A Simple Guide to Frozen Shoulder

A Simple Guide to Frozen Shoulder
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What is Frozen Shoulder?
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Frozen Shoulder (also known as adhesive capsulitis) is a disorder of the shoulder characterised by the slow onset of pain and restriction of movement.

It tends to be chronic and full recovery may take several months.

It is more common in women and diabetes.

Incidence is about 2 in a 1000.

What are the causes of Frozen Shoulder?
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The exact cause is unknown but several conditions has been blamed:

1.bicipital tenosynovitis- inflammation of the biceps muscles and tendon limmiting its movements

2.rotator cuff tendonitis - inflammation of the rotator cuff muscles which surrounds the shoulder with resultant adhesions and stiffness causing limitation of movement

3.reflex sympathetic dystrophy- a disturbance in the sympatheic nervous system cause pain ine the shoulder joint and hypersensitivity of the muscles surrounding the joint. There is swelling of the arm followed by atrophy of the muscles

4.trauma - injury to the joint may cause tightening of the injured muscles around the shoulder joint.

5.Surgery of the shoulder, breast and lung may also cause frozen shoulder because of the pain resulting from the movement of the shoulder and hence stiffness of the muscles.

What is the natural progression of frozen shoulder in most cases?
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Frozen shoulder is a disabiliting disease which can last from 5 months to 4 years.

There is chronic inflammation of the muscles surrounding the joint with adhesios formed between joint and muscles causing restriction of movement of the joint.

There is also reduced fluid in the joint further restricting movement.

Stage one("freezing" or painful stage):
There is a slow onset of pain which becomes worse and stiffening of the joint occurs.

This lasts 5 weeks to 9 months.

Stage two("frozen" or adhesive stage):
There is a slow but steady improvement in pain, but the stiffness persists.

This lasts 4 -9 months.

Stage three("thawing" or recovery):
There is a gradual return to normalcy in the shoulder motion.

This lasts 5 -26 months.

What are the symptoms and signs of Frozen Shoulder?
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Symptoms:

1.Pain in the shoulder radiating down the deltoid muscle and anterior aspect of the arm

2.Pain usually is worse at night especially lying on the affected shoulder

3.Certain movements makes the pain worse

4.Pain is described as constant, dull and aching

5.complaints of stiffness of the shoulder

6.inability to wear a shirt or blouse because of restricted movements

Signs:

1.apprehensive patient who holds the arm protectively

2.Generalised tenderness of rotator cuff and biceps muscles

3.Limited shoulder movement

4.Range of muscle movement is reduced in all directions

5.Arthrogram or MRI of shoulder can be done to confirm the diagnosis and exclude a posterior shoulder dislocation..

What is the Treatment of Frozen Shoulder?
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Conservative treatment:
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Initial phase:
1.rest of the shoulder

2.moist heat

3.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain

4.Muscle relaxant to relax muscles

5.injection of local anesthetic and long acting steroid into the rotator cuff muscle may help to relieve pain.

Mobilisation phase:
1.Physiotherapy such as traction, shortwave diathermy

2.gradual mobilisation and exercises to loosen the tight muscles surrounding the shoulder

Maintenance phase:
1.Continual exercises of the shoulder muscles

2.Avoidance of strain on the muscles of the shoulder

Manipulation of the frozen shoulder may be done under anaethesia to break the adhesions and restore some movement.

Surgery is usually not indicated in frozen shoulder.
Rarely surgery is used to cut the adhesions.

What is the prognosis of Frozen Shoulder?
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Prognosis depends on the underlying cause.

In most cases frozen shoulder may resolve itself with time

A Simple Guide to Dandruff

A Simple Guide to Dandruff
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What is Dandruff?
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Dandruff is an acute to chronic inflammatory scaly disease of the hairy areas of the scalp endowed with sebaceous glands.

As a result scales that are shedded from the the dead skin cells of the scalp are called dandruff or pityriasis capitis.

What are the Causes of Dandruff?
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The cause of Dandruff is not completely known but are related to three possible factors:

1.Excessive sebaceous or oil gland secretions from the skin

2.the fungus Malassezia furfur has been known to be a possible cause of dandruff.
It metabolises the oils present in sebum to a lipid byproduct oleic acid .This oleic acid can cause an inflmmation in the epithelium of the scaly resulting in the shedding of dry scales.

3. allergic reaction to chemicals in hair oils, cream or gel

Certain oily foods may trigger the production of dandruff

Stress has been known to trigger off dandruff


What are the symptoms of Dandruff?
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Onset is usually gradual.

Symptoms:
1.Flaking of scales from the scalp.

2.Itchiness of the scalp

3.Redness of the skin on scalp, forehead and eyebrows

Signs:
1.Dry, rounded, greyish macular or papular lesions on the scalp.

2.The surface consists of dry scales which can be rubbed off

3.Sometimes the lesions can become crusted

4.Some lesions may become purulent with yellow exudate.

What is the Treatment of Dandruff?
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1.Dandruff shampoo such as Sebutone, Genisol, Selsun will help to remove flakes and reduce the lesions.

2.fungus infection should be treated with antifungal orally with ketoconazole
and topical antifungal lotion and shampoo such as salicylate acid lotion, nizoral or ketoconazole shampoo.

3.For more severe cases with bacterial infection a combination of hydrocortisone and tetracycline ointment can be used to remove infected crusts.

4.General hair hygiene -
shampoo hair daily

Avoid too strong hair cream or gels


What is the prognosis of Dandruff?
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Generally good with treatment.

However recurrences are not uncommon.

General hair hygiene is important.