By Tedler D. Depaynos, MD
His family has been growing flowering plants for quite some time and has been doing good. Recently because of the previous holidays the demand of their products has more than tripled and his buyers in Metro Manila were starting to buy from others. Hence, he thought of expanding his flower plantation by acquiring a wide piece of lot.
When they were inspecting the area, he suddenly slipped on a hilly portion and before he could land on his back he was able to turn and land on his right shoulder. Initially the pain was minimal and tolerable but in the evening, the pain worsened so that he applied warm compress and requested one of his young lady workers who was working as a part time masseur to massage his shoulders. The relief was dramatic.
After a few days they returned to the area and started to do some cleaning with their bolos and sickles to identify the boundaries. In one unfortunate swing with his bolo while cutting a short bush, he felt something snap in his right arm and the pain in his right shoulder suddenly recurred. The pain worsened despite the massage so that he was forced to consult their family MD. There were no signs of significant contusion like hematoma and pain on palpation was very minimal. Stretching however in some directions elicited some pain so he was diagnosed to have sprain or injury to his muscles or tendons or strain which is an injury of the ligaments. He was prescribed some analgesics and anti-inflammatory meds. He was also advised to rest his right arm and shoulder for at least 2 or 3 weeks.
When he failed to return to the area he wanted to buy, the owner visited him and suggested that they do some “native rites”. He might have disturbed some “unseen inhabitants” in the area. Smiling, he consented and even wanted jokingly to talk to the “inhabitants” for they might be hiding something valuable. Despite the rites, however, the pain worsened because probably he could not completely rest. There were times that he had to carry some heavy objects which elicited more pain occasionally.
Their family MD suggested then a simple x-ray of his right shoulder. They were happy that there was no fracture but there was irregular and closer alignment of the shoulder joint called acromio-clavicular joint which was interpreted by the radiologist as Degenerative Osteoarthritis. In short there was also “wear and tear” of his joint due to old age considering that he was already nearing his 7th decade and due to constant use. It was analogous to an iron which was rusting. The “rusting” joints were rubbing against each other which was precipitated by the falling down trauma causing the pain. If this could happen to the patient’s shoulder joint, it could happen in all the other joints. Hence, elderly individuals have to be careful. Lucky are the ones with young human canes.
In elderly females they have a greater tendency to have weakened bones called Osteoporosis due to ‘no more’ estrogen. They may easily encounter fracture when they slip. Chronic intake of Calcium tablets or drink may be prescribed to counter the Osteoporosis.
Stronger anti-inflammatory meds were prescribed for the patient to ease the pain and to hasten the disappearance of the inflammation. The patient however was advised that the joint defect is permanent and relief of the manifestations may take some time and maybe temporary for sure friction of the joints would happen from time to time causing a recurrence of the pain.
Despite the insistence of the lot owner to repeat the “native rites”, the smile of the patient lessened and he appeared reluctant to buy the lot.
**
