There is a particular type of patient I see quite often in the pharmacy.
They come in holding their shoulder.
Or rubbing their elbow.
Or flexing a finger repeatedly because it keeps catching.
And the conversation usually starts with:
“I think I’ve pulled something.”
Sometimes they have.
But quite often, it is something else.
Our muscles, tendons, joints and the little fluid-filled sacs around them can all develop problems — particularly as we get older.
And many of these conditions are painful, annoying and surprisingly persistent.
Trigger finger — when your finger gets stuck
Trigger finger is one of those conditions that sounds almost amusing until you have it.
A finger becomes painful, stiff or difficult to straighten.
Sometimes it catches or locks in a bent position and then suddenly releases with a click.
The problem is usually around the tendon and the sheath it travels through.
The tendon becomes irritated or swollen and doesn’t glide smoothly.
It can be particularly noticeable first thing in the morning.
Diabetes increases the risk, and it is more common in women and middle-aged or older adults.
Mild cases may improve with rest, avoiding activities that aggravate it and sometimes splinting.
A steroid injection can be very effective when symptoms persist.
If the problem continues despite treatment, a small surgical procedure can release the tendon.
The important thing is that repeatedly forcing the finger straight isn’t necessarily going to fix the underlying problem.
Frozen shoulder — and it really can feel frozen
Frozen shoulder, or adhesive capsulitis, is another condition that can seriously interfere with everyday life.
The shoulder becomes painful and increasingly stiff.
Reaching overhead becomes difficult.
Putting on a shirt becomes a struggle.
Reaching behind your back can be almost impossible.
And sleeping can become miserable.
It tends to progress through stages, and unfortunately it can last for months — sometimes considerably longer.
Diabetes is an important risk factor.
Treatment can include pain relief, physiotherapy and exercises designed to maintain movement.
Steroid injections may help reduce pain and improve movement, particularly earlier in the condition.
In stubborn cases, specialist procedures may be considered.
The biggest mistake is assuming that because the shoulder hurts, you should keep it completely still.
Too much rest can make stiffness worse.
Bursitis — the body’s little cushions become inflamed
Around many joints we have small fluid-filled sacs called bursae.
They reduce friction between tissues.
When a bursa becomes inflamed, we call it bursitis.
It can occur around the shoulder, elbow, hip or knee.
There may be pain, tenderness and sometimes swelling.
Repeated pressure or overuse can trigger it.
Kneeling for long periods, for example, can cause bursitis around the knee.
Treatment often involves reducing the activity that is aggravating the area, using appropriate pain relief and gradually returning to normal movement.
But there is an important warning.
If a joint or bursa becomes very red, hot, swollen and painful, particularly with fever, infection needs to be considered.
That requires medical assessment.
Tennis elbow — and you don’t need to play tennis
Tennis elbow is a classic example.
You can develop it without ever picking up a tennis racket.
It causes pain around the outside of the elbow, often aggravated by gripping, lifting or twisting.
It is usually related to irritation or overloading of the tendons attached to the muscles of the forearm.
The same principle applies to golfer’s elbow, which affects the inner side of the elbow.
Treatment generally involves modifying the activity that is aggravating the tendon, maintaining appropriate movement and gradually strengthening it.
Painkillers may help in the short term.
But tendons don’t always respond well to simply resting them indefinitely.
They often need a gradual return to loading.
Plantar fasciitis — when every morning starts painfully
This is a common cause of heel pain.
The plantar fascia is a strong band of tissue running along the bottom of the foot.
When it becomes irritated, people often experience sharp pain underneath the heel, particularly with the first few steps after getting out of bed.
Then it may ease as they move around.
Good footwear, stretching, managing activity and appropriate strengthening can help.
Again, patience is important.
These tendon and connective-tissue problems can take weeks or months to settle.
Carpal tunnel syndrome — when your hand starts tingling
This one is slightly different.
Carpal tunnel syndrome occurs when the median nerve is compressed at the wrist.
Typical symptoms include tingling, numbness or burning in the thumb, index, middle and part of the ring finger.
Symptoms can be worse at night.
Some people wake up shaking their hand because it feels numb.
A wrist splint worn at night can help some people.
Steroid injections can provide temporary relief.
Persistent or severe cases may require surgery to release the nerve.
Don’t ignore progressive numbness or weakness in the hand.
Long-standing nerve compression can cause permanent problems.
Why do these conditions seem to appear out of nowhere?
Often they don’t.
The problem may have been developing gradually.
Repeated movements.
Poor technique.
A sudden increase in exercise.
Manual work.
Gardening.
DIY.
Typing.
Using a computer mouse.
Or simply the effects of ageing.
And sometimes there isn’t an obvious trigger at all.
So should you use painkillers?
They can certainly have a role.
Paracetamol may help some types of pain.
Anti-inflammatory medicines such as ibuprofen can help in appropriate people, but they aren’t suitable for everyone.
People with stomach ulcers, kidney disease, certain heart conditions, some forms of asthma, those taking particular medicines and older adults may need to avoid or use NSAIDs cautiously.
This is where asking a pharmacist before buying them is worthwhile.
Topical anti-inflammatory gels can sometimes provide pain relief with less systemic exposure than tablets, although they aren’t risk-free either.
What about physiotherapy?
For many of these conditions, physiotherapy can be far more important than people realise.
The aim isn’t simply to massage the painful area.
A good rehabilitation programme may involve restoring movement, improving flexibility, strengthening muscles and gradually increasing the load placed on the affected tendon or joint.
That is particularly important for problems such as frozen shoulder, tennis elbow and plantar fasciitis.
When should you get it checked?
Don’t automatically assume every ache is an injury that will disappear.
Seek medical advice if:
- Pain is severe or rapidly worsening.
- A joint is hot, red and swollen.
- You have a fever or feel unwell.
- You cannot properly use the affected limb.
- There is significant weakness or numbness.
- Symptoms persist despite sensible self-care.
- The problem keeps coming back.
And if you have suffered a significant injury, particularly with deformity or inability to bear weight, don’t try to diagnose it yourself.
My view as a pharmacist
One thing I would tell people is to be patient.
We live in a world where we expect a tablet to fix everything by tomorrow morning.
Unfortunately, tendons, ligaments and joints didn’t get the memo.
Some of these conditions take time.
The answer is often not complete rest and it isn’t necessarily taking painkillers every day.
It may be a combination of sensible pain relief, modifying the activity that caused the problem, maintaining movement and gradually rebuilding strength.
And sometimes you need a physiotherapist, GP, orthopaedic specialist or other healthcare professional to work out exactly what is going on.
So if your finger starts clicking, your shoulder refuses to move, your heel hurts every morning or your elbow complains every time you lift the kettle, don’t just assume you’re getting old.
Your body may be telling you that something needs attention.
Listen to it.
Until next time take care of yourself.
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