Ask the Doctor: Torn Rotator Cuff; Metanx for Neuropathy
Q I have a torn rotator cuff from playing tennis. Is this serious?
A Repetitive use is a common cause of a torn rotator cuff. This tendon connects the muscle to the bone around the shoulder joint. Constant and forceful use of the shoulder, such as with tennis, certainly can strain this tendon. As for the seriousness of it, know that a rotator cuff tear can get larger over time. If the pain worsens, is more frequent, and the shoulder feels weaker, those are indicators your shoulder tear is likely expanding. Since your pain sounds like it’s been ongoing, it’s best to have it checked out by your primary care physician or orthopaedic sports specialist. Early diagnosis can help prevent loss of strength and range of motion. Many rotator tears can be treated nonsurgically. Treatments include anti-inflammatory medications, steroid injections, and especially physical therapy. The goal is to restore good function, and physical therapists can ensure correct alignment and help to correct any muscle imbalances. Surgery may be indicated if pain isn’t resolved through other means. People who require surgery often feel pain at night and have great difficulty lifting the arm. As your injury doesn’t sound like it’s reached that stage, you may be able to resolve the issue while it’s still minor. Seek out physical therapists knowledgeable about tennis. They can assess and treat the injury and can also help refine your swing. That not only will reduce potential future injuries, but it may improve your game, too.
Q I was told that taking a prescription “vitamin” called Metanx would prevent diabetic neuropathy. Can you tell me more about this?
A Metanx capsules include a combination of B vitamins. Because neuropathy issues may be related to vitamin B deficiencies, supplementation with vitamin B12, vitamin B6, and folate (vitamin B9) may improve diabetic peripheral neuropathy, but more research is needed to say definitively. Studies suggest that people who have a vitamin B12 deficiency may have a reduction of symptoms, but it hasn’t been shown to benefit those who do not have a deficiency. That said, taking the vitamins is generally considered to be safe, but as they can interact with medications, do so only if your physician recommends it. Metanx is what’s called a “medical food” for use only under the supervision of a physician. A medical food, according to the U.S. Food and Drug Administration (FDA), is meant for the specific dietary management of a patient who, because of therapeutic or chronic medical needs, may not be able to ingest, digest, absorb, or metabolize ordinary foodstuffs or certain nutrients, or who has other special medically determined nutrient requirements that cannot be achieved through diet alone. Because it is considered a medical food and not drug, it is not regulated by the FDA. According to a 2012 double-blind, placebo-controlled study published in the American Journal of Medicine, participants taking Metanx reported symptom relief and quality of life improvement. The study author also stated that it appeared to be a safe and effective therapy for alleviation of peripheral neuropathy symptoms, at least in the short term. The trial was 24 weeks and included 200 participants. A 2015 survey study conducted via automated phone prompts included 544 people taking Metanx. Researchers similarly reported reduction of pain and less disruption in work/school, and social/family life over the 12-week trial period. In 2020, researchers analyzed 24 published articles, called a systematic review, and reported that both B12, taken alone or in combination with other vitamins or conventional treatments (such as gabapentinoids), showed some evidence of neuropathic pain relief. The article appeared in the July 25, 2020, issue of Nutrients. So while Metanx may ptoduce positive outcomes in some people, other vitamin B formulations may worksimilarly to reduce symptoms. But just because medical foods contain vitamins, it doesn’t mean they are completely safe for everyone. Allergic reactions have been reported. Use only with a physician’s supervision, especially if you are taking other medications.
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