DEAR DR. ROACH: I am a 75-year-old female suffering with very painful "end-stage, bone on bone" osteoarthritis with bone spurs of both shoulders and rotator cuff damage (tendonitis). This shoulder arthritis seems strange, because I have little or no arthritis in my hips, knees, etc. I'm wondering if the cause of this shoulder damage could be because I always wore very tight bras (sometimes needed two bras) due to very large pendulous breasts. I remember the discomfort of the bra straps digging into my shoulders from a very young age.
Steroid injections and physical therapy have not helped at all. Diclofenac gel and Tylenol provide minimal temporary lessening of the pain. Ice makes it worse; moist heat is comforting.
Two different orthopedic doctors have said there is nothing else to try and that I must consider shoulder replacement. I am VERY reluctant to undergo this surgery. Do you know of any other treatment that might help?
Should young women be warned about the long-term damage that might result from tight bra straps? -- Anon.
ANSWER: Osteoarthritis in just one joint does make me concerned that trauma to the joint led to the arthritis. In my experience, the trauma has usually been of high intensity. I did do some research and found that there is evidence that women with larger breasts are more likely to develop chronic neck and shoulder pain (this will not be a surprise to many readers); however, there's not much evidence for development of osteoarthritis, with the bone spurs you mention.
I did find description of tight bra straps causing damage to the nerve and blood supply that runs directly under the collarbone. This can be compressed by pressure, and it was originally described in soldiers with heavy backpacks. I was able to easily find online bras made with wide, comfortable-appearing straps, but many women will benefit from custom fitting.
When osteoarthritis of any joint is end-stage, with bone-on-bone interaction, then replacement surgery is usually the only effective option. Some experts will try hyaluronic acid injections or platelet-rich plasma injections; unfortunately, there is not much evidence showing benefit. It may be too late for these to be of much help.
Women of any age with chronic back and neck pain due to large breasts may be candidates for breast reduction surgery. I have had several patients undergo this surgery, and all have been very happy with the results. Insurance companies are loath to pay for it, but diligent documentation by the patient's regular doctor and the surgeon can usually be effective.
DEAR DR. ROACH: Is it possible to have colon cancer with no polyps? My wife died seven months ago from colon cancer with no polyps. -- B.V.
ANSWER: I am very sorry about your wife.
About 5% of colon cancers are due to hereditary nonpolyposis colorectal cancer, also called Lynch syndrome. In these cases, there may be very few or no polyps. It would be important to know if this were the case, because her family members would be at high risk for developing colon cancer early and need to be aggressively screened. Families with this syndrome often have other cancers, especially of the uterus, but also ovary, stomach and others. It is diagnosed by pathological studies of the tumor.
It is also possible that she had a polyp that was missed by screening. No screening test is perfect.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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