Wednesday, January 13, 2010

TMI and Shoulders

Shoulder Update: My physical therapist decided that he wanted an orthopedic specialist to take a look at my shoulder... so...

I visited the specialist. This required filling out various forms that made me wonder how much information the two offices really share (they're on the same computer system...).

I met the doctor, who seemed nice and not like he graduated from high school last June. He seemed amused when I answered "how's your health?" with "Well, I'm 45, I probably don't exercise enough and I could eat better."

After feeling my shoulder it was Off For X-rays! The X-ray machine uses a rotating anode source that is excited by lots of electricity so that its electrons emit gamma rays when the fall back into a more stable electron shell. Got the X-ray tech -- who doesn't read much science fiction -- to admit that the machine read-outs on CSI are from machines that the actors aren't using. Three shoulder X-rays confirm no bone spurs or arthritis. Real-live, honest-to-God, ithiopathic Adhesive Encapsulitis diagnosis confirmed. R-L H-T-G IAE is "rare." The doctor has only seen R-L H-T-G IAE three times in ten years (the others have been fake, I suppose).

This leads to the following Treatment Decision Tree:

  • Do nothing -- L-R H-T-G IAE will probably cure itself in a year (or two). Probably there will always be some stiffness. Nobody knows what causes it.

  • Cortisone injection -- Cortisone might loosen up the shoulder for PT to be more effective. It's a local injection, so it won't go all over your body like it was an oral application and suppress your immune system. It can't hurt, and it may help.

  • "Manipulation" -- The doctor knocks me out and makes my shoulder move. Massive PT to follow to keep things limber (and there will probably be some stiffness). Possibility that I'll go to sleep and wake up with a broken arm.

  • "Capsule Release" -- The doctor goes in with an orthoscope and snips away the shoulder capsule to release its death-grip on my humorous. He doesn't think much of the procedure, and prefers to rip (his word) the arm loose.

After a discussion of the side-effects of cortisone, I accepted a shot. This required lying on my side on a foam wedge, a nurse, and Really Big Needles. The numbing spray was cool, but the shot hurt (I had no idea they had spray-on numb spray). Judging by the bandages afterward, I imagine there was blood everywhere (my eyes were closed and I was concentrating on breathing at the time). Driving home felt nice, but I think the spray is wearing off as I type this.


There's some calcium loss from the humorous bone because I haven't been stressing it -- so eat plenty of calcium pills and vitamin D pills (everyone in Oregon is vitamin D deficient). (I did actually mention broccoli, but I don't think the doctor heard me...)

Don't play baseball or do anything that might hurt because the cortisone kind of makes it hard to feel things. And don't overstretch (but keep doing your PT stretches).

Oh. Right. And check for diabetes, because there's a slight correspondence between R-L H-T-G IAE and diabetes. Sigh.
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