So Tim, the reason your shoulder hurts is because your shoulder is fucked

Regular readers will know that I was complaining a few weeks back about my shoulder hurting. Given that my social circle includes a doctor this led to a series of tests.

Left arm/shoulder pain in a 50 year old boozer and smoker is sometimes  sign of something more than just left shoulder pain.

So, of course, I could still keel over tomorrow. But the ECG says that bit’s fine, the blood tests say the liver, kidneys, that whatever that deals with insulin, they’re all fine. Blood pressure is a bit high but we’ll pill and diet and exercise to see what.

And then there’s the x-ray of the lungs. Which comes back and says that, actually, since we did your shoulder as well, we can tell you why your shoulder hurts.

It’s fucked.

Sporting injuries, those dislocations while playing rugby, have caught up with you. Nowt very much to do about it, certainly not until it all becomes a great deal worse.

What’s that? You swam 2 km this arvo and it’s twingeing? Well, yes, it will, for the rest of your life, get used to it.

I did, of course, shake the Doctor’s hand and thank him very much for telling me that I am, mildly, crippled. For I am English.

Well, that and the information that it is a joint problem, not a cancer or a heart beating its last.

Best bit?

Given that I know the Doctor socially he hunted through the three pubs I’m likely to use of an evening to give me the news.

God Bless the medical system* of the Czech Republic.

 

*For which I paid, full price, no complaints, bloomin’marvellous. GP reference to X-Ray was 3 days, given the Sat and Sun in between. X-Ray to completed diagnosis delivered to me another 3 days. That includes the hunting through the pubs to find me.

Perhaps charging for things is the way medical systems ought to work?

51 thoughts on “So Tim, the reason your shoulder hurts is because your shoulder is fucked”

  1. “Blood pressure is a bit high”: that’s the medical equivalent of “Good morning”. Beware. From Richard Lehman’s blog at the BMJ:

    Ann Intern Med 20 Aug 2013 Vol 159
    233 Following Ray Moynihan et al’s measured argument in the BMJ against labelling 11% of adults as having “chronic kidney disease,” there have been lots of responses from single interest people to the effect that this is so that we can target them for special preventive treatment, including tighter control of blood pressure. This study of US Veterans with CKD introduces some observational evidence into the debate. Lowering diastolic BP in these people below 70 is associated with higher mortality, irrespective of the systolic pressure. The best outcomes were seen with diastolics between 70 and 89, and systolics between 130 and 159 Hg. Note that last figure. Male “patients with CKD”—mostly healthy asymptomatic people—are quite OK to run a systolic BP up to 159, and not OK to run a diastolic below 70. These figures bear no relation to any targets set by tunnel-vision committees of specialists and CKD “champions,” and apply equally to those with albuminuria and those without.

  2. Why shouldn’t you thank the Dr ?. If nutting him would cure your shoulder it might be worth thinking about but it won’t and it isn’t his fault you played daft games back when they seemed like a good idea.

  3. Bloke in Costa Rica

    Both my rotator cuffs are buggered beyond (realistic) repair. It’s very sore at times and feeds into moderate-to-severe back pain. Almost certainly a result of rugby at school. Not much to be done about it; not much point feeling sorry for myself. Had I known I would have steered clear of team games even more assiduously than I did. It is quite surprising how so many of these things really started catching up with me when I turned 40, though.

  4. I only ever played one game of rugby at school (or indeed, anywhere). It was by surprise; the teacher simply said, let’s play rugby for a change. So we did. At least, everyone else did. I had no idea of the rules in even the vaguest way, so I idled around the pitch saying hullo clouds hullo sky. Every now and again the teacher, or somebody else, bellowed an incomprensible instruction at me, to which I replied with e peaceful smile, before continuing my perambulations, taking particular care to avoid the packs of red faced boys surging to and fro.

    I can honestly say that I have never for a single second felt the urge to play, or to watch, sports of any kind. I am entirely baffled by their popularity.

    All of my joints are working admirably at the age of 48.

  5. Tis a badge of honour. If you get towards 50 and no joint hurts now and again you probably haven’t been trying. Or you are some sort of athletic God.

  6. I’m a 33 year old smoker of 20 years and drinker of 17 years. When I was 22 I thought I’d take up cricket again. I hadn’t played since I took up smoking and drinking.

    It was great fun. We had a professional coach at uni, who taught me how to bowl some nasty late outswingers that could get good players out. One week he handed us all a thick documents detailing some kind of gruelling exercise regime. I chucked it in the bin and carried on getting ratted every night, smoking 20 a day, then bowling as fast as I could once a week.

    By the age of 29 my shoulder was completely and utterly **cked. The NHS just told me to stop playing.

  7. And don’t forget that you fell off that blimmin bike of yours.
    Incidentally, if the shoulder thing is Fibrositis, could be related to hypothyroisism.

  8. eventually you may well find shoulder replacement an interesting experience.
    A relative age 73 has had it done after being on a waiting list for two years (lots of pain but this is Australia) and actually survived ( just).

  9. Left shoulder fucked due to torn rotator cuff playing baseball senior year of high school. That’s 38 years ago. Pain would have been worth it if I’d actually been a half decent pitcher.

    Anyway, let me suggest multiple sessions of acupuncture… especially when the needles are hooked up to deliver mild electrical pulses. Took five sessions and I’ve been pain free for nearly a year.

    Helps with chronic back pain, too.

  10. Is there actually a team sport which is “good for you”?

    They all seem to combine getting a bit of exercise with being on the receiving end of a bit of brutality, and with the risk of some pretty nasty injuries even in the non-contact sports.

    While my school did force us to play rugby, I reduced the ruleset to:
    1. Attempt to stay three-dimensional.
    2. If anyone gives you the ball, give it to somebody else immediately.

    With those modifications I found it survivable albeit unpalatable.

    I have an appalling level of physical fitness, partly due to disability, and often ponder whether, had I picked up a sport as a youngster, I’d be in better shape now. Or more likely, carrying war wounds. The only sport I can think of that claims a low injury rate by design is tchoukball, but even that looks like it has the potential to land you with a strain or a ball in your face.

  11. “The only sport I can think of that claims a low injury rate by design is tchoukball, but even that looks like it has the potential to land you with a strain or a ball in your face.”

    Curling?

    Although it looks more like housekeeping than a sport to me.

  12. My father played rugby league (this was the North) at school. Once. He told me the first time he got the ball, he ran down the wing, saw the oncoming horde and passed the ball to the nearest spectator.

  13. “I can honestly say that I have never for a single second felt the urge to play, or to watch, sports of any kind…”

    “All of my joints are working admirably at the age of 48.”

    I’ve got a very old harmonica that’s in perfect working order because I never use it. Then again, I never get any enjoyment out of it, either.

  14. Gazing across that unbridgeable gulf…
    ———————————————-

    “I can honestly say that I have never for a single second felt the urge to play, or to watch, sports of any kind…”

    “I’ve got a very old harmonica that’s in perfect working order because I never use it. Then again, I never get any enjoyment out of it, either.”

    ———————————————

    …knowing there really are things in life are enjoyable, apart from sport, but accepting sports enthusiasts are never, ever going to see that

  15. Shoulder – cricket – chronic calcific tendinitis

    Ankle – basketball – ligaments so stretched they barely hold joint together

    Achilles – football – rupture stubbornly refuses to fully repair

    Had 30 great years of sport but now in my mid-40s and stuck in my armchair going slowly bonkers from the lack of exercise and compeitition.

  16. When the times comes to return my constituent parts to storage, I’d prefer they were very well used indeed. The good thing about being in the front 5 is you can go on into your 60s. The damage is more than compensated for by the fact of still being able to wear clothes you had aged 18.

  17. At 130lbs my only defence was speed. I was good over 60yds and learnt to live with the occasional concussion. Forty-five years later I remain 133lbs but alas the speed has gone.

  18. ‘Is there actually a team sport which is “good for you”?’

    Depends what you mean by good for you. Running around is good for your CV fitness, blood pressure.

    A life of inactivity leads to low bone density (I wonder how Ian B and others will be in 10 years’ time) and heart disease.

    But obviously you don’t dislocate your shoulder watching the telly.

    To me the main benefit of team sport is that you’re part of a team, with all that brings.

    I’m just back from a trip to the Grand Massif where I had more fun with my mates than I could have doing almost anything else.

  19. Don’t know if this will help, but both my shoulders have partial rotator cuff tears. Get to the gym and ask somebody who knows for exercises to strengthen Deltoids, Serratus posterior and minor / major rhomboids. Doesn’t fix anything, but keeping this combination of muscles groups strong helps to pull the shoulder joint back into the position it should be (Tears tend to be painful simply because we allow the shoulder to move forward over the years to compensate, which throws the back muscles out of whack).

    Oh, and pushing the whole shoulder back with the aid of a doorframe or similar also helps.

  20. “A life of inactivity leads to low bone density (I wonder how Ian B and others will be in 10 years’ time) and heart disease.”

    Depends on what you regard as inactivity. Continual smoking & regular heavy drinking do take considerable effort, you know. There’s the trips to the tobacconists & the exhausting regimen of night clubs into the not-so-small hours, for a start. Nevertheless, last unnecessary confrontation with the medical fraternity had this mid 60s layabout clocking figures more appropriate for a mid 40s. Trouble with sports is, they take functions of the body it’s capable of performing without undue detriment, then test them to destruction in a competitive environment. OK if it involves teenage nymphomaniacs, but otherwise best avoided.

  21. ” Depends what you mean by good for you. Running around is good for your CV fitness, blood pressure.”

    I don’t dispute the benefits of exercise. Just curious (colour me skeptical) about the efficacy of sport as a means of imbibing said exercise. Particularly team sport, but it doesn’t look like being eg a semi-serious tennis player is low injury risk either.

    In many ways sports seem to push the body to/beyond the limits, and as BIS says doing that in a competitive environment means safe limits are more likely to be breached. Did the ancient hunters have to make so many sudden changes in direction, with attendant risk of sprains or falls? Is there any exercise benefit from actions such as slides, dives or collisions that counterbenefits their associated risks? Or is there a sport in which physical elements posing injury risk have been designed out, while those providing health benefits are left in?

    Perhaps I’m just noncompetitive, but in terms of physical advantages only I can’t see why sport should be preferred to gym or swimming pool or just going for a run. Actively avoided seems more sensible. I’m not knocking the camaraderie, opportunities for travel, adrenaline, or anecdotage supply it provides. Even the enjoyment, though I don’t grok it myself. Just whether being sporty is “good for you”.

  22. ” I’m not knocking the camaraderie, opportunities for travel, adrenaline, or anecdotage supply it provides.”

    I am. Sharing bar space with the boring assoles rivals root canal work.

  23. @MBE

    I suppose it depends on a number of factors. I don’t think you can say anything ‘is good for you’ without further enquiry.

    What level of sport? Village cricket probably doesn’t do that much for your CV output, but is excellent socially. Premiership Rugby will (or may well) leave you with serious long-lasting damage to your shoulders, neck, back, knees, but you will be aerobically very fit. I know a number of former pro rugby players, now in their 40s; they remain fit, because habits of half a lifetime, and wouldn’t swap a thing, despite having little knee cartilage to speak of.

    I was just saying (in response to the specific question ‘‘Is there actually a team sport which is “good for you”?’) there are benefits to sport for some people (those who enjoy them) that probably outweigh the potential harm; likewise there may well be benefits to smoking and drinking that outweight the harm. It’s all up to the individual, really.

  24. ‘I am. Sharing bar space with the boring assoles rivals root canal work.’

    All people who play team sport are boring ‘assoles’?

    Were you bullied at school by the bigger boys?

  25. “All people who play team sport are boring ‘assoles’?
    Invariably.
    You forget. I share bar space with Premier League footballers. The pinnacle of assoledom.

    “Were you bullied at school by the bigger boys?

    Rarely. One of the benefits of early bar training is the knowledge, they’re all about the same height lying down nursing painful & unexpected surprises. Both of them if you judge the angle right. Fair fight? What’s that? One thing fighting should not be. Competitive..

  26. @ Interested

    Clearly everyone’s mileage may vary. I was interested that a study into the benefits of Boris Bikes suggested that older men, who tended to be less fit, got a health advantage from the exercise that outweighed the risk of being mangled by a lorry. But for young men who were reasonably fit to start with, the benefits were less clear. http://m.bbc.co.uk/news/health-26171326

    But what gets me about competitive sports is that so many of the downsides seem so avoidable. Essential to gameplay as we know it in many of our favourite sporting codes, but not obvious why they should be fundamental to sport per se. Standing in front of a hard fast ball is a good way to get hurt (but so is trying to bowl or pitch or catch it). Colliding into people is a good way to get hurt. Sliding across the ground is a good way to get hurt. The list goes on, but none of those elements seem essential either to aerobic fitness or personal enjoyment. Is it beyond the wit of man to design a game with better risk-reward payoff?

  27. @BIS

    ‘You forget. I share bar space with Premier League footballers. The pinnacle of assoledom.’

    I didn’t forget it because I didn’t know it, but I can understand why that would be a pain. Some sportsmen are dickheads just as some non-sportsmen are dickheads, I guess.

    I agree with you re fighting. However, you generally only get to cheap shot someone once and school takes many years. So it can’t purely have been that you were dirty.

  28. @MBE That is an interesting study, though I suppose fairly trivial.

    Re standing in front of the hard ball (team), or schussing down a steep run (solitary) – for those who are interested in doing so that’s a substantial part of the whole point! Challenging yourself. The risk is the reward.

    The fitness is in many cases I think a by-product (though you’re more likely to get injured if you try some of these things and you’re not fit.)

    I’m not claiming to be a sports guru or particular adrenaline junkie, by the way. I’ve just been to the Grand Massif with some mates including a chap who recently won the MC for strolling into machine gun fire in Afghanistan, and spends his days parachuting into the sea and passing P Company and the All Arms Commando Course in his sleep. I think he’s mad.

  29. The clue’s in the tag. One of the location’s few disadvantages.

    “So it can’t purely have been that you were dirty.”

    It’s not a point on a scale. It’s a scale. Once introduced to a point on that scale, few wish to explore the endpoint.

    There is also an important point to this. Bullying is ritualised violence. Not much different to sport. Perhaps that’s why the bigger boys are so often both bullies & sportsmen. Winning for its own sake. Like sport it has rules. . Why should the intended loser play by the rules of the intended victor?

  30. @Interested

    ” The risk is the reward.”

    Or “risk je zisk” as the Slovaks say (“risk is gain” but I think the sense is “nothing ventured nothing gained”). Wonder if the Czechs have an equivalent aphorism. At least that makes more sense to me than that classic sports-freak wisdom, “no pain no gain”. For me, a suitable gain would be the avoidance of pain.

    Is there a reason that people can’t just challenge themselves doing something vaguely sensible? Some sports have a brutal element of ritualized violence, but not all, so that can’t be the only explanation.

    Indisputably our common pastimes have Victorian – or earlier – basic rulesets that could not pay heed to modern medical knowledge, nor had a core design objective of improving the health of participants (a “purpose” which public health bods instead seem to have rather thrust upon sports, and which administrators sensing funding streams have been happy to promote). Yet along with the message that “active is healthy”, we have acclimatized to the notion of sports providing dangers that we would not accept in many other aspects of life – if they invented American Football today, I’m sure many of its features would have to be changed radically.

    Would a “safe by design” sport necessarily be as bland and joyless as decaffeinated coffee? Other than tchoukball (and I’d love to know how free of injury that is in practice), are there any?

  31. Well, not every bar in Spain is overrun with Premiership Footballers, so the clue’s not really in the tag.

    But anyway.

    ‘Once introduced to a point on that scale, few wish to explore the endpoint.’

    Tee hee. Fucking hell! Either you were in Spetsnaz, or you are a bad scriptwriter of Dolph Lundgren/Stephen Seagal films.

  32. @MBE Is there a reason that people can’t just challenge themselves doing something vaguely sensible?’

    No, obviously there’s no reason this can’t hapen – it does all the time. Chess, jigsaws, poker, whatever.

    Equally, there’s no reason people who like a physical challenge shouldn’t take it on, I guess.

    ‘if they invented American Football today, I’m sure many of its features would have to be changed radically.’

    This is happening anyway, in lots of sports.

    ‘Would a “safe by design” sport necessarily be as bland and joyless as decaffeinated coffee?’

    For me, yes. To be interesting sport must involve physical danger (though that is only a necessary element, not a sufficient one – I like rugby union, martial arts, skiing, cricket, but I don’t like rugby league (much), AFL, association football or motor racing).

    But that doesn’t mean there aren’t other pastimes which are not interesting and safe – I like playing chess, for instance.

  33. “Tee hee. Fucking hell! Either you were in Spetsnaz, or you are a bad scriptwriter of Dolph Lundgren/Stephen Seagal films.”

    Not in the slightest. But most people do the bullying thing presume (for some unaccountable reason) there are limits to violence. So much inflicted damage is permissible. Victorhood should be visible & acclaimed. If you don’t subscribe to any of that, there are certain advantages.
    Something I’ve observed in life. If you want to pick on someone, go for the big guy. Worst way, you’ll collect a few bruises. The little runt might just screw a broken glass into your face. He’s nothing to lose.

  34. I damaged my rotator cuff fixing a light in the kitchen ceiling…
    So it does not have to be a rite of passage for middle-aged sportsmen. Also, while danger, usually extremely attenuated, exists for almost all sports, most participants enjoy taking part while not many enjoy housework which causes more deaths and injuries.

  35. TW extols the health service provided in an ex Communist country . I assume it provided value for money. My only recent experience of the private sector was with the cat who had got into a fight= £120 for antibiotics and a check-up a week later. Lovely middle-class vets in the best part of town. Dread to think what they would charge for treating people.

  36. @Interested
    So you might understand this:
    The motivations are different.
    “To me the main benefit of team sport is that you’re part of a team, with all that brings.”
    “To be interesting sport must involve physical danger”
    “Challenging yourself. The risk is the reward.”

    And some people just want to be left alone.

  37. ‘Something I’ve observed in life. If you want to pick on someone, go for the big guy. Worst way, you’ll collect a few bruises. The little runt might just screw a broken glass into your face. He’s nothing to lose.’

    Yeh, right. Big blokes can’t fight, and other cliches.

    No, the ‘worst way’ if you pick on a big bloke who knows what he’s about is he’ll take your head off and mash you into the ground, whereas the little guy (maybe) gets one go (if you’re careless) and then it’s curtains for him. Look at the one punch KO stats for heavyweights vs featherweights.

    And some people just want to be left alone.’

    Highly uncontroversial. As I said at 1.16pm, ‘It’s all up to the individual, really.’

  38. ‘TW extols the health service provided in an ex Communist country . I assume it provided value for money. My only recent experience of the private sector was with the cat who had got into a fight= £120 for antibiotics and a check-up a week later. Lovely middle-class vets in the best part of town. Dread to think what they would charge for treating people.’

    Whereas, in Venezuela, the Peoples’ Veterinary Corps, er, provides free care for your old moggie?

    What, exactly, is your point? Vets overcharge? Says you? Based on what?

  39. I suspect older social players of chess or bridge get substantial health benefits in terms of keeping the brain ticking over.

    And clearly people can derive sensations of challenge, satisfaction and pleasure, from “safe” pastimes.

    Which to my mind makes it more puzzling why we don’t have “safe” (everything being relative) competitive sports which provide physical stimulation and associated health benefits, comparable to the aforementioned mentally stimulating competitive pastimes. Or to noncompetitive but health/fitness oriented physical activities, in which risk control has a higher priority.

    Is there a fundamental incompatibility, perhaps physical competitiveness makes people push safe boubdaries? Or risk is somehow intrinsic to the “point” of the exercise? Or is it not inevitable, just the result of path dependency which leaves us playing mostly traditional (and in health respects, poorly designed) sports?

  40. Interested. You really do sound like an accident waiting to happen.

    “Yeh, right. Big blokes can’t fight, and other cliches…..Look at the one punch KO stats for heavyweights vs featherweights.”

    Have you ever seen a real fight?

  41. @ MBE
    “Which to my mind makes it more puzzling why we don’t have “safe” (everything being relative) competitive sports”
    We do – it’s called Netball.
    When I was young it was a compulsory sport for girls just as soccer was for boys in most schools. A few grown-up women play Netball, millions of adults of both sexes (mostly but not entirely men) play soccer.
    Simple answer is that soccer is more fun.

  42. Bloke in Central Illinois

    Cross Country skiing is much safer than downhill skiing, and much less popular. Draw your own conclusions.

  43. Reed:
    Vets make good living but if that was all their prices would be much lower. High prices come courtesy of the state.
    * The high cost of becoming a vet–govt controlled–and the reduction of competition caused by govt licensing of vets.
    *Business costs –taxes, rates, local council thieves.
    *Inflation–govt thieving part 2
    *Having to buy drugs at high prices–why?–because the govt fuckwits pay vast prices without a thought–not their money–driving up prices–and helping their corporate socialist buddies in Big Pharma.

    The list goes on and on.
    Try thinking instead of spewing the usual sanctimonious socialist shite.

  44. @Mr Ecks
    With respect, small animal vets in urban locations can be a complete rip-off. I kept 3 dogs for years & copped vet bills’d make your eyes water. I can have a pretty good guess at the antibiotic DBC’s moggie will have been prescribed & the vet’ll be likely making a 10x mark-up on it.* In London, the dogs used the Royal Veterinary College’s clinic in Camden Town. For what he’s describing – which is probably a check for damage & wound cleansing, prophylactic antibi & follow up exam – bill would have likely been half that £120.
    It’s no different in France. There’s a vet near the Lille apartment. But the French dog (bi-lingual border collie) uses a farm orientated practice, one of the smaller towns. About third the price. It’s the farmers. You can’t tell a farmer it’s 3€ a shot per head of livestock but the farmdog’s are a 100€. They’d get very agricultural on you.

    *The last Britdog was on 6 different meds for a heart complaint. I was getting the drugs from an online veterinary pharmacist & running bills at £30 p/w for much of a year. Really got familiar with those catalog prices. Mostly, a small fraction of what a vet would bill

  45. @john77

    Even netball isn’t terribly “safe”, lots of sudden sprints and changes of direction. Good chance of spraining yourself, or doing some more serious harm by slipping or tripping, or through accidental collision with another player.

    Jumping can give you patellar tendonitis… or you can fail to land properly. A netball might not be very hard, but trying to receive it at pace can result in a fractured finger. All that throwing can mangle your rotator cuffs.

    Of course, compared to rugby it’s a vast improvement, but it seems a lot worse than going for a swim in the local pool. The need to pivot, jump, or make sudden changes in directions comes at a price, as does use of hands to catch and throw the ball. I strongly suspect that in terms of netting out health benefits versus injury risks, it comes out in positive territory. But it clearly wouldn’t be impossible to design a safer sport.

  46. @DBC
    I can only say shop around for an affordable vet before you need an affordable vet. You may need two vets. The cheap one for basic treatments & a clinic, with good surgical facilities, for the hopefully never needed stuff.
    And don’t be reluctant to get a second opinion if time’s not of the essence. I was told a dog needed surgery for a prostrate problem. The second told me operating in the region of a dog’s prostrate involves unzipping & tipping most of the dog out on the table to get at it. He diagnosed & treated a simple hernia. But the diagnosis & the treatment were actually exactly the same. Just that the first one was describing it in a way to justify a bill in the several hundreds. Unconcerned by monetary considerations, dogboy lived to a ripe old age.

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