DEAR READER: Cortisone can be injected into joints such as the ankle, knee, shoulder and other areas to relieve pain and inflammation. They have been known to help osteoarthritis, gout, carpal-tunnel syndrome, bursitis, plantar fasciitis and a host of other conditions. About 30 years ago, corticosteroids were given with great regularity. Today, however, a different approach is taken. Some physicians restrict a person to three injections a year, others to three in a lifetime. This has resulted from research indicating that repeated injections can cause damage to tissues over time when given in excess quantities to one area of the body. One consideration is whether or not the injections work. If one or two are unsuccessful for reducing pain, it’s rather unlikely that additional ones will respond any differently.

Side effects include a cortisone flare, in which the injected material crystallizes, causing pain for up to two days that could be greater than what was experienced prior to the injection. Tendons can be weakened, there can be pain at the injection site, and the color of the skin at the site can change. The most common systemic reaction is observed in diabetic patients, who should monitor their readings, because cortisone can cause a rise in blood-sugar levels. Long-term risks of high doses with frequent administration can include weight gain, facial puffiness, cataracts, osteoporosis, hypertension and rare but serious damage to the large joint bones, known as avascular necrosis.

So, in answer to your question, your mother should return to her orthopedic surgeon or the physician who gave her the injections. If that specialist (who is familiar with her medical history) feels strongly that no more should be administered, then I suggest you heed the warning. If, however, your mother is aging, her quality of life is affected, and she cannot find relief from pain through other means, perhaps she will receive a favorable response. The pros and cons can be answered only by the person behind the needle.

To provide related information, I am sending you a copy of my Health Report “Osteoporosis.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title.

Would it hurt to try and do light exercise? Is it better to wait until the inflammation and pain go away? With proper treatment, how long do you think it will take to heal?

Would an MRI test on both shoulders help to determine how much inflammation is present and whether there are any muscle tears in the shoulder joints? I would appreciate any insight and information you can provide.

DEAR READER: Bursitis and tendinitis are common conditions that cause inflammation of the soft tissue around muscles and bones of the shoulders, elbows, hips, knees, ankles or wrists.

A bursa is a cushioning, fluid-filled sac located between bones, muscles, tendons or skin. Bursitis occurs when a bursa becomes inflamed. Bursitis is often caused by trauma or overuse.

A tendon is a flexible band of fibrous tissue that connects muscle to bone. Tendinitis is inflammation of a tendon that commonly occurs with the repetition of an act such as weightlifting, swinging a hammer, golfing, playing tennis or a musical instrument or other activities that place stress on joints.

There are two types of tendinitis that can affect the shoulder. Biceps tendinitis results in pain in the front or side of the shoulder. That pain may radiate to the elbow or forearm. Rotator-cuff tendinitis may result in shoulder pain at the upper outer arm and tip of the shoulder. Pain can be worsened by raising the arm above shoulder level or by lying on the affected side. Activity such as weightlifting can cause irritation to the bursa or rotator cuff and could lead to inflammation and impingement.

Diagnosis can be made through medical history and examination. Physicians and/or therapists might use manual testing known as selective tissue tension to determine which tendon is involved. X-rays might be helpful in ruling out problems with arthritis or bone but will not reveal tendons and bursae. Magnetic resonance imaging (MRI) should confirm or deny any tear and its extent. An anesthetic-injection test could also confirm the diagnosis of tendinitis. During this test, lidocaine hydrochloride is injected into the painful area. If the pain is relieved temporarily, the diagnosis is confirmed.

Treatment is directed toward healing the injured bursa or tendon.

Mild symptoms are commonly relieved with rest, elevation of the affected joint and over-the-counter medications such as ibuprofen or naproxen. Ice is often used following an initial injury for up to five days but isn’t generally helpful for chronic cases of either disorder. Corticosteroid injections may be given for control but should be used with caution because they can lead to weakening or rupture of tendons, primarily those that bear weight, such as the knees and ankles. In cases where bursitis is caused by infection, antibiotics will likely be ordered. Controlled, limited exercise or physical therapy can be performed prior to complete healing. When all else fails, surgery may be necessary.

To provide related information, I am sending you a copy of my Health Report “Managing Chronic Pain.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order made payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

Accidents happen all the time and while modern cars can often withstand quite a bit of “injury”, the human body often can not.

Your head weighs 8 to 10 pounds; if your seat belt is fastened, the force of a collision can cause your head to whip forward and back or side to side. Accidents are at times unavoidable, but there are things you can do to decrease the chance of sustaining a whiplash injury.

• Always fasten your seat belt.

• Position your head rest to “catch” your head, which means it should be right in the center of your head. Positioning it too high or too low can actually cause or worsen a whiplash injury.

• Position your seat properly. You should be sitting up straight and the seat should be as close to your head as possible to lessen the distance between your head and the seat upon impact.

• Be aware of your surroundings — which means no calling, texting, eating, putting on makeup, etc.

If you do sustain a whiplash injury, get checked out by a medical professional. Some of the symptoms of whiplash: blurred vision, dizziness, jaw, shoulder or neck pain, headaches, vertigo, memory loss, irritability, sleeplessness, fatigue.

Most pain associated with whiplash is caused by tense muscles. When the neck is forced back and forth in a jarring motion, such as the type caused by a car accident, muscles and ligaments in the area are stretched beyond their normal limits. In severe instances, the supportive muscles of the spine are torn. Muscles in the surrounding area then tighten to try and support the injured tissues. This limits range of motion and causes strain on those muscles which are not being used to bearing the extra load. This causes more pain.

Muscle pain is your chiropractor’s specialty, so get checked out. And be careful out there.

Monica S. Nowak, DC
The Chiropractic Center of Canaan
176 Ashley Falls Road
Canaan, CT 06018
860-824-0748

DEAR READER: There is an increasing demand, and rightly so, for the use of autologous (self-donated) blood products that aid the healing process. Blood contains red and white blood cells, platelets and plasma. The platelets are responsible for the production and revitalization of new connective tissue. Let me briefly discuss PRP, and then I will try to answer your question.

During the procedure you are considering, about 30 to 60 milliliters of a patient’s blood are drawn and spun down in a centrifuge for 15 minutes. From that draw, between 3 and 6 ccs of PRP become available. The concentrated platelets are then injected into the patient at the site of the injury.

The process was first used and documented in 1987 by a physician who performed open -heart surgery. However, it has been only about a year since it has been used in conjunction with sports-related/overuse injuries. Perhaps because tendons get very little blood, injury sites heal slowly. The thought process behind PRP is that concentrated platelets injected into the injury site should speed recovery.

A Journal of the American Medical Association (Jan. 13, 2010) reported the use of PRP for Achilles tendinopathy and indicated the PRP injection, compared to a saline injection, did not result in greater improvement in pain and activity. Keep in mind this report was for chronic Achilles tendinopathy, not shoulder impingement. I state this only because there is little, if any, information regarding the shoulder.

The New York Times covered the topic on Jan. 12, 2010, stating the treatment has become so popular that patients are willing to pay $1,000 or more out of pocket for PRP — especially after hearing that Tiger Woods had his knee injected and two football players, Troy Polamalu and Hines Ward, received injections, all with positive reports. Thousands of doctors and about 500 hospitals are offering the service today. However, the first rigorous study found that platelet injections are no more effective than saltwater. Again, this report extracted from the JAMA report is related only to acute Achilles tendinopathy.

In defense of the procedure, another study in the American Journal of Sports Medicine due out soon concludes that platelet injections may help tennis elbow, but some indicate the study has a design flaw that leads them to question its conclusions. This may be worth watching for final analysis.

As you can see, the jury is out on this one, and I am a member of the jury. Thank heavens testing continues. My problem is that PRP is in its infancy and has been used for sports-related injuries for only about a year. I’m not daring enough to be on the cutting edge, nor am I willing to step up to the plate and take a stand. It’s simply too soon for my endorsement.

Only you know your physician’s qualifications. Perhaps a second opinion at a large sports-medicine center or teaching hospital is appropriate. Good luck.

To provide related information, I am sending you a copy of my Health Report “An Informed Approach to Surgery.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

DEAR READER: Identified and documented as far back as 1895, rice bodies were originally thought related to tuberculous arthritis. The name originated because of a similarity in appearance to grains of polished white rice.

Today, rice bodies are commonly linked with chronic rheumatoid arthritis (RA), as a complication of bursitis or an underlying systemic disorder. They appear to represent an unrelated group of particles that may contain fibrin, fibronectin, mononuclear and blood cells, collagen and amorphous materials.

Diagnosis is accomplished through X-ray, ultrasound or MRI. I cannot tell you which antibiotic to take because management depends on the underlying cause. For example, if your rice bodies are the result of chronic bursitis, an antibiotic may not be appropriate. Only your physician can direct you in that regard. Elimination of the offender in conjunction with treatment for any possible underlying disease should provide relief.

Infusion therapy is a means of administering medication through a needle or catheter intravenously. Infections and disorders unresponsive to oral medications, dehydration, diseases of the gastrointestinal tract, congestive heart failure and immune deficiencies are commonly handled through this form of therapy. Thirty years ago, patients being infused were required to remain in the hospital for the duration of the treatment. However, with expenses as they are in a hospital setting, the same service can now be provided in an outpatient setting or at home. I remember when a woman remained in hospital for close to a week following childbirth. Surgical patients undergoing relatively simple procedures spent almost the same amount of time recuperating before being sent home. Now, however, the sooner a patient returns to normal activity, the better.

Rice bodies can be found in joint areas such as the shoulder, knee or ankle. If your condition is the result of chronic bursitis or RA, multiple joints can be affected, but I can’t guess whether that will occur in your case.

To provide related information, I am sending you a copy of my Health Report “Managing Chronic Pain.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

DEAR READER: A bursa is defined as a small, fluid-filled sac whose purpose is to reduce friction between bodily tissues. There are 160 bursae throughout the body, all of which are located in areas of large joints, such as the knees, elbows, hips and shoulders. The main symptom of bursitis of the shoulder is severe pain, primarily on movement. Causes include arthritis, infection, injury to the site or, most likely in your case, overuse.

Symptoms are commonly treated by resting the affected joint, and with cold packs, anti-inflammatory over-the-counter medications, heat once any swelling disappears and antibiotic therapy for infection. Some cases don’t respond to simple treatment and require aspiration of the bursa fluid. This procedure is commonly performed in a physician’s office and may be followed by a cortisone injection into the affected area.

When inflammation in the subacromial bursa adds to pain experienced, the lubricating sack is often removed by a surgeon in a procedure known as bursectomy or debridement. Generally speaking, recovery is rapid, because range-of-motion exercises are begun soon after surgery in an attempt to accelerate rehabilitation.

Now comes the difficult part. You need to sit down with your specialist and explain that you want to remain physically active. Determine how long you might anticipate the recovery period to last and whether there will likely be any unwanted side effects. Your surgeon knows your case and should be able to predict the outcome based on your general health. Ask whether he plans to do arthroscopy, which will be less invasive and require less recuperation rather than make a larger incision, which will take longer to heal. You might also feel more comfortable requesting a second opinion.

To provide related information, I am sending you a copy of my Health Report “An Informed Approach to Surgery.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

DEAR READER: The muscles and tendons that connect the upper arm bone to the shoulder blade and hold the ball of the bone firmly into the shoulder socket are known as the rotator cuff. Injuries result primarily from a fall with impact to the arm, the aging process, poor posture and from repetitive activity — specifically, that which is done overhead. Symptoms include loss of motion because of pain and shoulder weakness.

A torn rotator cuff can occur because of bursitis, tendonitis or a tear or strain. Bursitis is irritation and/or inflammation of the bursa located between the shoulder joint and tendons of the rotator cuff. Tendonitis is essentially inflammation of the tendons caused by excessive use, such as is seen in tennis players or carpenters. This excessive use can lead to tears or strains of the area.

Diagnosis is commonly made by physical exam. When questions remain, your physician might choose to order an X-ray, ultrasound or MRI.

Temporarily discontinuing the irritating activity, applying cold packs, which can be purchased at your local pharmacy or improvised with a bag of frozen peas from your refrigerator, gentle daily exercise and over-the-counter nonsteroidal anti-inflammatory drugs, such as ibuprofen or acetaminophen, can ease the pain. If these conservative measures fail to provide relief, visit your physician to determine the next step that might be physical therapy, a steroid injection or surgery. If surgery is recommend, obtain a referral to an orthopedic specialist for confirmation. He or she will be able to repair any tears or remove any bone spurs or calcium deposits.

I do not believe your age or medical history should prevent you from having surgery; however, I recommend you consider conservative measures first.

To provide related information, I am sending you copies of my Health Reports “Managing Chronic Pain” and “An Informed Approach to Surgery.” Other readers who would like copies should send a self-addressed stamped No. 10 envelope and a $2 check or money order for each report to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title(s) or print an order form off my website at www.AskDrGottMD.com. Good luck.

A few years ago, I suddenly got severe muscle pains in my shoulders and arms. My doctor could only advise cortisone shots which I declined. Shortly after, I went to visit a relative who lives in Germany who has suffered from terrible rheumatism all his life. I had visited because he was about to be released from the hospital after a heart problem. While helping him get ready to leave, I noticed his discharge instructions at the foot of his bed. His doctor had written that he needed to avoid peas, beans and lentils.

I remembered that, in months before, I had really indulged in these legumes which I love and are supposed to be very healthful. After that I stayed away from them and within a few weeks all the pain in my arms and shoulders disappeared. I have not had a problem in years.

Now to the best part: proof that these edibles caused my problem! A short while ago I thought it would have some lentil soup. Two days later I had pain in my shoulders! I have not had peas, beans or lentils again and the pain went away again.

I hope this may benefit some of your readers.

DEAR READER:
I am unaware of any information about peas, beans and lentils causing joint and muscle pain. However, you appear to have found the source of your pain in these healthful legumes. I suggest you speak to your physician about this potential link.

That being said, most authorities encourage diets that contain peas, beans and lentils. They play an important role in achieving adequate protein consumption in vegetarian and vegan diets.

To the best of my knowledge, the worst that these legumes can cause is abdominal pain due to increased gas pressure. That is why most people find it easier to handle small quantities at a time which can then be slowly increased. Beano is also helpful in preventing painful gas due to increased legume and fiber intake.

To give you related information, I am sending you a copy of my Health Report “Managing Chronic Pain”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

DEAR READER: The rotator cuff helps stabilize the shoulder. Consequently, it can be easily strained, irritated or torn in people who are physically active. Therefore, in answer to your question, swimming and other forms of exercise can aggravate your shoulder and may be the cause of the rotator cuff problem, if that is what is causing your discomfort. If you gain pleasure from remaining fit, and it appears you certainly do, I highly endorse the exercise. If, however, you feel you are damaging your shoulder every day, you might consider taking a few days or a couple of weeks off to determine if the pain subsides. Settle for a brisk walk to get your daily exercise. If you remain pain free, gradually introduce a modified hiking schedule that shouldn’t require much shoulder involvement. You can ultimately add a modified swim program once or twice a week, stepping the program up to your current daily regimen if you remain pain free.

Treatment depends on the amount of damage. A strained cuff usually responds to rest and heat. An irritated cuff usually improves with rest, over-the-counter anti-inflammatory drugs such as Advil, Aleve and others, coupled with physical therapy. A torn cuff can be a real problem that may require surgery.

You may need further testing, such as a CT scan or MRI, to determine the extent of damage. Ask your primary care physician for his recommendation of a referral because more than anything, you need a consultation with an orthopedic surgeon who is familiar with sports injuries. He may determine your pain isn’t related to your rotator cuff at all. The CT or MRI can provide vital information on this annoying problem.