degenerative arthritis 退化性關節炎

I am sorry to hear that you have such a problem. I have knee pain and it was diagnosed as Patellofemoral pain syndrome. The orthopedist whom I consulted warned me that it may cause degenerative arthritis finally. Luckily, X-ray shows no irregularity but I have not been checked by MRI which is a most effective way to diagnose the damage of cartilage and ligament. I have been taking Glucosamine sulphate powder for almost half year and my situation has got some improvement. As I know, Glucosamine must be taken continuously for at least 3 months until it shows effect on the pain.

Thanks for chengcc209's comments. In your situation, how did the orthopedist suggest you? Frankly, I am just afraid the diagnosis was wrong because I have not got any pain on my left shoulder for the past 20 years (after I hurt it some 20 years ago). I found that my left shoulder could not move properly when I woke up one day in mid December. At that time, I just guessed I needed several days for recovery. But, the situation continued until early January, and I then consulted a GP. I just feel the situation has not improved but has got worse. I am thinking of consulting a physiotherapist or orthopedist. Which one will be more helpful to me? I appreciate any comments from runners. I am really worrying that one day I could not run anymore before the age of 50.

I suggest you are better to have it checked by an orthopedist. My mother broke her arm bone but a doctor gave totally wrong comments. It caused a serious delay of treatment and her arm still couldn't move around as usual. If physiotherapist is needed, the orthopedist will recommend for you. Don't worry about so much. I also had a number of serious injury before but all recovered finally by continuous exercises. A doctor told me that I couldn't run any more due to the injury of my left leg when I was 18. However, I can still complete 100KM race after 32 years later.

Some comments on your L shoulder pain: Is the onset of the pain comes suddenly or gradually? Sudden onset of pain points towards some acute injury (may be to the soft tissue like the tendon, ligament or capsule); gradually onset indicates more subtle development of the pathology like in Frozen shoulder (the pain comes gradually and becomes more severe in one week and then followed by the onset of shoulder stiffness) Is it triggered by some sort of injury like a fall, sprain, or undue exertions (for example during gymn exercise or weight training)? Any pain at rest? You have some limitations of L shoulder movement especially the internal rotation (put you L hand behind your lower back) and abduction (lift your L arm sideway up) & forward flexion (lift your L arm up to the front). Pain and stiffness of the shoulder joint may suggest the common diagnosis like frozen shoulder (adhesive tenditis 肩週炎), or acute tendinitis (急性肌腱炎) acute calcific tendinitis. But it is more proper to consult an Orthopaedic surgeon for detail medical history & physical examination to exclude other differential diagnosis like pain arc syndrome, impingement syndrome. You gave the medical history of having injured your L shoulder in teenage. Was it a fracture or dislocation? If not, post-traumatic degenerative changes is rather unlikely. I'm not sure the degenerative changes is genuine. If the diagnosis is frozen shoulder, the mainstay treatment is pain control + anti-inflammatory medication (Voltaren is an non-steroidal anti-inflammatory drug and is appropiate for treating frozen shoulder) and physiotherapy (pain control + mobilization exercise + IFT/US & local heat therapy) is important to prevent or minimze residual joint stiffness. James Lui

Hi Madrunner and James Lui Many thanks for your comments, especially the detail explanation from James Lui. First, I don't know what was the problem with my left shoulder when I was young. Similar to this time, I woke up one day (when I was about 18) and found my left shoulder moved with pain. I guessed it was dislocation and went to see a 鐵打醫師. It was even hurt more by the 醫師. Then, I went to see a GP who said it was inflammatory and gave me some medicine. After recovery, my left shoulder did not have any pain until this time. However, when I did some motions (such as turning my hand to the back to touch the other hand), the left shoulder looks very slightly different from the right shoulder, but no pain. Actually, my left shoulder does not have any pain at rest. Just when I do the following motions as described by James Lui: "You have some limitations of L shoulder movement especially the internal rotation (put you L hand behind your lower back) and abduction (lift your L arm sideway up) & forward flexion (lift your L arm up to the front)", my left shoulder will be painful and looks like deformed as compared to the right shoulder, especially the abduction. Also, I could not lift my left arm up straight point to the sky. My X-ray report was written in English as follows: No calcification at the supraspinatus insertion. Degenerative changes are present in the acromioclavicular and the glenohumeral joint with joint space narrowing. Tonight, after running training, my left shoulder was extremely painful when I moved my left hand sideway to try to pick up a glass of water. 掛住用右手抺汗,下意識用左手拿杯,咁就痛到飛起,標晒眼水,現在還有小小痛. I will consult an Orthopaedic Surgeon. Before I do this, I would still like to listen to any comments if I miss any important points or what I should (or should not) do to protect my left shoulder. For example, can I eat the Voltaran together with the Glucosamine&Chondroitin together? Should I do pushup if I can do it with a very slight pain? Thank you so much.

Your condition sounds very much like frozen shoulder or acute tendinitis esp the supraspinatus tendon (that calcification may not be evident in one set of X-ray, but may be present at the heaing phase). For the so-called injury at your teenage (you are still very young just 43), it seems to be some trivial condition without long lasting symptoms. Glucosamine & Chrondoitin are "health" food instead of medications. For glucosamine, it is recommended to take continuously for one month and see if you feel better. But, in most case of acute tendinitis, if you manage it properly, the symptoms will subside with 2 to 4 weeks without glucosamine. The therapeutic effects of Glucosamine & Chrondoitin are not well established yet. To my understanding, they don't have serious side effect (EXCEPT drug allergy). Therefore, you are rather safe to take it together with Voltaren. The only concerns are the cost & your expectation. I still wonder if the "degenerative changes" are genuine. The joint line od gleno-humeral joint is oblique to the projection of the XR and it may appear overlapped and sometimes mis-interpreted as decreased joint space. If you don't mind to perform a MRI scan (about ?$3.5K to $4K without contrast), it will be very informative about the pathology of your shoulder though the indication for such investigation is not very strong at the moment (but the understanding of your shoulder pathology may relieve your anxiety & worries). You SHOULD NOT perform any strenuous exercise like push-up that will aggravate the condition and make the condition complicated before complete recovery. Afterwards, you may resume the execise involving your shoulder girdle gradually (only gradually) to prevent relapse of the condition. BUT you should always practise mobilization exercise and gentle stretching exercise (within your tolerable limit) to keep your shoulder joint supple & to minimize the residual joint stiffness. James Lui

Many thanks for James Lui's advice. Your information is very useful to me. I will consider to have an MRI scan as I am very concerned about my situation. Thank you for saying that I am still "very young". I think all those who are 40s are very happy to hear this. I guess I know who you are. It is a pity that I am overseas for a contract (about one year) and could not contact you for further advice. However, when I come back to Hong Kong, I will contact you. Thank you so much again for your invaluable advice.

This is just my personal experience, which may or may not be useful to you. I had pain on my left shoulder joint about one year ago. It wasn't that bad as your case sounds. But I couldn't raise my arm above the level of the shoulder, and couldn't post my arm in certain angle. A Chinese doctor said it was 肩週炎 and he gave me acutepuncture plus some excercise treatment with my arm. The pain then went away and seems 100% recovered.

Thanks for wellgp's message. I also hope it is 肩週炎 or even less serious problem. My understanding is that 肩週炎 can be totally recovered. I will have a thorough check later. Thanks again for all those who have commented on my problem. 真是無言感激！