Worry over calcium levels after aching shoulder diagnosis

Q My right shoulder has become quite an issue – it is painful and even lifting my arm to blow dry my hair at the back is really difficult. Also I have to do my bra up at the front then twist it round.

An ultrasound scan showed calcium deposits in the tendons. Why has this happened? Does it mean my calcium levels are too high? And is there any way of getting rid of them? A

The upper tendons inside the shoulder joint are particularly prone to developing calcium deposits, especially in people over 40.

Exactly why this happens is not known (it is not caused by a high level of calcium in the blood), but it may be triggered by general wear and tear of the tendons that occurs with increasing age.

These deposits cause inflammation in the surrounding tissues, which can create pain that can vary from fairly mild to severe, as well as stiffness when the affected tendon is put under tension.

This is why some movements, especially putting your arm behind you, are more difficult than others.

Anti-inflammatory tablets, such as ibuprofen, can be helpful and additional paracetamol can ease the pain more, while exercises are really beneficial in helping to keep your shoulder mobile. Your doctor may be able to give you an instruction leaflet on these while you wait for your physiotherapy appointment.

If the pain persists, then a local anaesthetic and steroid injection into the joint can be of benefit in some patients. Another possible treatment is shockwave therapy, which can help break up the calcium deposits.

In time, they are usually reabsorbed by the body and severe pain usually resolves in a few months, but it can take several years for the condition to get completely better.

Q When I was pregnant I developed piles. Initially there was just a small lump, but now it feels bigger and is more uncomfortable and occasionally there is bleeding. I saw my GP a couple of years ago and he confirmed the diagnosis and said he would refer me to the hospital, but then Covid hit and I heard nothing more. Piles are hardly an urgent problem and I know the NHS is really busy, so what should I do?

A

Piles – or haemorrhoids – are swollen veins just inside the anus, the lowest part of the back passage. Smaller ones stay inside the anus but larger ones may protrude, especially after passing a motion, where they feel like a rubbery lump. It may be possible to push the lump back in, but larger ones often remain permanently prolapsed out. The most common symptom caused by piles is bleeding, which occurs after going to the toilet, is bright red and may look like an alarming amount.

Larger external piles cause discomfort, itching and there may be a mucous discharge as well. Piles are extremely common, affecting around half of adults in the UK at some time in their life. They are more likely to occur if you have constipation and have to strain to pass a motion, and also often appear during pregnancy, due to the pressure from the weight of the womb on the lower bowel. They often develop with increasing age and can run in families.

As long as they are identified as the cause of bleeding from the rectum (rather than anything more sinister) then small piles don’t require treatment and often improve with a high-fibre diet and plenty of waterbased drinks, which will help prevent constipation. Avoiding any painkillers that contain codeine is important too, as this can cause hard stools.

However, if bleeding or discomfort persist then it is worth getting them treated. The most commonly used procedure is placing a tight rubber band at the base of the haemorrhoid, which cuts off its blood supply, so the lump dies and drops off after a few days. It isn’t painful and it is done as an outpatient procedure. Rectal clinics at hospitals should now be running as normal – and although there is a backlog of patients on the waiting list, please don’t let this put you off. Over time, external piles can become larger and may require surgical excision, which can be painful, so ask for a referral now. Q I’ve been experiencing an unpleasant sensation behind my breastbone for some time and it is worse when I eat. I had a phone consultation with my GP who asked a lot of questions and then said it sounded like I had inflammation of my oesophagus and prescribed tablets to reduce stomach acid. I can’t help but worry it might be my heart though. Shouldn’t I be seen in person and have some tests done?

A

Inflammation of the oesophagus, or oesophagitis, is a common cause of pain behind the breastbone, especially after swallowing hot fluids such as cups of tea or coffee, or after meals, especially if hot or spicy.

The pain is usually described as “burning” and may also be worse if you bend over or when you lie down.

It’s usually caused by reflux of the strong acid digestive juices upwards from the stomach into the oesophagus. The oesophagus doesn’t have the same protective lining as the stomach, so the acid causes inflammation which may lead to ulceration.

Normally, muscle contractions keep the lower end of the oesophagus closed, but any weakening of the muscles allows reflux of acid to occur.

In some cases, the reflux is caused by a hiatus hernia, which is a protrusion of a small upper part of the stomach into the chest cavity. Many people with oesophagitis also have heartburn, with an acid taste occurring in the mouth.

Diagnosis is usually based on the very distinctive symptoms and treatment is with tablets such as omeprazole or lansoprazole, which reduce the production of stomach acid. They don’t work immediately, but within a couple of weeks you should notice a difference – and if the pain begins to ease, then you can be assured your doctor has almost certainly got the diagnosis right.

If the pain persists and the treatment doesn’t appear to be making any difference, go back to your doctor to discuss whether you need some investigations.

● If you have a health question for Dr Leonard, you can email her in confidence at yourhealth@express. co.uk. Dr Leonard regrets she cannot enter into personal correspondence or reply to everyone.