DR MARTIN SCURR: Why You Should Keep Moving When You Have a Frozen Shoulder

I am in a lot of pain from a frozen shoulder. My GP said it can last up to three years and there is little that can be done except physiotherapy and painkilling cream. Is there anything else?

John Haley, Staffordshire.

A frozen shoulder, where the joint is stiff and painful for months or years and has limited range of motion, is a miserable condition. I understand that you want to do as much as possible to help your recovery.

This common complaint occurs when the strong connective tissue surrounding the shoulder joint becomes inflamed and thickened.

It is most common in women over 40 (possibly due to hormonal changes) and people with diabetes (because high blood sugar can damage connective tissue). It can also develop after the shoulder has been immobilized for a long time, such as after a broken arm, because the tissue around the joint can tighten.

Frozen shoulder usually has three stages. In the early stages, which can last for months, the shoulder becomes increasingly stiff and painful. In the middle stages, the pain decreases but movement is limited due to increased stiffness. After that, the shoulder gradually recovers and regains its mobility. Most patients recover completely, but it can take a considerable amount of time.

There is no consensus on the best treatment, but steroid injections may be useful.

In about one in ten patients, the injections can cause pain for a few days, but these disappear and patients notice that they can move better and are less stiff. This makes it easier for them to perform the recommended physiotherapy exercises.

In fact, steroid injections combined with physical therapy appear to offer the best prospects for speeding recovery.

Another option is hydrodilation, where salt water is injected into the shoulder to stretch the tissue and improve movement. However, not everyone is convinced that this works.

Self-help remedies include applying a heat pack or hot water bottle to your shoulder for 20 minutes at a time to help relieve the pain. Short courses of ibuprofen or diclofenac can help, but see your GP. Finally, use your shoulder as much as possible – keeping it still will make the pain worse.

Last year I was fitted with a pacemaker and prescribed edoxaban after a check showed my heart rate was low at 35 beats per minute. I used to enjoy two walks a day but now I get tired quickly and lose interest. I am tempted to stop taking edoxaban to see if I can get my energy back.

Johannes Matthew, Dundee.

I am sorry to hear that you have lost your enthusiasm for the walks you used to enjoy, but I do not think that the medication you are taking is the cause. When your low heart rate, or bradycardia, was noticed, you would have been referred to a cardiologist who would have performed tests to determine the cause.

These tests would have included an electrocardiogram to measure the electrical activity of the heart. I suspect this showed that you also had another heart rhythm problem, atrial fibrillation (AF), and that is why you were prescribed edoxaban. Normally, the walls of the heart contract as it beats to push blood around the body.

In AF, the walls of the upper chambers (atria) do not contract but quiver – making it harder to pump blood into the chambers below. Blood can then pool, causing clots to form. These can then travel to the brain, causing a stroke.

Edoxaban reduces this risk by thinning the blood, so I would strongly advise against stopping it.

In AF, the irregular pumping of the heart reduces blood flow to the rest of the body, which can cause fatigue. I suspect this is the cause of your lethargy.

I would recommend discussing your fatigue with your cardiologist, as additional medications may be needed to improve your heart’s strength and contractions. I would also recommend asking your GP for a blood test for anemia, which can cause fatigue.

In my opinion…beware of hand, foot and mouth disease

The sickest patient I saw this summer was a plumber who suddenly became unwell. In addition to a fever, he had an ulcerated mouth and throat that were so painful that he would only accept sips of water.

He also had blisters on his hands, so when I examined him the diagnosis was immediately clear: hand, foot and mouth disease.

The disease is caused by a virus, Coxsackie A16. In children it is a harmless disease that disappears within a few days. In adults, however, the disease is much more serious and lasts ten days or more. The general symptoms are at least as bad as those of the flu.

The disease is spread by infected people shedding the virus through their mouth, respiratory tract, or feces in small droplets over a period of many weeks.

The number of cases peaks at this time of year. Therefore, I urge you all to wash your hands extra well with soap and water after using the toilet. You should also pay extra attention to the hygiene of door handles in such areas.

I am also forced to think about the possible infectiousness of water in wild swimming, given the neglect of water companies and the pollution of rivers with sewage.