I’m in a lot of pain from frozen shoulder. My GP said it could last up to three years and there’s not much that can be done apart from physiotherapy and painkilling creams. Is there anything else?
John Haley, Staffordshire.
Frozen shoulder, where the joint is stiff and painful for months or years, limiting movement, is a miserable condition and I completely understand your desire to do everything you can to aid your recovery.
This common complaint occurs when the strong connective tissue surrounding the shoulder joint becomes inflamed and thickened.
It is especially common in women over 40 (possibly due to hormonal changes) and in people with diabetes (as high blood sugar can damage connective tissue). It can also develop after keeping the shoulder immobile for a long period of time, such as after an arm fracture, as the tissue around the joint can become tight.
Frozen shoulder, where the joint is stiff and painful for months or years, limiting movement, is a miserable condition.
Frozen shoulder usually has three phases. In the initial phase, which can last for many months, the shoulder becomes increasingly stiff and painful. During the middle phase, the pain decreases, but movement is more limited due to increased stiffness. After that, the shoulder gradually heals and regains its mobility. Most patients recover completely, but it can take a considerable amount of time.
There is no consensus on which is the best treatment, but steroid injections may be worth it.
In about one in ten patients, the injections may cause pain to last for several days, but then this will resolve and patients will notice increased mobility and reduced stiffness, making it easier to perform the recommended physical therapy exercises.
In fact, steroid injections combined with physical therapy appear to offer the best prospect of speeding recovery.
Another option is hydrodilatation, where salt water is injected into the shoulder to stretch the tissue and improve movement. However, not everyone is convinced that this works.
Remedies you can try yourself include placing a warm compress or hot water bottle on your shoulder for 20 minutes to relieve the pain. Short courses of ibuprofen or diclofenac may also help, but check with your GP. Finally, use your shoulder as much as possible – keeping it still will make the pain worse.
Last year I had a pacemaker fitted and was prescribed edoxaban after a check-up revealed my heart rate was low, at 35 beats per minute. I used to enjoy two walks a day, but now I tire easily and have lost interest. I am tempted to stop taking edoxaban to see if I can regain my energy.
Juan Mateo, Dundee.
I’m sorry you’ve lost your enthusiasm for the walks you used to enjoy so much, but I don’t think the medication you’re taking is to blame. When they detected your low heart rate or bradycardia, you would have been referred to a cardiologist who would have run tests to determine the cause.
These tests would have included an electrocardiogram to measure the electrical activity of the heart. I suspect this showed that he also had another heart rhythm disorder called atrial fibrillation (AF) and that is why he was prescribed edoxaban. Normally, when the heart beats, its walls contract to push blood around the body.
In atrial fibrillation, the walls of the upper chambers (atria) do not contract but quiver, making it difficult for blood to flow into the lower chambers. Blood can pool and form clots that can travel to the brain, where they cause a stroke.
Edoxaban reduces this risk by thinning the blood, so I strongly recommend that you do not stop taking it.
In atrial fibrillation, the erratic pumping of the heart reduces the blood supply to the rest of the body, which can cause fatigue; I suspect this is the cause of the lethargy.
I recommend that you consult with your cardiologist about your fatigue, you may need additional medication to improve the strength and contractions of your heart. I suggest that you ask your GP for a blood test to check for anaemia, which can cause fatigue.
In my opinion… beware of hand, foot and mouth disease
The sickest patient I saw this summer was a plumber who suddenly felt ill. In addition to a fever, he had ulcers in his mouth and throat, so painful that he would only accept sips of water.
He also had blisters on his hands, so the diagnosis was clear as soon as I examined him: hand, foot, and mouth disease.
The disease is caused by a virus, Coxsackie A16, and while in children it is a minor illness, which resolves quickly in a matter of days, for adults the illness is much more serious, lasting ten days or more, with generalized symptoms at least as severe as the flu.
The disease is spread by infected people shedding the virus through their mouth, respiratory tract or feces in small droplets for many weeks.
Cases peak at this time of year, so I urge everyone to be especially vigilant about washing their hands thoroughly with soap and water after using the bathroom, and to take special care to clean the door handles in such places.
I am also forced to reflect on the potential infectivity of water when swimming in open water, given the negligence of water companies and the pollution of rivers with sewage.