Does a cortisone shot help a frozen shoulder? Adhesive capsulitis is the fancy term for a frozen shoulder. The bones of the shoulder are held together by a ligamentous capsule. The range of motion of the shoulder is very extensive so the capsule has to be loose to allow that motion. If, and when, the joint capsule becomes inflamed, such as from overuse, it heals by forming scar tissue. Scar tissue shrinks the capsule, causing the range of motion of the shoulder to be reduced. The joint capsule develops adhesions and becomes tight, or frozen, so the patient now has a frozen shoulder, or adhesive capsulitis. Pain and decreased range of motion are the symptoms. Would a shot of cortisone into the frozen shoulder help? According to a review of 65 trials, intra-articular cortisone “significantly improved pain…at 1 month, 2 months, and 3 months,” but not at 4-6 months after injection. However, “Range of motion was not significantly different at 1 month, 2 months, and especially 6 months.” I was never hesitant to inject a painful, stiff, frozen shoulder. In my experience, 80 mg of intra-articular Depo Medrol (cortisone) with 2cc of 1% lidocaine made a lot of patients happy immediately and for many weeks thereafter. Of course, cortisone injections weren’t 100% successful, but my results were good enough that I preferred that treatment over rest, ice, and oral anti-inflammatory drugs.
Reference: Cunningham AK, Yang CK. Intra-Articular Steroids for Adhesive Capsulitis Am Fam Phys 2024 September;110(3):307-308.
Arm position makes a difference when checking blood pressure: “Guidelines for blood pressure measurement recommend [the] arm [be] support[ed] on a desk with the mid cuff at heart level.” Supporting the arm on one’s lap “overestimated systolic BP by 3.9 mmHg and diastolic BP by 4.0 mmHg.” When the arm hung at one’s side, readings “overestimated SBP by 6.5 mmHg and DBP by 4.4 mmHg. All studies used only patients’ right arms. Consistency was stressed for the sake of accuracy.
Reference: Frellick M. Poor arm position may significantly skew BP readings. Medscape Medical News 2024 October 8.
CDC uncertain flu vaccine this year is effective: Vaccine components are determined each year by the strains of virus affecting countries in the Southern Hemisphere. Flu season in South America is from April to September. Argentina, Brazil, Chile, Paraguay, and Uruguay project results that tell the CDC what to anticipate for our flu season, from October to April. Those countries report this year’s vaccine was 35% effective as compared to last year’s 51.9% effectiveness. Last flu season (Oct. ‘23 to April ‘24) U.S. vaccines were 41%-44% effective in preventing flu-related hospitalization in adults and 52%-61% effective for children. This year’s statistics have yet to evolve, but I know they will. Hopefully, they won’t be bad news.
Reference: Ellis R. The flu vaccine might be less effective this year. WebMD Health News 2024 October 9.
Detecting vascular plaque buildup before it causes harm: Patients with no cardiovascular symptoms often have arterial plaques (arteriosclerosis) bad enough to be associated with death. Two tests were developed to detect plaque: one, 3D vascular ultrasound. Two, coronary calcium score on CT. “Plaque that goes undetected (subclinical disease) predicts mortality.” The presence of plaque on these two tests was “a better predictor of death than traditional risk factors.” 3D Vascular ultrasound is performed on the carotid artery (in the neck) and has found significant plaque in patients in their 20’s. If the carotid artery contains plaque, there is a very strong likelihood it is in the coronaries, as well. Finding plaque early leads to coronary angiography, angioplasty, stent placement, or bypass surgery, and thus, to the prevention of sudden, unexpected death. Coronary calcium score (CCS) is helpful, but there are many false positives. The inability to determine the seriousness of the plaques and evaluate progression is a major drawback. Vascular ultrasound can monitor progression of non-calcified plaques, something CCS is incapable of. “Finding any atherosclerosis means an increased risk for death…progression of atherosclerosis increases risk even further.” Their accuracy, especially that of 3D Vascular ultrasound, is critical to preventing problems before they are insurmountable.”
Reference: Brown C. New evidence that plaque buildup shouldn’t be ignored. Medscape Medical News 2024 October 9.
Routine Vitamin D testing is unnecessary. I published a review of Vitamin D in DrGOpines.com in September. In it, I reported that 10 years ago Vitamin D, or lack thereof, was alleged to be the basis for many diseases, and that taking vitamin D would hopefully generate a more healthy American populace. That outcome, unfortunately, has not occurred. Now we get further evidence that routine screening for Vitamin D deficiency is unnecessary 75% of the time. It leads to overtreatment and even toxic levels that trigger hypercalcemia, hypercalcuria with renal stones, and parathyroid hormone suppression. The authors of the reference article advise against routine screening for vitamin D deficiency. They do recognize the need for vitamin D in children with proven Ricketts disease, however.
Reference: Lazris A, Roth A. Routine Vitamin D Testing: Unnecessary and Ineffective. Am Fam Ohys 2024 September;110(3):302-304.
