Royce Turned His Whole Body to Hand Me a Wrench

Royce was under the hood of my truck back in August and asked me for the three-eighths wrench.

It was on the fender behind him. He turned around to get it. Not his arm — all of him, shoulders and hips and feet, the way a gate swings. He picked it up left-handed and passed it over.

Any of us would have reached back and grabbed it.

I let it go at the time. But I’d watched him do it at his daughter’s in the spring, going after a plate on the second shelf. And again over a cooler in June.

Twenty months, as it turned out. He’s been steering around that arm the whole time, and he has never once put a name to it.

I brought it up over coffee afterward.

He said it started the winter before last, when he moved a washing machine. He said it’s fine so long as he doesn’t do anything foolish with it. He said he’s resting it.

Twenty months isn’t resting it. Twenty months is quitting on it slowly enough that nobody notices, yourself included.

Royce isn’t lazy and he isn’t stubborn. He did what most men do. He waited for it to sort itself out, then built a life around the fact that it didn’t.

Overhead goes first. Then behind you — the seatbelt, the back pocket, the second sleeve of a coat. Somewhere in there a man quits calling it an injury and starts calling it his shoulder, like it came with the house.

A shoulder doesn’t sit quietly and knit itself back together. It has a second way of going wrong on top of whatever started it, and that one you bring on yourself.

Frozen shoulder is the name most people use. Doctors call it adhesive capsulitis. It’s the capsule around the joint thickening and drawing tight.

StatPearls, the reference a lot of clinicians actually read, puts it at 2% to 5% of the general population. Mean age of onset is right around 55. Women get it somewhat more than men, about 1.4 to 1. It also turns up more in the hand you don’t lead with.

That’s an observation, not a mechanism. Nobody handed me a study saying disuse causes the thing.

But the Hospital for Special Surgery lists long immobilization as a risk. It sits right alongside thyroid disease, diabetes and injury. And a man who spends twenty months protecting one arm is a long way down that road without ever deciding to be.

If you’re diabetic, read that twice. A review out this year pooled 351,486 people. It put the odds of frozen shoulder 3.69 times higher in diabetics.

A study in the Journal of Bone and Joint Surgery took 420 volunteers, aged 50 to 79. None of them had a shoulder complaint. All of them got an ultrasound.

Full-thickness rotator cuff tears showed up in 7.6% of them. Broken out by decade: 2.1% in the fifties, 5.7% in the sixties, 15% in the seventies.

Not one of those people knew.

The authors’ own conclusion is worth quoting, because the back half of it argues with the front. Asymptomatic tears, they wrote, “should be regarded as part of the normal ageing process in the elderly but may be less common than hitherto believed.”

That second clause deserves more than a passing mention. You’ll hear it said that half of everybody past 60 is walking around torn. This study, with this method, found a good deal less. Different imaging and different groups give different numbers. The field doesn’t agree with itself, and I won’t paper over that.

What isn’t in dispute is the part Royce needs. A tear on a picture is not automatically the reason your arm has stopped working. The American Academy of Orthopaedic Surgeons puts it plainly: some rotator cuff tears are not painful.

Which is why the scan isn’t the first move. It comes after somebody has put hands on the shoulder and watched it move.

Those three stages and their lengths are the AAOS’s, not mine.

Add the low end of each and you’re at about eleven months. Add the high ends and you’re past three years, which is where the AAOS puts full recovery at the outside.

Nobody sits down and schedules that. It just gets spent, a week at a time, while a man tells his friends he’s resting it.

The Hospital for Special Surgery is blunter than the AAOS about the do-nothing version. Left untreated, they say, it will worsen and can last two years or longer. They also note that about a third of patients end up with symptoms in both shoulders.

And the finish line isn’t as clean as the word thawing makes it sound. StatPearls says 10% to 20% of patients are left with residual symptoms, stiffness and discomfort included.

So waiting it out is a real option. It’s just an expensive one, and the currency is years.

Here’s the figure I’d tape inside a cabinet door. For rotator cuff tears, the AAOS says nonsurgical treatment relieves pain and improves function in about 80% to 85% of patients.

Eight out of ten. No operating room.

But take that word nonsurgical the way they mean it, not the way Royce does. Theirs is rest and activity changes, yes. It’s also anti-inflammatories, sometimes a steroid shot, and strengthening work with a physical therapist.

Royce has been doing one piece of the treatment and calling it the whole treatment.

Don’t swing the other way either. The AAOS also says a tear can get larger over time. Keep using the shoulder through rising pain, they say, and you may do further damage.

Neither hiding from it nor gutting through it is a plan. The plan is somebody who knows shoulders telling you what yours needs, and in what order.

Start at the top and work down.

▸ Put a date on the calendar this week. Not a resolution to go sometime. A day, written down, the way you’d write down an inspection.
▸ Get hands on it before you get a picture of it. That means someone moving the arm through its range and watching what happens. Order the scan first and you’ve answered a question nobody has asked yet.
▸ Ask for the program in writing. The AAOS gives its shoulder conditioning program away free. Run it 4 to 6 weeks, they say, unless your doctor or therapist tells you different. Stretching most days, strengthening three days a week.
▸ Warm up before you stretch anything. Their instruction, not a flourish of mine: 5 to 10 minutes of low-impact activity first, walking or a stationary bicycle.
▸ Expect the exercises to look like nothing. Pendulum, crossover arm stretch, sleeper stretch, internal and external rotation. There’s no heroism in any of them. That’s exactly why men skip them.
▸ Let the therapist pick which ones are yours. It’s on the handout itself: talk to your doctor or physical therapist about which exercises will best help you meet your rehabilitation goals. A frozen capsule and a torn tendon don’t want the same week.

He went. That’s the whole update, and it’s further than I expected to get.

The physician assistant spent ten minutes moving the arm around, then wrote a referral and ordered no pictures. Royce told me that part twice, the way you do when you think you’ve got away with something.

He’s four weeks in now. He says the stretches are dull and the bands feel like nothing at all.

He also got a coffee cup down off the second shelf last week without planning the move first. Then he called me about it. Which tells you what twenty months of not doing that had been costing him.

I don’t know how this finishes for him. Some of these never come all the way back, and I’d rather say so than sell you an ending.

But he isn’t waiting anymore, and the waiting was the only part of it he was ever actually in charge of.

— Walter