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Don’t skip the shots or the PT for frozen shoulder

BY KEITH ROACH, M.D.

DEAR DR. ROACH: I have been diagnosed with frozen shoulder after an X-ray by an orthopedic doctor. He sent me to physical therapy, but this is the slowest recovery and the most agonizing pain. No over-the-counter products help, and I do not want surgery. He offered a shot for the pain. I declined. I could go back for it but, I do not want a temporary solution. I’m told this could last one to three years. Any suggestions? — D.E.

ANSWER: A frozen shoulder, also called adhesive capsulitis, is a painful loss of motion of one of the joints in the shoulder — the glenohumeral joint, between the shoulder blade and arm bone. It can come on by itself, but often, is the result of not treating an injury such as a rotator cuff syndrome early and aggressively. Without treatment, healing could take the one to three years you were warned about.

Physical therapy is crucial for treatment; however, a joint injection is an effective supplementary treatment that you should reconsider. Studies have shown that one or more injections can speed up recovery. It does only provide temporary relief, but my experience is that physical therapy is more effective when people are in less pain and greater movement because of the injection. The injection can be repeated if necessary.

I have had patients get so much relief with the injection that they never go to physical therapy: That’s a mistake. The PT is the definitive treatment. Without PT, the benefit from the shot goes away and the symptoms return.

Orthopedic surgeons, rheumatologists, and regular doctors like family physicians often give these injections.

DEAR DR. ROACH: I’m a 76-year-old oncologist. I was scheduled to run a 10k race when I was 42 and got the flu the night before and was too ill to run. I’ve been getting flu shots yearly ever since. Knock on wood, I haven’t contracted flu for 34 years. I’m aware that flu shots can differ from one year to the next, but it seems to me that antibody levels should be high. Has anyone looked at antibody levels in patients like me who have had so many flu shots? — J.M.C.

ANSWER: The cumulative effect of many years of consecutive flu shots has been looked at, but the results are conflicting.

On one side, studies have shown that at least in some particular years (2011-2012 and 2012-2013), those who had gotten a flu shot in both consecutive years had less protection in the second year than those who got only the flu shot the second year. However, other studies, looking at a longer timeline, have shown that people who get their vaccines every year have lower-than-expected risk of hospitalization or death due to flu.

The antibody levels themselves are not the best indicator of effectiveness of the flu vaccine, because antibody levels can drop to nondetectable and still provide a person protection. The protection can be very long-lasting. Memory B-cells can still be found in people who survived the 1918 flu pandemic (which was strain H1N1), and those have protected them from other H1N1 seasonal influenzas.

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