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Frozen Shoulder
Definition:
Frozen shoulder as the term implies that mobility of the affected shoulder is severely restricted. Frozen shoulder is the result of inflammation, scarring, thickening and shrinkage of the capsule that surrounds the normal shoulder joint.
The diagnosis of frozen shoulder is sometimes loosely used for any painful shoulder condition resulting in a loss of motion, but it is the severe restriction of movement of the shoulder in all directions rather than the pain that is the hallmark of this common disorder.
Who is at risk?
Frozen shoulders occur more frequently in the middle aged from 40 to 60, and are twice as common in women. For unknown reasons, frozen shoulder is more common in people with diabetes. People who have experienced prolonged immobility of their shoulder - perhaps due to trauma or surgery - often experience frozen shoulder. People with systemic disease, such as hyperthyroidism, hypothyroidism, cardiovascular disease, or Parkinson's disease, may experience frozen shoulder.
Symptoms:
The condition is characterized by a markedly restricted range of movement in all directions of the shoulder joint. Simple actions such as combing the hair and scratching the back become impossible.
Pain is also a common symptom, especially in the early stage of the disease. As the disease progresses, pain diminishes, but the mobility worsens.
Doctors can usually make the diagnosis with clinical history and physical examination. Blood tests and X-rays are sometimes ordered to exclude other conditions.
Treatment:
When pain is a significant complaint, doctors may prescribe non-steroidal anti-inflammatory drugs (NSAID) or similar medicine to help. Physiotherapy with ultrasound, ice or heat may also help relieve symptoms. Stretching exercises are most important to restore the range of mobility. Exercises should be monitored by doctors or physiotherapists. Since it can take up to 18 months to regain full mobility, patients must continue exercising the upper limb to avoid muscle wasting. When symptoms are severe, doctors may sometimes resort to using local corticosteroid injections in order to decrease the inflammation.
If patients do not respond to the above measures, orthopaedic surgeons may consider surgery. Sometimes when the patient is under anesthesia, the doctor may be able to break up the inflammatory adhesions by manipulating the affected shoulder. If not, a small telescope called an arthroscope can be inserted into the joint to cut through the adhesions.
Prevention:
Any injury to the shoulder can lead to frozen shoulder, including tendinitis, bursitis, and rotator cuff injury. Prompt treatment of these injuries can help prevent developing frozen shoulder. Diabetic patients should keep tight control of their blood glucose levels. Patients undergoing breast or chest surgery should keep doing stretching exercises to avoid frozen shoulder. Maintaining a good posture is also important.
Early aggressive treatment of frozen shoulder can help to prevent long-term stiffness in this important joint, so contact your health care provider if you develop shoulder pain that limits your range of motion for an extended period of time.
Fracture
Definition:
A break in bone or cartilage, which may or may not be caused by trauma.
Who is at risk?
- People taking part in adventure sports
- People, especially women, who have the low bone density condition of Osteoporosis
- Patients with cancer
- Genetic factor: Osteogenesis imperfecta, for example, is a congenital defect in the connective tissue in the body resulting in fragile bones
Symptoms:
- Gross deformity of the affected area, especially after injury
- Swelling, bruising and redness
- Intense pain, especially on movement
- Inability to move the affected area
Treatment:
Pain relief, offered by analgesic drugs, local ice application and a period of rest may be all that's required for some fractures, such as an un-displaced fracture in the rib. A bandage or a splint may be offered for immobilization so as to minimize pain. A cast or a splint is often applied to keep the broken bones in the correct position after the broken ends are brought back to the correct position (reduction). In closed reduction, the doctor re-aligns the broken ends into the correct position by manipulation without surgery. If close reduction fails, the doctor needs to perform an operation (open reduction). Sometimes pins, screws or other fixing devices may be necessary to fix the broken bones into correct position, especially in sites where accurate alignment is of paramount importance, such as fractures across joint surfaces.
Prevention:
- Wear protection while participating in adventurous activities
- Supervise young children and ensure environmental safety
- Scrutinize the living environment of the elderly to eliminate fracture risks such as using handrails on staircases and non-skid mats near bathrooms, encourage the use of a walking stick, and avoid unnecessary medications that can cause drowsiness
- Osteoporosis is a major risk factor for fractures in the elderly, so take measures to prevent osteoporosis and screen for the condition so as to start treatment early
Fever
Definition:
Fever Elevation of body temperature above normal. A healthy person's body temperature can fluctuate within a narrow range, but a temperature above 100.4 degrees °F (38 degrees °C) is usually clinically significant. It is a sign that an underlying disease is going on.
Who is at risk?
Very high fever may be caused by a relatively minor infection, while a serious condition can present as a low grade fever. This is especially true in small babies, the elderly and those with impaired immune function.
Fever is more likely to be associated with a serious condition if the patient:
- is unusually tired, listless or irritable.
- is unresponsive and sleeping most of the time.
- has other symptoms that are rapidly progressing, such as respiratory difficulty, a developing rash or is vomiting repeatedly.
Symptoms:
Fever causes discomfort, but the degree of discomfort may vary depending on age and the underlying cause. The patient often has:
- Tiredness, general weakness
- Headache, muscle aches, bone pain
- Loss of appetite
- Shivering, sweating
Treatment:
When a serious underlying cause is suspected or is likely, the patient should be evaluated by a doctor. If there is no reason to suspect a serious underlying condition, the symptom may be managed without medication by:
- Drinking plenty of fluids
- Dress in light clothing
- Bed rest
- Keep the environment cool, dry and well ventilated
- Taking lukewarm baths periodically
It is not necessary to bring down the temperature at all costs. Lowering the body temperature may relieve the discomfort associated with fever, but may also mask the symptom and cause a delay in diagnosis. Antipyretics such as paracetamol are safe provided that the patient is not allergic to the drug and the dosage is not exceeded. Overdoses of antipyretics may cause liver or kidney damage and can be fatal. Children should avoid aspirin. It is important to record down the body temperature so as to follow the trend of the disease. The fever pattern will provide valuable information for the doctor to diagnose the underlying condition.
Prevention:
Observe personal hygiene may reduce, but cannot totally eliminate, the chance of getting infections which are the most common cause of fever.
