Being told to ‘loosen up’ is a real pain...
There is currently renewed interest in a treatment first advocated nearly 30 years ago
The shoulder is a masterpiece of technical design, with much the widest range of movement (an astonishing 640 degrees) of any joint – all held firmly in place by a complex interplay of muscles and tendons. The two main conditions impinging that range of movement are thus not just physically but psychologically disabling though, regrettably, there is considerable dissension as to what their optimal treatment might be.
The first is the aptly named frozen shoulder, an acute inflammation of the membrane around the joint that often starts abruptly, with pain a prominent symptom. This gradually resolves, but the shoulder is left almost completely immobile and may remain so for a couple of years or more before slowly thawing out.
Over the years, many therapies have been proposed, but in general patients tend to be prescribed anti-inflammatory drugs and advised the shoulder will eventually “loosen up”. Contrary to this rather nihilistic approach, there is currently renewed interest in a treatment first advocated nearly 30 years ago, whereby the shoulder is manipulated under general
anaesthetic to disrupt the fibrous adhesions causing the stiffness along with a combined injection of a steroid and local anaesthetic into the joint. “One can expect a significant and rapid improvement,” observes orthopaedic surgeon William Thomas.
The symptoms of pain and restricted movement are also a feature of a quite different condition where the tendons around the joint become inflamed by rubbing against the bone and ligaments holding the joint in place – usually referred to as rotator cuff impingement syndrome. This should be amenable to a keyhole operation (subacromial decompression) to release the “impingement”, though a recent review has advised against on the grounds that it “provides no benefit on pain, function or quality of life”.
This verdict is disputed, but it seems only sensible to be aware of the current reservations about the merits of this commonly practised procedure.
Flu fatigue
The double whammy of a nasty attack of the flu which, rather than resolving within a week or so, as might be expected, then morphs into post-viral chronic fatigue, has prompted several observations.
The cause of the persistent disability, with reduced stamina and impaired cognition that can last for three months or more, remains obscure.
Accordingly, there is no certain remedy; but several of those afflicted claim to have benefited from energising relaxation techniques.
“I am usually constantly on the go,” writes one woman, but since an episode of viral bronchitis back in January, she can now “barely walk a mile”.
However, she has found that despite feeling exhausted by the prospect of a session of tai chi or yoga, they do seem to boost her energy levels. There are advocates, too, for acupuncture, while another woman reports that the ambience of a daily walk in the woods near her home “helps me to look more positively at life”.
Though recognising it might be a placebo effect, a couple of readers believe that a daily dose of the vitamin combination Minavex accelerated their recovery. More specifically, it has been suggested that the ready fatigability of the muscles may be due to a deficiency of the naturally occurring amino acid carnitine, which can be corrected by taking it as a nutritional supplement.
Holiday blockage
This week’s medical query comes courtesy of veteran traveller Mrs WF from Sheffield, increasingly reluctant to go on holiday, or even visit friends for a few days, as whenever she does so she is invariably troubled by immovable constipation. This is impervious to standard remedies (Andrews salts, Senokot, Movicol) and may persist for up to a fortnight after her return.
“Neurotically, I have even started keeping a diary to identify some possible explanation,” she writes, but has found no obvious pattern in what she does or eats. Any suggestions from others who might experience this unusual syndrome would be very much appreciated. Email medical questions confidentially to Dr James Le Fanu at drjames @telegraph.co.uk