Sites on shoulder problems - part two

Websites related to this week's Clinical Review selected by Dr Keith Barnard.

SHOULDER REPLACEMENT

This site has mostly curiosity value because shoulder replacements make up only a fraction of the total joint rep- lacement operations carried out each year.

But it is worth taking a quick look to see the superb illustration, the before-and-after X-rays, and the photograph of the fearsome bit of kit that looks more like one of those spiky balls on a chain that a medieval knight would hurl round his head during a joust than a joint prosthesis.

Why go there: for interest.
Downside: peripheral knowledge for the GP.
Information from: American Academy of Orthopaedic Surgeons.
Address: http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=291&topcategory=Shoulder

CHRONIC PAIN

There is much ground to cover here with chronic shoulder pain - complications of fractures of the humerus, scapula and clavicle, recurrent dislocation of the humerus, and strains or sprains of the acromioclavicular and sternoclavicular joints, not to mention impingement syndromes, frozen shoulder and biceps tendinitis. Osteoarthritis of the glenohumeral or acromioclavicular joint can also occur.

What I did not realise (although it is logical) is that a posterior dislocation of the sternoclavicular joint can be life threatening because of compression of the trachea and great vessels of the neck.

Some helpful X-rays and tables make it easy to skim this long article for key points.

Why go there: covers a lot of ground.
Downside: none.
Information from: American Academy of Family Physicians.
Address: www.aafp.org/afp/20000601/3291.html

PAIN RELIEF

There is evidence that glucosamine taken in large oral doses might help arthritis pain, but I have not heard of spraying it on the skin, as advertised on this website.

For £21.95 plus P&P you can buy four fluid ounces of a concoction containing menthol, isopropyl alcohol, water, glucosamine sulphate, methyl sulphonyl methane, peppermint, eucalyptus, and a natural skin conditioner.

This spray will apparently effectively treat pain at almost any location.

So maybe the menthol will clear your sinuses, the peppermint will make it taste nice if you drink it, the alcohol will cool the skin, and the eucalyptus will keep the flies away. As you can tell, I am not convinced.

Why go there: to see what your patients are being offered.
Downside: a US site but it can be bought online in the UK.
Information from: Smart Pain Solutions.
Address: www.247painrelief.com/index.htm

- Dr Barnard is a former GP in Fareham, Hampshire

WEBSITE OF THE WEEK

These web pages are devoted to shoulder dislocation and instability in young athletes. Given the increasing interest in playing rugby and cricket, and the perennial interest in football, it is surprising we do not see more of these injuries.

This detailed article discusses examination techniques for instability, includes X-rays, and has high-quality arthroscopic images to show how the unstable or recurrently dislocating shoulder can be repaired.

Although we are not much involved ourselves, patients increasingly expect their GP to explain what their options are and what is going to happen to them in hospital. Although your local hospital may wail about this, patients often come away from the outpatient department not understanding what is planned for them.

One thing is certain. If you read the bit about reduction of a dislocation, you will discover there's more to it than a quick foot in the armpit and swift yank, which is the way it is usually done on TV. Here you will see a fascinating picture of a nurse tied to one side of a patient while the doctor heaves on the opposite arm. I have never seen that on TV.

Why go there: all you need to know.
Downside: rather technical.
Information from: The Physician and Sportsmedicine Journal.
Address: www.physsportsmed.com/issues/2002/12_02/levine.htm

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