Shoulder pain (illustrative).
(photo credit: INGIMAGE)
I am a 42-year-old woman who recently developed pains that my family doctor called “frozen shoulder.” He prescribed some pain relievers, but he didn’t do much else for me. Is there any effective treatment? H.V., Karmiel
Dr. Ehud Atoun, head of the shoulder surgery and sports medicine unit at Barzilai Medical Center in Ashkelon, replies:
Frozen shoulder is a disease that causes pain and increasing limitations in active movement (by the patient) and passive movement (when someone else tries to move it) of the shoulder. The medical term is adhesive capsulitis. The limitation may continue for many years and disrupt daily functioning because of difficulty in making circular motions with the hand at shoulder height.
It occurs in about 3 percent of the general population and up to a fifth of people with diabetes. It most commonly begins from one’s 30s to one’s 50s and is more common in women, patients suffering from abnormal thyroid functioning and heart disease, and those who avoid moving their shoulders after undergoing surgery, a fracture or other injury. The cause of the condition is unknown, but it is characterized by the thickening and contraction of the capsule surrounding the shoulder joint (mainly the front part).
The first stage of the disease presents itself as pain; in the second stage, there is gradual limitation in the ability to move the limb; and in the third stage, the shoulder is “frozen” and significantly limited in its ability to move. In the fourth stage, that of “defrosting,” there may be a gradual improvement in range of movement; this occurs mostly within two years of the beginning of the pain, but some studies have shown it can happen even after seven years.
Some patients have to undergo surgery to release the adhesions and remove the swollen tissue.
The diagnosis is carried out by a doctor’s physical exam, together with an x-ray and ultrasound of the shoulder to rule out other causes of the limitation of movement. One can also perform an MRI to examine the thickened capsule that characterizes the disease.
Possible treatment includes painkillers, anti-inflammatory drugs and a steroid injection into the shoulder joint during the earlier stages of the disease; physiotherapy and stretching exercises; shockwave treatment and electrotherapy; complementary medicine (osteopathic or chiropractic treatment); and neural blocks at a pain clinic.
There are also treatments given under local, regional or general anesthesia that are not surgical, such as injecting liquid under pressure into the joint to expand the thickened capsule, or manipulation of the shoulder under anesthesia to free it up or cause fissures in the thickened tissue without harming the bones and ligaments. These two require immediate physiotherapy.
Surgery includes minimally invasive or open operations to release the adhesions in the shoulder and remove damaged tissue.
I am interested in anything that will help age-related macular degeneration (AMD), from which I suffer. What would happen if I had my cataracts operated on? Would that mean not being able to take advantage of any new advances for retinal improvement? J.F., Michmoret
Prof. Anat Loewenstein, chairman of the ophthalmology department at Tel Aviv Sourasky Medical Center, replies:
For the treatment of your macular degeneration, I recommend, of course, that you see a retina specialist, who will diagnose the stage of the disease and the eligibility for treatment. If you have wet AMD, you need to be treated by intravitreal injections of one of three available drugs. Your cataracts need to be taken care of regardless of your retina situation.
It has been proven that cataract surgery does not aggravate the situation in macular degeneration. This has nothing to do with your eligibility for existing therapies for macular degeneration.
Is there any difference nutritionally, including for weight-watchers and diabetics, among white sugar, brown sugar, silan (date honey), honey or fructose corn syrup? C.T., Ramat Gan
Dr. Olga Raz, chief clinical nutritionist at Tel Aviv Sourasky Medical Center, answers:
There are no nutritional or calorie differences among these. They are all sugar, so there is no question about what is better or worse. Fructose corn syrup – which is cheap and widely used in processed foods – and natural silan contain fructose.
Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting.
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