Frozen Shoulder Injury Threatens To Derail Grandmother’s Family Vacation

Tonya Oxford always looks forward to her annual family vacation, and she was particularly excited this year. She and her husband, Tony, were taking their three daughters and three grandchildren to Bimini in the Bahamas.

“I wanted my grandkids to see the spotted brown dolphins,” Oxford says.

For Oxford, who oversees a small farm in Howey-in-the-Hills alongside her husband, the vacation was much-needed. Oxford Family Farms may be a small operation, but with 40 acres of chickens, cows and vegetables to oversee, the job is never-ending and physically demanding.

“There’s always something to plant, chop or fertilize,” Oxford says.

During a routine cow feeding, Oxford lifted a five-gallon bucket filled with feed to transport it to the herd, a grueling but familiar chore. This time, however, she knew something was wrong.

“I went to put the bucket over the fence and one arm went up just fine,” she says. “The other arm tried, but the strength went away.”

Within seconds, Oxford was unable to move her right shoulder without searing pain. She continued working on the farm with limited mobility, using her right arm as little as possible.

But after two weeks of worsening pain and no improvement to her range of motion, Oxford worried she would have to postpone her family trip.

Treating a ‘Stiff Water Balloon’

Oxford’s primary care physician referred her to Dr. George Eldayrie, a board-certified sports medicine physician with the Orlando Health Jewett Orthopedic Institute. He diagnosed her with adhesive capsulitis, commonly known as frozen shoulder.

“The full cause of frozen shoulder isn’t understood yet,” says Dr. Eldayrie. “It’s a condition that causes gradual limitation of range of motion to the shoulder.”

With frozen shoulder, the shoulder capsule — the flexible, strong connective tissue that surrounds the ball-and-socket joint — becomes thick and stiff. The condition makes everyday tasks like hair brushing or opening a cupboard painful, or even impossible.

Think of the capsule like a water balloon. When you move the balloon, water sloshes around and stretches it, but frozen shoulder is like a stiff water balloon where the rubber loses its elasticity. – Orlando Health
physical therapist
Matthew Hixon

“Think of the capsule like a water balloon,” Orlando Health physical therapist Matthew Hixon says. “When you move the balloon, water sloshes around and stretches it, but frozen shoulder is like a stiff water balloon where the rubber loses its elasticity.”

Historically, doctors have treated frozen shoulder with steroid injections, anti-inflammatory medicine or debridement, a minimally invasive surgical procedure in which the surgeon repairs the shoulder joint arthroscopically.

But more orthopedists like Dr. Eldayrie are now opting for an alternative solution: hydrodilatation. The procedure, guided by ultrasound, involves injecting the hardened shoulder capsule with a saline solution that expands and stretches the area, allowing the shoulder to regain range of motion.

Hydrodilatation proved to be the best course of action for Oxford. With work piling up on the farm and a big family vacation approaching, she wanted a straightforward solution without surgery and down time.

“Dr. Eldayrie gave me an alternative that fit my lifestyle and kept me in my life,” Oxford says. “I have a farm and three grandkids, and I don’t want to miss anything.”

It took less than 30 minutes for Dr. Eldayrie to complete Oxford’s hydrodilatation injections.

“I felt pain relief almost right away,” Oxford says.

Unique Approach to Recovery

After the hydrodilatation injection was complete, Oxford was immediately transferred to Hixon to begin moving her right shoulder once again.

“The success rate of hydrodilatation is highly dependent on starting physical therapy right away,” Dr. Eldayrie says. “Tonya was in physical therapy with Matt two hours after I treated her.”

Dr. Eldayrie worked directly with Hixon to develop a custom recovery plan for Oxford, a unique approach compared to the standard referral method, in which physical therapists work independently from doctors and clinics. The collaboration between the clinical and rehabilitation sides of the Orlando Health Jewett Orthopedic Institute was essential to Oxford’s recovery.

“If we leave the hydrodilatation injection and don’t do anything, the saline will pass through the body, and the capsule will just go back to its normal size,” Hixon says. “But with immediate therapy we can capitalize on the flexibility the injection brought us.”

For Oxford, who also lives with multiple sclerosis, her rehabilitation exercises with Hixon had to strike a delicate balance: rigorous enough to stretch her shoulder back to full motion, but not so much that they would cause pain and risk an MS flareup.

“It felt very tailored,” Oxford says. “After two weeks with Matt I could raise my hand again, and after six weeks I could go back to what I was doing before.”

By week 12, she was discharged from physical therapy.

“Tonya was set up for success from the very beginning,” says Dr. Eldayrie, who monitored Oxford’s condition through the completion of her physical therapy sessions. “She was a great candidate for hydrodilatation.”

‘Quality, Not Quantity’

With her shoulder back in commission, Oxford went on vacation knowing she could fully enjoy the time with her family.

A few of her favorite adventures? Climbing aboard a seaplane to take in the pristine coastline of the Bahamas from above and hopping on a boat to experience the marine life down below.

“For me, that’s what it’s about — quality of life, not quantity,” Oxford says.

Upon returning home, Oxford also got back to work on the farm and continued exercising her shoulder. The therapy, stretches and massages she still does every morning keep her moving with ease, strengthening her shoulder along the way. The dedication to therapy and physical activity have made the biggest difference in her life, she says.

“They taught me how to make my shoulder stronger and keep it stretched out and healthy,” Oxford says. “I’m not compensating every time I feel a bit of pain anymore; I’m actually fixing the problem.”