American Medical Association Family Medical Guide - American Medical Association [705]
Symptoms and Diagnosis
At first, a frozen shoulder is difficult to move, and the slightest movement causes pain. The discomfort may be worse at night. The pain may eventually subside, but the shoulder will be permanently impaired unless it is treated. To diagnose frozen shoulder, the doctor moves your arm to evaluate the range of motion of your shoulder joint.
Treatment
If you have frozen shoulder, your doctor may prescribe a nonsteroidal anti-inflammatory drug such as aspirin to help relieve the pain and reduce inflammation. He or she may refer you to a physical therapist, who will teach you how to improve the mobility of your shoulder with exercises. (A frozen shoulder should be kept in motion as much as possible.) At each session, you will be given ultrasound therapy, in which high-frequency sound waves are directed at the injured areas, in combination with intense massage to help loosen the scar tissue that has caused the pain and immobility. Your doctor may inject a corticosteroid drug into your shoulder to reduce inflammation if the condition persists. In severe cases, the doctor may need to manipulate the shoulder while the person is under general anesthesia or perform a surgical procedure to loosen the scar tissue.
Septic Arthritis
Septic arthritis is a type of infectious arthritis that is usually caused by a bacterium but can also be caused by a fungus. The condition can result when bacteria enter the joint through a wound, when bacteria spread from a generalized infection such as tuberculosis (see page 663), or when bacteria travel through the bloodstream from an infection elsewhere in the body such as a boil on the skin. Usually only one joint is affected. The condition tends to occur in people who have a weakened immune system or who have joint damage from an inflammatory disorder such as rheumatoid arthritis (see page 918).
Symptoms and Diagnosis
In septic arthritis, the bacteria multiply inside the joint and cause redness, warmth, pain, and swelling. A person with septic arthritis usually has a fever (which can be as high as 104°F) with shaking and chills. If you have symptoms of septic arthritis, your doctor can diagnose it by analyzing samples of your blood and synovial fluid (taken from inside the joint) for the presence of bacteria.
Treatment
Septic arthritis is treated with antibiotics. Your doctor or a surgeon may open the joint to drain the infected synovial fluid to relieve the pressure and pain. Once the infection has cleared up, your doctor will recommend exercises you can do to prevent the joint from becoming permanently stiff.
Gout and Pseudogout
Gout is a common joint disease in which deposits of uric acid crystals in a joint (usually the joint at the base of the big toe, but also the joints of the knees, elbows, ankles, wrists, or fingers) cause painful inflammation. Uric acid is a waste product that normally passes through the kidneys and out of the body in urine. If your body is producing too much uric acid or if your kidneys are not working properly, uric acid crystals accumulate in the spaces in a joint (usually only one joint is affected). Although gout most often occurs in people over age 70, a hereditary form of the disease can affect males shortly after puberty. People who take diuretics (medications that eliminate excess fluid from the body) are at increased risk of developing gout.
Pseudogout (also called calcium pyrophosphate deposition disease, or CPDD) occurs when the attacks of arthritis are caused by calcium pyrophosphate dihydrate crystals rather than uric acid crystals. Like gout, pseudogout usually develops later in life, although it can develop in younger people, especially those who have thyroid disorders. The cause of pseudogout is unknown.
Symptoms
The symptoms of gout or pseudogout are severe pain, redness, warmth, and swelling in the affected joint. The person often has a fever, which can be as high as 101 °F. Attacks