I’m in a lot of pain with a frozen shoulder. My GP said it could last up to three years and there’s little that can be done other than physio and pain-relieving cream. Is there anything else?
John Haley, Staffordshire.
Frozen shoulder, in which the joint is stiff and painful for months or years, limiting movement, is a miserable condition and I quite understand your desire to do as much as possible to aid your recovery.
This common complaint occurs when the strong connective tissue that surrounds the shoulder joint becomes inflamed and thickened.
It is particularly common in women over 40 (possibly due to hormonal changes) and people with diabetes (as high blood sugar can damage the connective tissue). It can also develop after the shoulder is kept still for a long period, such as after breaking an arm, as the tissue around the joint can tighten.
Frozen shoulder, in which the joint is stiff and painful for months or years, limiting movement, is a miserable condition
Frozen shoulder typically has three phases. In the initial phase, which can last many months, the shoulder becomes increasingly stiff and painful. During the mid-phase, the pain diminishes, but movement is more limited due to greater stiffness. After that, the shoulder gradually recovers and regains its mobility. Most patients make a full recovery, but it can take a considerable amount of time.
There is no consensus on the best treatment, but steroid injections could be worthwhile.
In around one in ten patients the jabs can cause pain to flare for several days, but this settles and patients will notice greater mobility and reduced stiffness, making it easier to carry out the recommended physio exercises.
Indeed, steroid injections in conjunction with physiotherapy seem to offer the best prospect of hastening 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 heat pack or hot water bottle on your shoulder for 20 minutes at a time to ease the pain. Short courses of ibuprofen or diclofenac can be helpful, 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 pulse rate was low, at 35 beats per minute. I used to enjoy two walks a day but now I get tired easily and have lost interest. I’m tempted to stop taking edoxaban to see if I get my energy back.
John Matthew, Dundee.
I’m sorry to hear you have lost enthusiasm for the walks you enjoyed so much but I don’t think the drug you are taking is to blame. When your low heart rate, or bradycardia, was spotted you would have been referred to a cardiologist who would have done tests to determine the cause.
These tests would have included an electrocardiogram to measure the heart’s electrical activity. I suspect this showed you also had another heart rhythm disorder called atrial fibrillation (AF) and that’s why you were prescribed edoxaban. Normally when the heart beats, its walls contract to force blood out around the body.
In AF, the walls of the upper chambers (atria) do not contract, but quiver – making it harder to push blood into the chambers below. Blood can then pool, allowing clots to form. These can then travel to the brain, where they cause a stroke.
Edoxaban reduces this risk by thinning the blood. So I’d very much advise against stopping it.
In AF, the erratic pumping of the heart reduces the blood supply to the rest of the body, which can cause tiredness – I suspect this is behind your lethargy.
I recommend you discuss your tiredness with your cardiologist, it may be that additional medication is needed to improve the force and contractions of your heart. I suggest you ask your GP for a blood test for anaemia, which can cause tiredness.
In my view… beware hand, foot and mouth disease
The sickest patient I have seen this summer was a plumber who became suddenly unwell. Alongside a fever, he had an ulcerated mouth and throat so painful that he’d only accept sips of water.
He also had blistering on his hands, so the diagnosis was clear as soon as I examined him: hand, foot and mouth disease.
The illness is caused by a virus, Coxsackie A16, and while in children this is a minor disease, rapidly resolving within days, for adults the illness is far more severe, lasting ten days or more, with generalised symptoms at least as bad as the flu.
The illness is spread by infected individuals who shed the virus from their mouth, respiratory tract or faeces in tiny droplets over many weeks.
Cases peak at this time of year, which is why I’d urge you all to be especially vigilant about washing your hands properly with soap and water after using the loo, and to be particularly careful about the cleanliness of door handles of such places.
I am also forced to ponder the potential infectivity of water when wild swimming – bearing in mind the dereliction of water companies and the contamination of rivers with sewage.
