1. Questions Apr 19 2011
1.-Recurrent Shoulder Dislocation
Hi doctor i am 21 years old man 2years back i fall down from the bike my right shoulder was dis
located my hand turned back that time some unknown person came and he turned my hand
correct position and next day i went to hospital so doctor just given some medicine and he gave
one belt to my hand after one month i removed that n doing my work some day when i throwing
the boll it was again dislocated and with in seconds again set again so from that day when
throwing something it getting dis located now yesterday i went to swimming pool when i
swimming my hand was to much dislocated again so from yesterday to much paining i cant lift
my hand also.....so plz tell me sir Wat i have to do i have X ray also.........and is it possible to stop
continue sly dislocation of my shoulder....
Age: 19-25 years
Sex: Male
Current Medication, Known Allergies and Medical History were left blank.
Generally, if your shoulder is wrenched upward and backward, you may dislocate it out of its
socket .Basically now, try to avoid shoulder straining movements and activities that could
potentially produce a new dislocation. The shoulder dislocation is both painful and
incapacitating. The force required is often that of a fall or a collision with another person or
object (both of which can occur during many sports). Most shoulder dislocations happen at the
lower front of the shoulder, because of the particular anatomy of the shoulder joint. The bones
of the shoulder are the socket of the shoulder blade and the ball at the upper end of the arm
bone (humerus). The socket on the shoulder blade is fairly shallow, but a lip or rim of cartilage
makes it deeper. The joint is supported on all sides by ligaments called the joint capsule, and
the whole thing is covered by the rotator cuff. The rotator cuff is made up of four tendons
attached to muscles that start on the scapula and end on the upper humerus. They reinforce the
shoulder joint from above, in front, and in back, which makes the weakest point in the rotator
cuff in the lower front. You can wear a sling, If a sling is not available, rig one by tying a long
piece of cloth in a circle (a bed sheet or towel may do nicely). A pillow placed between the arm
and body may also help support the injured shoulder. After a period of immobilization (usually a
few weeks), slowly and gradually begin to increase the range of motion at the shoulder joint.
This helps to preserve natural movement and lessen the risk of recurrent dislocation which is
your particular case here. When good progress is made with range of motion, strengthening
exercises may be added to help you to return to full function. According to the current medical
literature, the recurrence rate for shoulder instability is highly dependent on the age of the
patient. Nonoperative care should be performed first before entertaining the thought of
surgery. Most patients are able to rehabilitate their shoulder with rest and physical therapy. In
patients , as your case, who have recurrent shoulder instability, operative care should be highly
considered. Numerous studies have shown the increased likelihood of traumatic glenohumeral
arthritis in patients with multiple shoulder dislocations. Operative care may consist of both open
or arthroscopic treatment of the cause of instability, and of course a Rehabilitation program after
surgery to control pain, limitation and regain full function.

2. 2.-Possible Psoriasis Arthritis
I recently have been diagnosed with Dermititis, then I got grovers disease, then I got Psoriasis
and now it seems I have Psoriatic arthritis. How is this possible in just 6 months? Is there some
underlying condition that maybe causing this? I'm 58 and have been in excellent health.
Appreciate any info. thank you.
Age: 56-65 years
Sex: Male
Current Medication: Zocar, verapimil,linisopril
Psoriatic Arthritis is a type of arthritis that affects some persons who have Psoriasis. The majority of
people with Psoriasis are later diagnosed with joint problems that correspond to Psoriatic Arthritis. The
main symptoms are: joint pain, stiffness, swelling, they may affect any joint from fingers to Spine and
may go from mild to severe. There is no cure for the Psoriatic Arthritis what you can do is control the
symptoms when they flare and try to prevent more damage to your joints. The medications currently
used to treat Psoriatic Arthritis include: NSAIDs, disease modifying anti rheumatic drugs (DMARDs),
immunosuppressant medications and for the most severe cases: Tumor necrosis factor-alpha inhibitors.
But you can help yourself for example: keeping a healthy weight, exercising regularly, avoiding strain or
additional stress in your joints, applying alternating hot-cold packs several times a day for about 20-30
minutes each time, also try to get enough rest during the day.
3.-Testosterone side effects
What sort of adverse effects can be caused by testosterone boosters such as p-6 extreme.
Age: 19-25 years
Sex: Male
Anabolic steroids refer to hormones or in this case, pro-hormones that are either taken orally or by
injection that influence the body's hormonal system to produce extra testosterone. The goal of taking
anabolic steroids is to increase muscle mass. Anabolic refers to this muscle-building capability. The use
of steroids suppresses the naturally occurring testosterone in the body and, in males, may lead to a
decrease in testicle size (atrophy), decreased sperm production, infertility, acne and baldness. As well,
the excess steroid can be converted to estrogen in males and may lead to enlarged breasts (known as
gynecomastia). Liver damage may often occur, and liver cancer is a risk. Psychiatric effects of steroids
include excitation and depression. Aggression is common. Manic episodes of aggressive behavior are
known as "roid rage," and violence may be the outcome. Depression and suicide may also occur.

3. 4.-MRI showing canal stenosis of cervical spine
I have a lot of shoulder and arm pain, and now my Dr. thinks it's coming from my neck. MRI
results: C3-4: small central disc bulge causing mild flattening of the thecal sac without stenosis.
C4-5: disc bulge with superimposed soft disc protrusion causing indentation of the cord and
moderate canal stenosis. foramina are patent bilaterally. C5-6: broad central disc protrusion
indentation of the cord with moderate canal stenosis. Mild foraminal stenosis bilaterally
secondary to uncovertebral joint hypertrophy with impingement of the exiting C6 root. C7:
central disc extrusion extending inferiorly causing indentation of the cord with moderate canal
stenosis. Foramina are patent bilaterally. What does this all mean?
Age: 46-55 years
Sex: Female
The pain in your neck and shoulder might be due to a cervical nerve compressionyou’re your
doctor thinks, according to the results of your recent MRI, but it would be important to rule out
also an inflammation of the peripheral nerves at the level of the arm and hand. In the younger
patients, cervical radiculopathy may be a result of a disc herniation or an acute injury causing
impingement of an exiting nerve. In the older patient, cervical radiculopathy is often a result of
spinal canal narrowing (stenosis) from bone (osteophyte) formation, decreased disc height and
degenerative changes due to aging process. The treatment strategy usually includes: physical
therapy program aimed to reduce pain and inflammation, and the use of anti-inflammatory
medication (“Motrin”, “Advil”), also a re-education of your posture may improve quality of life.
You should be independent in a stretching and strengthening routine and continue with these
exercises under the periodic supervision of a physical therapist initially and then completely on
your own. If your condition fails to improve with a comprehensive rehabilitation program and
selective injections , you may be presented with a surgical evaluation. Often, you can
experience progressive improvement over the first 6-8 weeks with conservative treatment. If
there is no significant improvement in this time frame, consider a surgical evaluation.
5.-HIV and unprotected sex for 10 months
Is it possible to not contract HIV after after having unprotected sex with someone for 10 months?
Age: 36-45 years
Sex: Male
The following factors are associated with an increased risk of acquiring HIV infection:
Unprotected sex, receptive anal intercourse carries a particularly high risk, injection drug
use (sharing needles or drug paraphernalia), occupational needle stick or body fluid splash
(estimated transmission rate <0.3%), contaminated blood products (before 1985 in the

4. United States). Around the world approximately 40 million people are currently living with HIV
infection, and an estimated 25 million have died from this disease. In the United States, roughly
one-third of new diagnoses appear to be related to heterosexual transmission. Male-to-male
sexual contact still accounts for nearly half of new diagnoses and intravenous drug use make
the remaining of the cases. In your particular case, if you are not sure about the HIV status of
the person with who you had unprotected intercourse for 10 months or if you are feeling
very stressed out and worried, it is strongly recommended that you get tested. There is a
test that can be done without using a needle. This test, called the OraQuick Rapid HIV Test for
Oral Fluid, gives results in 20 minutes using saliva. This test can detect only HIV type 1 (HIV-1)
antibodies. Also, a negative test result does not mean you are immune to HIV, always keep in
mind that engaging in risky behaviors (having unprotected sexual intercourse with an infected
person or sharing needles or syringes with an infected person) can transmit HIV.