Ask the Doctors October 2007 Issue

Ask The Doctor: 10/07

I have arthritis in my shoulders and have been told by my doctor that I need a total shoulder replacement. Are there any non-surgical options I can pursue? I’m taking Fosamax (once a week) and glucosamine/chondroitin. I have no cartilage in my shoulders—just bone on bone—and it’s very painful.

If your arthritis has progressed to the point that cartilage damage is so extensive, non-surgical treatments are unlikely to be successful. If you have tried the usual non-surgical treatments—rest, physical therapy, icing, and anti-inflammatory medications—without relief, total shoulder replacement may be your best option. The procedure is very effective, and most patients regain full use of their shoulders, with normal strength within a few months. There are several types of shoulder replacement procedures. Usually, the arthritic joint surfaces are replaced with a metal ball, attached to a stem, and a plastic socket. Depending on the severity of arthritis in each of the joint surfaces, only the humeral component (ball) may be used. Your orthopaedist can determine which type of shoulder replacement is most appropriate for you.

 

I would like to try the herbal extract Zyflamend, which claims to have anti-inflammatory effects. Is it safe to take with the prescription drugs I take (Celebrex, Flovent, Albuterol, Hyzaar, Levoxyl)? Local doctors won’t say yes or no when it comes to natural products, and naturopathic doctors won’t say anything if you’re using conventional medications.

 

Herb-drug interactions have been identified with respect to a handful of herbs and vitamins. However, because of the variety of herbal preparation ingredients and methods, for the vast majority of these products this information remains unknown. While herbal medicine has had a long history of safe use, its history has not included many of the modern pharmaceutical medications that are used today. One of the biggest dangers with herbal preparations is substituting them for proven medications. You don’t say why you need an anti-inflammatory medication, but even its makers note that Zyflamend is not a drug that is intended as an alternative to prescription anti-inflammatories. With the multitude of prescription drugs you already use, I would suggest that you talk with your doctor about the appropriate treatment of any inflammatory condition you may have.

 

I have neck pain that I’m told is caused by arthritis. Can non-surgical spinal decompression with cold-laser therapy help relieve my pain? 

Spinal manipulation to "decompress" the spine, followed by application of low-energy lasers, has become a widely promoted treatment for all kinds of neck pain. However, cervical spine manipulation can be dangerous, since excessive rotation of the head and upper cervical spine places a strain on the vertebral arteries and can result in vascular injury or stroke. Although so-called "flexion-distraction" techniques reportedly avoid this risk because the spine is not rotated, there is little scientific evidence to support their effectiveness and safety. Cold-laser therapy has been promoted as an effective way to accelerate healing of a variety of conditions, from relieving joint and muscle pain to stimulating hair growth and smoking cessation. Despite the proliferation of practitioners offering cold-laser therapy, there is little scientific evidence to support their claims. Talk with your orthopaedist about proven therapies for cervical spine arthritis, such as anti-inflammatory medications, physical therapy, or the temporary use of a soft neck brace until symptoms subside.