Tips of the week
Thawing The Frozen Shoulder
Frozen shoulder, which is also known as adhesive capsulitis, occurs as an end result of an inflammatory reaction. This leads to a stiff painful shoulder. The condition may occur as a result of trauma, breast surgery, age, extended immobilization after chest surgery, fracture, etc. In addition several medical conditions are also associated with frozen shoulder including Diabetes, heart attack, and stroke. X-rays are non-diagnostic, but should be ordered to rule out other causes of shoulder pain which can mimic capsulitis. Traditional treatment has included the use of both oral and local steroids, physical therapy, nerve stimulation, closed manipulation, ultrasound, acupuncture, and eventually arthroscopic and open surgery. In general the advantages from these treatment modalities have been relief of pain and improved motion. The disadvantages however include unpredictability in outcome, with less than hoped for, pain relief and improved range of motion. In addition some of the procedures are expensive, technically difficult, invasive, and require prolonged recovery and immobilization.
A recent article in a journal of Orthopedics has suggested another method of treatment. This emphasizes a closely monitored home therapy using moist heat, antiinflammatory medication, and a physician directed rehabilitation program. The article states that with this treatment every patient should expect to regain a significant amount of shoulder motion without pain. The author also stressed the importance of patience, since this form of treatment usually averages 14 months and may take up to 2-3 years. If you have not responded to conservative management, and surgery is unappealing to you, consider this gentle approach to treatment. It has the advantage of an inexpensive convenient home therapy which has been proven to work given enough time.
Cartilage is a smooth, bluish-white, rubbery tissue that acts as a shock absorber between your bones. Once damaged the changes to cartilage may be permanent because the tissue lacks blood vessles to repair itself. Damage may occur as a result of genetic factors, injury, infection, arthritis, and other medical conditions. If damage is severe, the joint must be replaced by an artificial one. Wouldn't it be wonderful if patients could simply grow back new cartilage to replace the old injured tissue. This is currently being investigated.
Swedish researchers pioneered a technique that allowed them to regenerate cartilage in damaged knee joints. Healthy cartilage from people who had cartilage defects in the knees was removed and placed in test tubes for culture. Periosteum (undeveloped tissue that surrounds bone) was transplanted from the leg into the damaged knee joint. Then doctors injected the persons own cartilage cells back into the defect. In more than half of the reported cases, new cartilage grew over the damaged area. This resulted in reduced swelling, pain, and locking of the knee joint.
Early results are encouraging, but more
time and research is needed, before the actual success rate of
this procedure can be established.
Dr. Bess Dawson-Hughes, of the Human Nutrition Research Center at Tufts University, has studied how Vitamin D works to help in absorption of calcium. A team of researchers at Tufts University compared women taking 700 units of Vitamin D with women taking only 100 units. After two years, they found the women taking the smaller amount lost more than twice as much bone from their hips as the others.
Since Vitamin D is manufactured in the presence of sunlight, women living north of the imaginary line connecting Baltimore and Sacramento probably are not getting the recommended daily allowance of Vitamin D during January and February. If you live above these northern cities, chances are you are not getting enough Vitamin D for at least four months a year, regardless of what you eat.
Therefore, where you live, may be another
risk factor for the development of osteoporosis.
Lyme disease is an infection caused by the
bacterium Borrelia burgdorferi. It can involve the skin, nervous
system, heart, and joints.Vectors (the ticks that carry and
transmit the disease) become infected
during their larval stage, by feeding on infected mammals such as
deer and mice. The ticks are often as small as a pinhead. A tick
must remain attached to a person 24-48 hours to cause infection.
People who have been infected usually develop a red rash with a
bull's-eye appearance at the site of the bite a few days to a
month after being bitten. Symptoms mimic those of the flu,
including headaches, chills, fever, and fatigue. In later stages
Lyme disease causes swollen joints, especially at the knees,
leading to a mistaken diagnosis of arthritis, and it may even
cause problems in the heart or nervous system. Since blood tests
for Lyme disease are not 100 percent accurate, your physician
must make a direct, hands-on diagnosis.
Some of the most helpful methods in treating arthritis are joint aspiration and injection of corticosteroids. Joint aspirates can be evaluated for cell counts and crystal analysis (polarized microscopy) as well as culture. Some joints, like the knee, wrist, and shoulder are easy to inject, others, like elbows, ankles, and finger joints require experience.
ankle
elbow
A Dairy Queen, enriched with milk, is
filled with calcium. Calcium is vital to the proper functioning
of the heart. It is necessary for blood clotting. We all know how
important this mineral is the prevention of osteoporosis in
women. It is also vitally important in men. Deficiencies have
been reported to be associated with hypertension, stroke, kidney
stones and colon cancer. To stay healthy, keep your calcium level
in balance.
Syn-Flex
Have you ever said to yourself "This
isn't very good. Why, I wouldn't even feed this to my dog".
Don't fret, this product will change your mind. Not only does it
have effective ingredients to reduce your
symptoms of degenerative arthritis, but it also works well in
your dog. Interested?...if so, why not give this web site a look.
For you...For Fido
NOT EXACTLY...
Don't be fooled by false and misleading claims and advertisements. Currently, there is no cure for arthritis, but effective help is available to all arthritic patients.
Tens of million patients worldwide suffer from many forms of arthritis. The newer anti-inflammatory agents called Cox-1 and Cox-2 NSAIDs have supplemented ASA and provided relief from pain, reduced deformity, and delayed a trip to the orthopedic surgeon for joint replacement. In all patients this help came at an expensive price, and in some patients, health was comprimised by adverse reactions to the medications. Because of gastrointestinal, cardiac, renal, and liver complications, many patients were forced to discontinue NSAID therapy. Looking for relief, alternative agents were tried. When reports of sucessful treatment started trickling into doctors offices, the majority of patients reported relief from a combination of glucosamine and chondroitin. These available supplements are found naturally in normal cartilage, and serve to protect and rebuild cartilage, and to reduce pain. Although a wealth of anecdotal data was accumulating, controlled medical research was needed before the medical profession would accept glucosamine and chondroitin as acceptable treatment for arthritis sufferers. These studies were pooled at the Arthritis Center of the Boston University School of Medicine, and a meta-analysis of 6 large studies on glucosamine and 9 large studies on chondroitin showed that glucosamine alone had a moderate effect on arthritis symptoms, and chondroitin had even a greater effect on pain relief. Final conclusion supported patients subjective feelings that symptoms of their arthritis was reduced with these supplements. The National Institutes of Health (NIH) are completing a 4 year study using these supplements alone and in combination, and will report their findings in 2003. Since these supplements have substantially less side effects* than current NSAIDs , they would seem a good choice for those people who have experienced adverse side effects to NSAID therapy, or who prefer a more natural type of medical treatment.
* Allergic reactions, blood sugar elevation, and excessive bleeding have been reported.
A HEARTY TIP... DON'T THROW OUT THE VIOXX
What's an arthritis patient to do?
After prolonged pre-announcement advertising, a long anticipated wait was over, and the new Cox-2 anti-inflammatory agents were approved by the FDA. Celebrex and Vioxx created quite a bit of excitement and interest. Patients were promised an effective and well tolerated drug, free from GI complications. No more ulcers or gastritis, and no major organ complications. All seemed rosy until recently. These drugs, in a large RA efficacy study, compared Naprosyn, a traditional Cox-1 anti-inflammatory agent with Celebrex and Vioxx. This study suggested that the three drugs were similar in success rate. Naprosyn, as expected, was associated with more GI symptoms, and in the Celebrex/Vioxx group, heart attacks were statically more prevalent. This study was worrisome, and caught the media's attention. Millions of arthritis suffers were understandably frightened. Concerned about the risk of heart attack, many chose to discontinue Vioxx and Celebrex, and return to the older Cox-1 anti-inflammatory agents. GI and renal complications seemed a better choice than heart attack.
Fortunately, for all arthritis patients, it was recognized, that none of the drugs in the original studies. were compared to placebo. An additional three studies, comparing the three drugs and placebo demonstrated no increased incidence of cardiovascular event with either Vioxx or Celebrex. Investigators were a bit surprised in finding that there appeared to be a lower incidence of cardiac events in the Naprosyn. group.
So...don't throw out your Vioxx or Celebrex. These drugs appear safe, effective, well tolerated, and free from increased incidence of heart attack.
According to a recently published article in the New England Journal of Medicine, about 200,000 patients each year undergo arthroscopic knee surgery to relieve arthritis pain. This new study of 180 patients suggests that arthroscopic surgery to relieve osteoarthritis (OA) knee pain may be of no value. When analgesics and NSAID's failed to control patients pain, surgery to "clean out" the joint, was considered a hopeful option to prolong the need for total joint replacement. It has long been considered that by removing joint debris and inflammatory enzymes, progression of arthritis and joint deterioration could be slowed, and assessment of performance values, i.e walking and stair climbing, improved. This study proved not to be the case. The Houston VA Medical Center study compared patients with arthroscopic knee flushing, flushing with scraping, and placebo surgery during which a skin incision was made, but nothing more was then done to the joint. Observers found that the placebo effect was very strong, and in all 3 groups response in pain relief and performance was about the same.
This is only 1 study, but does suggest that perhaps orthopedic surgeons and rheumatologists should reconsider their thoughts on relief of pain in OA afflicted knees, and defer arthroscopic surgery.