Dear Dr. Gott: I am seeking relief from the pain of adhesive capsulitis. I've been suffering for almost a year.

I've had X-rays, two MRIs, cortisone shots, distension arthrogram, 11 months of physical therapy, manipulation under anaesthesia and shoulder arthroscopy that removed a small bone spur.

Reply: Adhesive capsulitis is commonly known as a "frozen shoulder". The shoulder itself is a ball and socket joint, held intact with tough connective tissue. Frozen shoulder occurs when the shoulder capsule becomes inflamed and stiff and the shoulder bones are unable to move freely within the joint.

This results in limited range of motion and pain, making even simple tasks next to impossible.

There are a number of reasons for the condition to occur, such as prolonged immobilisation, diabetes, hyperthyroidism, open-heart surgery and advanced age.

Or there may be a decrease in the amount of synovial fluid around the joint. This sticky fluid resembles the white of an egg and provides lubrication for joints, tendons and bursa.

Diagnosis is made primarily through a patient's history and examination. An MRI may reveal widespread inflammation, but no specific indications of a frozen shoulder will appear.

Initial treatment is generally with over-the-counter non-steroidal anti-inflammatories (NSAIDs), such as acetaminophen or ibuprofen.

This is often followed with physical therapy, hot and/or cold treatments, prescription corticosteroids, arthroscopy, shoulder manipulation and electronic stimulation.

It appears you have run the gamut of treatment, right down to manipulation performed under anaesthesia.

During the process, your physician should have worked the shoulder joint through repeated movement to release any scar tissue present. The arthroscopy was performed in an effort to cut tightened ligaments and also to remove scar tissue.

There's not much left I can recommend, but here goes: Request a second opinion from an orthopaedic specialist at a teaching hospital.

Bring along your reports and any relevant information for his or her review. Get an opinion on acupuncture, which has helped some people, and ask for other solutions. Good luck.

To give you related information, I am sending you a copy of my Health Report "Managing Chronic Pain". Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, Ohio 44092. Be sure to mention the title.

Dear Dr. Gott: Your recent response about fainting, weakness and lightheadedness was incomplete. Very often, fainting is caused by dehydration, and the cure is simply the intake of water. This will save a lot of worries and expensive testing. Dehydration occurs most often in the dryer climates of the United States, primarily to people who just moved there.

The elderly seem particularly susceptible, since they may be unaware of the powers of the sun and humidity without proper hydration.

Reply: Sometimes the simplest solutions are best. While I attempted to cover all possibilities, I failed to step back and "kiss" — Keep It Simple, Stupid! Thank you for suggesting this remedy, which will likely help some people. Drinks such as Gatorade that contain electrolytes might be beneficial for faster recuperation.