees.” Patients with frozen shoulder typically start with non-surgical treatment options, such as over-the-counter anti-inflammatory medications (aspirin and ibuprofen) or steroid injections. Physical therapy is often prescribed to build strength and restore range of motion. When those options don’t relieve the pain, surgery is recommended.
Christy had physical therapy three times a week for three months before she agreed to have arthroscopic surgery.
Surgery and Rehabilitation
“We did surgery to release the scar tissue that had formed in her shoulder capsule and was restricting her motion,” explains Matava. “She also underwent a gentle manipulation of her shoulder to release further scar tissue and to assess the final range of motion that was achieved.” For Christy, the procedure provided almost immediate relief. “My range of motion was instantly better,” she says. “The pain was still there, but I went back to physical therapy to strengthen the shoulder and maintain that range of motion.”
Matava sent Christy to STAR: Sports Therapy and Rehabilitation at Barnes-Jewish West County Hospital. “Our physical therapists developed an individualized program for Lara including home exercises for strengthening, stabilization and range of motion maintenance, isokinetic strength testing and strengthening, as well as customized return to sport activities,” says Matthew Green, manager of rehabilitation services at STAR. “They understood and fought the fight with me,” says Christy. “They knew, and I knew, that my mobility would come back only through hard work and lots of therapy.”
Christy spent almost a year in rehabilitation following surgery. As she recovered and got stronger, Christy made the leap and decided to move to a location that had multiple close opportunities for kayaking. She chose North Carolina, becoming a nurse practitioner for the Veterans Administration and providing home-based primary care to veterans in rural parts of the state.
“Rolling in the Water”
Today she navigates class 4 rivers on a regular basis. Her only accommodation to her shoulder injury — a switch from stick paddles to hand paddles. “There is less torque on the shoulder joint and it’s a great way to maintain my strength in my arms, back and shoulders,” she says. She still lifts weights and continues to follow a shoulder strengthening routine to minimize the chance of re-injury.
“I knew as soon as I came to Dr. Matava’s team that he was going to help me achieve the best possible result,” Christy says. “I thought I would never kayak again and I certainly never thought I’d get back to the sport on this level. It feels so great to be rolling in the water again!”
For more information about sports medicine at Washington University and Barnes-Jewish Hospital, visit our Orthopedic Center.