Sunday, August 18, 2019

Only One Painful Shoulder, But MRI For Both Shoulders Abnormal?

Neck/ nerves can cause shoulder pain
A patient recently came to our clinic complaining of right shoulder pain. She had just gone to see an orthopaedic surgeon who after a short chat suggested getting a MRI scan for both shoulders for comparison purposes. The surgeon did not even bother assessing her first before suggesting she go for the scans.

I was initially surprised that the surgeon suggested imaging both shoulders especially when there was no physical assessment done on her painful right shoulder or her neck. But what she told me subsequently surprised me further.

Both right and left shoulder MRI scans were abnormal! She had tears in both her right and left supraspinatus muscles (right side possibly from swimming and badminton)! There was no pain at all in her left shoulder.
See the position of Supraspinatus under the acromion
Then Gino told me an article he'd seen where researchers found abnormal MRI findings in both shoulders (Barreto et al, 2019).

These subjects had self reported pain in one shoulder only. They had no history of previous upper arm fractures, frozen shoulder, significant range of motion deficits, no repeated dislocations and no neck related pain.

MRI's were done on both shoulders and randomly interpreted by an orthopaedic surgeon and a radiologist specializing in musculoskeletal conditions.

The conclusion was that abnormal MRI findings were very common in both shoulders! Only full thickness tears in the supraspinatus tendon and shoulder osteoarthritis were higher by 10 percent. Otherwise many patients had similar abnormal tears/ injuries in both shoulders. Yes, even in the non painful shoulder.

Please bear this mind if your surgeon sends you for a MRI scan without even assessing you thoroughly. So many problems can be caused by this and a lack of understanding of context especially if no physical assessment is done.


Barretto RPG, Braman JP et al (2019). Bilateral Magnetic Resonance Imaging Findings In Individuals With Unilateral Shoulder Pain. J Sh Elbow Surg. S1058-2746(19)30234-4. DOI: 10.1016/j.jse.2019.04.001

Tuesday, June 18, 2019

Physio Solutions Turns 12 Today!

Our clinic has been treating patients for 12 years now. A big thank you to all our patients, friends and family who have always been supportive and for referring their family members, relatives and friends. 

We would not have come this far without you. We will definitely strive to improve ourselves and make you (our patients) better as quickly as we can. 

Sunday, May 26, 2019

Don't Penalize Women Athletes After They Give Birth

Me exercising 33 days after giving birth
Thank goodness I'm not a sponsored athlete. I don't have to worry about getting back to racing form quickly after giving birth. Nike, Asics and other sports brands came under fire this past week for penalizing female athletes being pregnant. I was appalled reading what they had to go through after giving birth.

Nike's contracts allow for their athletes up to six months to recover from injuries. Their pay can be reduced but their contract cannot terminated. However, this does not include pregnancy and postpartum recovery. This forces female athletes to compete while pregnant or too soon after childbirth or risk losing pay.

Because of  clauses above, Olympian Kara Goucher (previously sponsored by Nike and now Oiselle and Skechers) was forced to choose between running 120 miles a week or breast feed her son as her body couldn't do both. She didn't mind resuming training a week after giving birth (in 2010), her toughest moment was when she learnt that Nike would stop paying her until she resumed racing.

If Allyson Felix, winner of six Olympic gold medals and 11-time world champion in athletics cannot secure maternity protection from Nike, who can?

There may be much more cases like these as many athletes who were interview requested anonymity as they feared retribution or had signed nondisclosure agreements.
Alysia Montano racing when 8 and half months pregnant
After all those recent Nike ads about empowering girls and women, they should put their money where their mouth is.

I wonder if our sponsored Singapore female athletes like Rachel Yang face similar pressures. After all, the women are not competing for themselves, they are also raising our future generation.

Thursday, May 2, 2019

Wi-Fi Lowers Your Chances Of Having Children

Straits Times article on 0202519
My "caveman" husband Gino didn't have a permanent mobile number until 2009 when he left the then Singapore Sports Council (now Singapore Sports Institute) to work in Physio Solutions. Yes, he was that adverse to technology and being contacted (so he could train in peace).

When he was traveling with the athletes, or competing overseas himself, he will often just get a prepaid line so I can contact him. No one else has that number except the athletes and I.

And for the longest time we didn't have a broadband connection in the house, only a dial up  connection. When we finally started having a broadband connection, he'll turn it off every night before we go to sleep. This was way before the generous amounts of data offered by the telcos for your mobile line.

Now that may have turned out well as a new study found that exposure to Wi-Fi connections lowers male fertility rates. So couples' chances of having kids are reduced since the electromagnetic waves kill sperms.

All the male participants in the study were previously involved in IVF or artificial insemination procedures. They averaged 38.4 years old and were divided into three groups.

A control group whose sperm samples were not exposed to electromagnetic waves from the Wi-Fi device. The shield group, whose sperm was protected by a small Wi-Fi shield that intercepts electromagnetic waves (EMW). The exposed group whose sperm was exposed to EMW.

The sperm were exposed to EMW for 30, 60 minutes, two and 24 hours and sperm motion was then tested. In the exposed group, the men had a pocket Wi-Fi router, similar to how a mobile phone would be carried in a man's pants (see picture below).
Oops, not the best place to put your phone
There was little difference in sperm motility rates across the groups for 30-60 minutes. After two hours, motility rate in the control group was 53.5%, shield group 44.9% and 26.4% in the exposed group.

After 24 hours, dead sperm group of the control group was 8.4%, shield group 18.2% and exposed group significantly higher at 23.3%.

Though the Wi-Fi shield offers some protection over a short period of time, the study shows mounting evidence on the harmful effects of EMW on sperm. The longer the exposure, the higher risk for potential negative effects.

If you look at the number of people over the next few decades using devices that rely on Wi-Fi connection, impact would be huge when it comes to fertility rates.

The article can be found in page A14 under the World section in today's Straits Times.

The study headed by researcher Kumiko Nakata (above) is being presented at the ASPIRE 2019 conference from 2-5 May, 2019.

Even if we turned off our Wi-Fi router now, there are heaps others surrounding us (picture above). Look at your own phone to see the available connections.

Saturday, April 20, 2019

Paying Kickbacks In Private Healthcare Clinics

ST 200419
Last year, we wrote about three local hospitals paying kickbacks to foreign medical agents to introduce patients from overseas who were seeking treatment.

After the Ministry of Health (MOH) outlawed this practice of paying fees to foreign agents, there's information to suggest that these mercenary agents have changed their focus to target private hospitals and doctors who work in private practice.

There is also evidence to suggest that local agents may actually be staff working in the private hospitals. They could be local Singapore staff or foreign staff working in our private hospitals. The foreign staff would be in a good position to discuss kickback fees on behalf of foreign agents.

These agents not only wanted a fixed retainer fee ($10,000), they also wanted to be paid a percentage of medical charges, which is banned under present guidelines. Apparently these rogue agents "shop around" and choose doctors who pay them the highest commissions.

For we all know, this practice of paying under-table payments/ kickbacks may have gone on before it started in our public hospitals as it is definitely easier to negotiate with  doctors in private practice and private hospitals.

The newspaper report also suggested that illegal transplant organ services may be touted as well though it wasn't clear if they took place in Singapore.

When kickback schemes like these are in practice, doctors in private practice would likely raise their fees to pay for whatever extra "costs" that are incurred. It is bad practices like this that leads to fee increases, increases in health insurance premiums and Mediasave-approved Integrated shield plans.

Have a look at the article in today's Straits Times on page B2 under the Home section.

Monday, March 25, 2019

PS Sim Heading to Mount Everest

You've read about PS Sim, winning a 100 km race despite having plantar fasciitis. Well,
she's featured in today's Straits Times on page B3 under the Home section.

She will be attempting to climb Mount Everest in May 2019 after successfully summitting Cho Oyu at 8201 meteres. Another of our patient made it to the top of Everest back in 2011.

We wish PS all the very best. You go girl!!

Tuesday, January 22, 2019

Renovations So Far at Physio Solutions

Updates on the renovations so far. For those of you who's been asking, here's how the front entrance is after we cleared it.

After some work done it look like this, after the new carpets have been put in.

Here's a quick look at what's been done so far in the passage way.

Stay tuned for more updates.