ASK THE DOCTOR: Did flu jab cause my husband's frozen shoulder? 

My husband had a flu jab in his left arm last October and a pneumonia jab in his right arm at the same time. He complained that his left arm felt tender and sore but thought it would ease. In fact it has got much worse and he now can't lift his left arm and the movement is severely reduced. When he tries to reach something it is very painful. The doctor suggested it might be arthritis but the X-rays are all clear. He is in agony.

Irene, Brighton.

My suspicion is that your husband has developed a frozen shoulder. Sometimes known as adhesive capsulitis, this is a common condition that affects about 5 per cent of the population, typically people in their 50s and 60s.

Once improvement is under way then strength building exercises can hasten his return to normal function

Once improvement is under way then strength building exercises can hasten his return to normal function

It may be pure coincidence that this problem occurred following the flu jab, but in fact I have seen exactly this scenario occur more than once in the past.

The condition develops when the flexible tissue that surrounds the shoulder joint, known as the capsule, becomes inflamed and thickened. This causes the disabling pain that your husband has experienced, which typically persists for some months.

It is followed by a phase of stiffness, during which the pain will gradually resolve. After that, the shoulder will recover and become more mobile over the course of a year or two.

Frozen shoulder typically occurs after injury to the joint, such as a tear to the rotator cuff, a group of muscles and tendons surrounding the shoulder joint.

It can also occur after major surgery such as heart surgery, or a stroke; it's also more common in those with diabetes or thyroid disorders, though there are no clear-cut reasons why.

As to whether the vaccination might be linked, there have been one or two cases reported in medical literature of what they call 'shoulder injury related to vaccine administration' (SIRVA).

Frozen shoulder typically occurs after injury

Frozen shoulder typically occurs after injury

There are suggestions it might be down to an inflammatory effect, perhaps caused by placing the injection too deep, but this is far from proven.

The point now is how to resolve the problem. For your husband's doctor, or orthopaedic specialist, if he is referred to one, diagnosis of frozen shoulder will be based upon his symptoms and a physical examination.

X-rays, MRI or ultrasound scans only serve to exclude other causes, such as a torn rotator cuff, which would explain why your husband's X-rays were clear.

However, as a diagnostic test, some specialists inject the joint with local anaesthetic - in the case of frozen shoulder the patient's mobility will show no improvement, whereas in other shoulder problems, such as a form of tendonitis, it will usually improve instantly, albeit briefly.

There are no standard treatments for frozen shoulder. However, some specialists recommend an injection of corticosteroid directly into the shoulder joint, to help relieve pain and improve movement - this may be most effective when given early in the condition. There is also a technique called hydrodilation, which involves injecting the joint with a mixture of steroids and cold salt water, helping to stretch the tissue of the capsule so the joint is easier to move and recovery can begin.

However, the first step for your husband must be an accurate diagnosis. Might he perhaps be referred to an orthopaedic specialist or a rheumatologist for a diagnostic opinion?

Once improvement is under way then strength building exercises, initially taught by a physiotherapist, can hasten his return to normal shoulder function.

I'm a healthy 73-year-old woman but seem to have inherited my father's condition of a leaking bowel, which I've had for 15 years. It's embarrassing and I have to wear underwear protection, especially shortly after a bowel movement. Very often I don't notice the leak happening. I've tried altering my diet. I gave up milk for a while, stopped eating fruit, put bran on my food for added fibre and taken probiotics. I've even taken a daily loperamide capsule to slow down my bowel. I haven't seen my GP as I thought I could sort it out myself. Can you advise?

Name and address withheld.

You have my sympathy. This symptom must be having a significant impact on your life, and you have tolerated it for too long, with a valiant self-imposed struggle for the past 15 years.

The diagnosis is faecal incontinence. There are two forms - those with urge incontinence experience a need to empty the bowel but, despite their best efforts, cannot reach the loo in time.

Those with the second type, passive incontinence, don't feel any sensation before the leak occurs. You fall into the second category.

The important question is: what is the cause?

When things are working properly, as the rectum (the last part of the large intestine, before the anal canal and anus) progressively fills, it causes an involuntary reflex opening of the ring of muscular tissue that sits about 6mm from the anus (the internal anal sphincter). But while the urge to defecate is increasing, the external sphincter maintains continence until the moment is right.

Maintaining control depends upon the interplay of a number of factors: psychology, the state of the anal sphincter (two rings of muscle which help keep the anus closed), sensation in the anus and rectum, and reflexes in the pelvis.

The volume and consistency of bowel contents are also important. Loss of continence may be due to abnormality of any of these factors - for example, anal sphincter weakness caused by nerve problems because of diabetes or injury to the spinal cord, or it may be due to trauma, such as damage from childbirth. Disorders such as multiple sclerosis or even dementia can impair rectal sensation.

My advice is that you do discuss this with your GP and seek referral to an expert for a full evaluation. This might then involve testing to detect abnormalities of the anal sphincters and the rectum, which all falls within the highly specialised province of a proctologist.

What is also unexplained is whether there is any link between your father's condition and your own. I am unable to think of an obvious one, and I see no relationship between faecal incontinence and the other health problems you've had, as set out in your longer letter: gallbladder removal, hernia repair, medication to lower cholesterol, or your underactive thyroid, now corrected by thyroxine supplements.

In summary, the time has come to seek expert help.

By the way ... It's time to clear the air in your home

The problem with air pollution is that unless it's really bad, we can't see it - and as a result, many remain oblivious to its pernicious effects. But we do so at our peril.

The problem with air pollution is that unless it's really bad, we can't see it. Many remain oblivious to its  effects

The problem with air pollution is that unless it's really bad, we can't see it. Many remain oblivious to its effects

In February the Royal College of Physicians published a report attributing 40,000 deaths a year to air pollution, citing a wide range of related causes: cancer, asthma, stroke, heart disease, diabetes, obesity, and dementia.

The damage appears to start early - even before birth, with pollution affecting the development of the brain - and early childhood is a time of particular vulnerability.

Previously, the main issue contributing to air pollution was the burning of coal - a problem subsequently banished by the Clean Air Act - and then more recently, the use of lead as an additive in petrol. Lead tetraethyl, an engine anti-knocking agent, is now also banned. These days the concern is the health-damaging effects of nitrogen oxides and particulates, tiny particles produced by vehicles burning diesel fuel.

WRITE TO DR SCURR

To contact Dr Scurr with a health query, write to him at Good Health Daily Mail, 2 Derry Street, London W8 5TT or email drmartin@dailymail.co.uk - including contact details.

Dr Scurr cannot enter into personal correspondence. His replies cannot apply to individual cases and should be taken in a general context. Always consult your own GP with any health worries. 

There is little doubt the problem is often worse in cities. Last month the think tank Policy Exchange suggested that millions of Londoners could live at least a month longer with the introduction of a series of anti-air pollution measures.

But we can also help ourselves avoid air pollution in our own homes. Nitrogen dioxide, one of these oxides, is also given off by gas boilers and cooking appliances; so it's also the home we need to think about.

Other sources of air pollution in the home include common items such as air fresheners, deodorants and cleaning products (these are sources of volatile compounds which evaporate into the air) and even furnishings, some of which are made with glues and resins that give off formaldehyde fumes.

Ensuring that there is adequate ventilation to reduce the build-up of chemical residues is vital, along with using eco-friendly cleaning materials which contain fewer pollutants.

Although it has to be said that, indoors, tobacco smoke is still the most serious cause of health damage.

With fears that the government is dragging its feet on air pollution (environmental lawyers have criticised its plans to cut pollutants as falling 'woefully short' of what's needed) we can't wait for officialdom to take action.

When it comes to cleaning up the air in your home, for some practical advice and tips I would recommend visiting the website myhealthyhome.com.

Don't wait for someone else to help you.

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