> WE'VE TALKED ABOUT KNEES AND HIPS BUT SHOULDERS CARRY A LOT OF OUR LIFE.
SHOULDER PROBLEMS; WHY, HOW AND WHEN SURGERY WORKS, TONIGHT, "ON CALL WITH THE PRAIRIE DOC."
>> GOOD EVENING AND WELCOME TO ON CALL WITH THE PRAIRIE DOC."
WE HAVE OFTEN EXPRESSED WONDER AT HOW INTRICATE AND FUNCTIONAL OUR JOINTS ARE.
THEY USUALLY WORK DAY AFTER DAY, YEAR AFTER YEAR WITHOUT COMPLAINT.
SOMETIMES THOUGH, A PROBLEM OCCURS AND WHAT WE DO THEN IS OUR SHOW TONIGHT.
FIRST, LET'S TAKE A LOOK AT THIS WEEK'S PRAIRIE DOC QUIZ QUESTION.
THE SHOULDER IS A COMPLEX JOINT OF THREE BONES.CAN YOU NAME THEM?
VIEWERS WHO CALL IN THE CORRECT ANSWER WILL BE ENTERED INTO A DRAWING
TO WIN A SIGNED COPY OF OUR BOOK, "THE PICTURE OF HEALTH."
EACH OF MY ESSAYS, ORIGINALLY WRITTEN FOR THIS SHOW,
COMES WITH A WONDERFUL ACCOMPANYING PHOTOGRAPH BY DR. JUDITH PETERSON.
WE WILL ANNOUNCE THE ANSWER AND THE WINNER AT THE END OF THE SHOW.
REMEMBER, YOU ONLY HAVE 10 MINUTES TO GET YOUR ANSWER IN!
WE ANSWER YOUR MEDICAL QUESTIONS ABOUT SHOULDER
HEALTH AS THEY ARE CALLED IN OR SENT TO US VIA FACEBOOK OR EMAIL.
CALL IN QUESTIONS TO 1-888-376-6225 OR SEND US AN EMAIL TO THE ADDRESS ON THE SCREEN.
THIS IS YOUR SHOW. GIVE US YOUR CALLS.
OPPORTUNITY TO ASK WONDERFUL EXPERTS ABOUT ORTHOPEDIC ISSUES.
JOINING US TONIGHT IS DR. PETE LOOBY AND DR. KEITH BAUMGARTEN
BOTH OF THE ORTHOPEDIC INSTITUTE, SIOUX FALLS. SOUTH DAKOTA.
THANK YOU GUYS FOR JOINING US.
>> THANKS RICK GOOD TO BE HERE.
>> SO WE'LL TALK WITH YOU FIRST, KEITH. WHAT -- WHERE ARE YOU FROM ORIGINALLY?
>> ORIGINALLY I'M FROM NEW YORK CITY.
>> NEW YORK CITY?
>> YEAH.
>> AND THEN YOU WENT TO HOPKINS UNDERGRAD.
>> JOHNS HOPKINS UNDERGRAD AND MEDICAL SCHOOL THERE IN BALTIMORE MARYLAND.
>> HARDLY KNOW THAT SCHOOL, BARELY KNOWN ABOUT. [ LAUGHTER ]
AND THEN YOU WENT TO WHERE FOR YOUR RESIDENCY IN.
>> IN ST. LOUIS MISSOURI AND WASHINGTON RESIDENCE.
I DID MY ORTHOPEDIC SURGEON RESIDENCY.
>> KIND OF A POOR SCHOOL, I THINK TOP 3 MED SCHOOLS IN THE
UNITED STATES AND THEN A FELLOWSHIP.
>> CORRECT IN SPORTS MEDICINE SHOULDER MEDICINE IN NEW YORK
CITY AT HOSPITAL FOR SPECIAL SURGERY.
>> THERE YOU ARE, NEW YORK BORN, FOR RAYED YOUR WAY OUT
TO WASHINGTON UNIVERSITY AND ST. LOUIS AND YOU WERE LOOKING
TO PRACTICE AND YOU ENDED UP IN SIOUX FALLS. HOW DID THAT HAPPEN?
>> IT WAS AN INTERESTING STORY.
I'M LIVING IN NEW YORK CITY AND LOOKING FORWARD TO STARTING MY CAREER AND
SPEAKING WITH MY WIFE, WHO WAS -- WE'RE CONSIDERING DEVELOPING A FAMILY,
AND SHE TELLS ME OUT OF THE BLUE THAT SHE DOESN'T WANT TO LIVE IN NEW YORK CITY.
>> SHE'S IN LA.
>> SHE'S FROM LOS ANGELES.
>> SHE DIDN'T WANT TO LIVE IN A BIG CITY.
SHE WANTED MORE OF A FAMILY ENVIRONMENT, AND SO WE LOOKED
ACROSS THE COUNTRY AND HAD AN OPPORTUNITY TO MEET WITH WITH A GUY AT THE ORTHOPEDIC INSTITUTE,
DR. LOOBY AND MY INITIAL IMPRESSION WAS WHO WANTS TO LIVE IN SOUTH DAKOTA?
AND YOU KNOW WHAT?
I TOOK A TRIP OUT HERE, AND MET THE GROUP AT THE ORTHOPEDIC INSTITUTE AND
DR. LOOBY AND WAS REALLY IMPRESSED BY THE PRACTICE,
AND WE LOOKED AROUND THE COMMUNITY AND TALKED TO PEOPLE AND WE SAID,
YOU KNOW WHAT? THIS LOOKS LIKE A GREAT OPPORTUNITY.
AND WE SAID WE'LL GIVE IT A YEAR, AND THIS IS OUR 13TH YEAR,
NOW HAVE FOUR KIDS HERE, LOVE IT.
I DON'T THINK YOU CAN GET ME OR MY WIFE OUT OF HERE.
>> AND YOUR DAUGHTER SAID WHAT YESTERDAY OR THIS MORNING?
>> MY DAUGHTER SAID, UFDA.
>> SHE IS SOUTH DAKOTA.
>> SOUTH DAKOTA, CORRECT.
DIDN'T SEE THAT COMING. [ LAUGHTER ]
>> YOU KNOW, CAN YOU SAY UFDA? THIS IS SOUTH DAKOTA.
>> IT'S GREAT. UNLESS WE GET KICKED OUT OF THE STATE
WE'RE STAYING HERE FOREVER. [ LAUGHTER ]
>> THAT'S A GREAT STORY AND A WONDERFUL AMOUNT OF TRAINING THAT YOU'VE HAD.
>> THANK YOU.
>> PETE, LET'S HEAR YOUR STORY. YOU'RE KIND OF A SOUTH DAKOTA BOY.
>> YEAH, I AM.
YOU KNOW, KEITH'S STORY IS REALLY COMPELLING AND FUN TO LISTEN TO.
MINE IS WAY MORE BORING.I'M THE SON OF AN OBSTETRICIAN GYNECOLOGIST DOCTOR.
>> DID HE DELIVER YOU?
>> I DON'T THINK SO.
>> YOU DON'T TAKE CARE OF YOUR OWN FAMILY.
>> DON'T TAKE CARE OF YOUR OWN FAMILY, YOU KNOW THAT.
AND WHEN I FINISHED AT LINCOLN HIGH SCHOOL WENT TO STANFORD UNIVERSITY.
I WAS IN ST. LOUIS AND DID MY RESIDENCY AT THE UNIVERSITY OF NEW MEXICO
AND MY SPORTS FELLOWSHIP AT HARVARD MASS GENERAL AND I MARRIED A SIOUX FALLS GIRL.
MY WIFE KATHERINE SANDBERG, WE WERE HIGH SCHOOL SWEETHEARTS.
THEN WHEN WE GOT DONE WITH TRAINING WE NATURALLY MOVED HOME.
>> CAME BACK.
>> YEAH, CAME BACK TO SOUTH DAKOTA.
>> SO WELL WE'RE GLAD TO HAVE BOTH YOU HERE IN THE STATE.
WE'RE TALKING ABOUT SHOULDERS.
NOW, I KNOW YOU ARE JUST PURE SHOULDER, THAT'S -- SHOULDER, ELBOW, ARM; RIGHT?
>> IT'S DEFINITELY INTERESTED IN THE SHOULDER AND ELBOW BUT I DO HIPS AND KNEES AS WELL.
>> WELL, I MEAN AND YOU WERE ON CALL, YOU FILL IN THE RESPONSIBILITY AS WELL.
AND YOU'RE KIND OF AN ALL AROUND GUY OR MORE SHOULDERS --
I MEAN, FOOTBALL, I'M SEEING YOU AS A FOOTBALL SPORTS FIXER UP.
>> YOU KNOW, RICK YOU'RE EXACTLY RIGHT.
KEITH AND I HAVE VERY SIMILAR TRAINING AS ORTHOPEDIC SURGERY AND THEN SPORTS MEDICINE
FELLOWSHIP WHICH REALLY CONCENTRATES ON RECONSTRUCTION OF THE KNEE AND THE SHOULDER,
SO HE AND I BOTH HAVE VERY BUSY KNEE AND SHOULDER PRACTICES,
DO A LOT OF ACL RECONSTRUCTIONS, LABRUM REPAIRS, ROTATOR CUFF REPAIRS.
>> MENISCECTOMY, MEANING MENISCUS OF THE SHOULDER, WE'RE TALKING SHOULDER; RIGHT?
>> KNEE.
>> OH, OF THE KNEE.
>> YEP.
>> AND YOU SAID LABRUM.
>> LABRUM, WHICH IS THE -- LABRUM WHICH IS JUST LATIN FOR LIP.
IT'S A LIP OF CARTILAGE THAT GOES AROUND THE SOCKET IN THE SHOULDER, AND UNFORTUNATELY
INDIVIDUALS ESPECIALLY YOUNG ATHLETES CAN TEAR THAT AND NEED TO HAVE IT REPAIRED.
>> MUST HAVE LEARNED THAT IN HARVARD. [ LAUGHTER ]
>> SO I KNOW THAT THE SHOULDER IS THE JOINT THAT IS THE MOST ABLE TO DO EVERYTHING.
I MEAN -- I MEAN, IF YOU THINK ABOUT IT, YOUR KNEES, YOUR FINGERS, I MEAN,
THEY ARE BASICALLY, YOU KNOW, THEY HAVE ONE DIRECTION.
THEY HAVE VERY LITTLE SIDE, BUT THE SHOULDER DOES EVERYTHING.
SO IT HAS THIS WONDERFUL FREEDOM, BUT IT LOSES ITS STABILITY. EXPLAIN THAT TO ME.
>> WELL, YEAH YOU'RE EXACTLY RIGHT.
THE SHOULDER HAS THE GREATEST DEGREES OF MOTION OF ANY JOINT IN THE BODY, A FULL 180 DEGREES.
THERE'S NO OTHER JOINT IN THE BODY THAT CAN DO THAT.
IT'S THIS AMAZING COMBINATION OF FLEXIBILITY AND STABILITY WHEN IT'S WORKING PROPERLY,
BUT SOMETIMES THINGS GO AWRY, AND THAT'S WHY WE'RE LUCKY TO HAVE PEOPLE LIKE
DR. BAUMGARTEN AROUND TO FIX IT WHEN IT GOES BAD.
>> SO THE INSTABILITY THAT PEOPLE HAVE, SOMETIMES THEY HAVE IT BECAUSE THEY WERE
SWIMMING AND THEIR SHOULDER POPPED OUT OF JOINT AND THEN ONCE YOU'VE DONE IT,
IS THERE ANYTHING THAT A PERSON WHO IS A HIGH SCHOOL KID CAN DO SO THAT HIS
SHOULDER STAYS IN GOOD SHAPE THE REST OF HIS LIFE.
>> SO BEFORE IT POPS OUT OF JOINT, IS THAT THE QUESTION?
>> RIGHT.
>> WELL, TYPICALLY HAVING GOOD STRENGTH OF THE ROTATOR CUFF IS VERY IMPORTANT,
AND MOST PEOPLE ARE BORN THAT WAY. MOST PEOPLE ARE ASYMPTOMATIC AND DO REALLY WELL.
>> WITHOUT SYMPTOMS.
>> WITHOUT SYMPTOMS.
IT'S THE ISSUE WHEN YOU START DEVELOPING SYMPTOMS. IF YOU DEVELOP SHOULDER PAIN,
INSTABILITY, WEAKNESS THAT'S WHEN YOU WANT TO MAKE CERTAIN THAT YOU TRY AND CATCH UP AND
MAKE SURE THAT THAT SHOULDER AND THE ROTATOR CUFF MUSCLES ARE STRONG.
THAT'S THE ONLY QUOTE, UNQUOTE, PREVENTIVE WAY OF PREVENTING INJURY.
>> SO WHAT EXERCISES? THIS AND THIS? THIS AND THIS?
>> CORRECT.
>> AND THIS?
>> SO YES, THAT'S THE MOTION COMING UP THROUGH HERE AND THAT WORKS THE MAIN ROTATOR CUFF MUSCLE.
THIS INTERNAL AND EXTERNAL ROTATION ARE WHAT ARE CALLED --
THOSE ARE THE MAIN STRENGTHENING TREATMENTS THERE.
SHOULDER STRETCHING EXERCISE THAT CAN BE DONE AS WELL,
BUT IN A NUTSHELL RIGHT THERE WHAT WE DO ON REHAB RIGHT THERE.
>> SO WE'RE TALKING -- WE'RE TALKING PREVENTIVE EXERCISES, AND I HAVE TO SAY THAT I HAVE
A SERIES OF ROTATOR CUFF EXERCISES I DO ON MY LITTLE WHITE MACHINE TWICE A WEEK TO
TRY TO STRENGTHEN MY SHOULDER, BECAUSE MY DAD HAD TERRIBLE PROBLEMS.
A LOT OF OLDER PEOPLE HAVE TROUBLE.
IS IT BECAUSE THEY HAVE INJURY OR THEY'RE OLDER OR ARTHRITIS EVERYWHERE?
>> YOU KNOW, RICK, I THINK IT'S MAINLY YOUR FAULT.
THE FANTASTIC INTERNAL MEDICINE DOCTORS AND THE CARDIOLOGISTS OF AMERICA
HAVE GOT US ALL OUTLIVING OUR JOINTS.THE AVERAGE LIFE EXPECTANCY WAS 34 YEARS --
>> WE NEVER HAD A PROBLEM.
>> WE DIDN'T HAVE A PROBLEM.
NOW PEOPLE ARE LIVING WELL INTO THEIR 80S AND 90S WE JUST KIND OF WEAR OUT.
AND SOME OF THAT IS FROM TRAUMA AND SOME IS JUST FROM HEAVY USE.
>> HEAVY USE.
SO SEE THERE'S THAT QUESTION.
I HAVE AN EAR NOSE AND THROAT FRIEND, DR. ROBERT REED WHO
SAYS I THINK YOU ONLY HAVE SO MANY HEARTBEATS, SO MANY KNEE BENDS, SO MANY SHOULDER MOVES,
AND THEN YOU KNOW YOU WEAR OUT, AND MY POINT IS, NO, A
REGULAR EXERCISE PROGRAM KEEPS YOU STRONGER AND KEEPS YOU ALIVE A LONG, LONG TIME.
DO YOU -- ARE YOU LANDING WITH REED OR WITH HOLM?
>> I'M ALWAYS WITH HOLM ESPECIALLY WHEN I'M ON HIS TV PROGRAM, I'M ALWAYS WITH HOLM.
[ LAUGHTER ]
>> SO IN ORTHOPEDICS AND KEITH WILL KNOW WAY MORE THAN I DO ABOUT THIS,
BUT THERE'S A CONCEPT CALLED WOLF'S LAW.
IT SAYS IF YOU REGULARLY STRESS A TISSUE, A TENDON, A MUSCLE, A JOINT, A BONE,
IT WILL GET STRONGER.
NOW, THERE ARE SOME LIMITS TO THAT OBVIOUSLY, BUT PEOPLE HAVE BEEN SHOWN, FOR INSTANCE,
TO BE ABLE TO INCREASE THEIR MUSCULAR STRENGTH UNTIL THE
DAY THEY DIE IF YOU PUT THEM IN A TRAINING PROGRAM, SO I'M A HOLM FAN ON THIS ONE.
>> I -- I'M THERE, TOO.
NOW, WHAT'S YOUR TAKE ON IT, KEITH?
>> I THINK IT'S A MATTER OF BOTH. I THINK THAT THERE'S --
OVER THE TIME OUR ROTATOR CUFFS TYPICALLY DEGENERATE REGARDLESS WHAT WE DO.
IF YOU LOOK AT THE PATIENT POPULATION, 60 AND OLDER,
THERE ARE STUDIES THAT SUGGEST 10 TO 25% HAVE A FULL
THICKNESS TEAR OF THE ROTATOR CUFF AND INTERESTINGLY ENOUGH
MOST PEOPLE DON'T KNOW ABOUT IT BECAUSE THEY'RE NOT HAVING PAIN, WEAKNESS.
>> IT HAPPENS SOMETIME IN THEIR LIFE.
>> SOMETIME IN THEIR LIFE PROBABLY JUST OVER THE YEARS THAT YOU GET MICRO TRAUMA
AND THEN IT BECOMES BIGGER AND BIGGER AND THEN YOU GET A TEAR THERE.
THAT'S WHERE I THINK BEING STRONG AND HAVING THAT EXERCISE PROBLEM
IF YOU'RE FIGHT YOU'RE LESS LIKELY TO HAVE SYMPTOMS FROM THAT.
>> OKAY IT SOUNDED MORE LIKE YOU WERE ON HOLM SIDE.
>> YOU KNOW I'M ON YOUR SIDE.
[ LAUGHTER ]
>> SO WE HAVE A FACEBOOK QUESTION.
FACEBOOK WORKS REALLY WELL, GUYS.
IN FACT, IF YOU GO TO ARIZONA OVER THIS WINTER,
YOU CAN WATCH OUR SHOW ON FACEBOOK LIVE AND CALL IN QUESTIONS FROM ARIZONA.
JUST TO SAY, DON'T FORGET THAT.
SO THE QUESTION IS FROM A 69-YEAR-OLD WOMAN.
HOW MANY CORTISONE INJECTIONS CAN I HAVE IN MY SHOULDER FOR TENDONITIS?
I'VE HAD ONE INJECTION A YEAR AGO AND THAT HELPED BUT THE PAIN HAS RETURNED.
SO HOW OFTEN?
I KNOW THAT THERE WAS A MAN WHO HAD TERRIBLE DEGENERATIVE KNEES
HAD AN INJECTION A WEEK FROM HIS PHYSICIAN AND
HE ENDED UP PRESENTING WITH CUSHING SYNDROME, TOO MUCH STEROID ON BOARD.
HE GOT A SEVERE INFECTION AND DIED FROM INJECTIONS.
WE CAN OVERDO THEM.
HOW OFTEN CAN YOU INJECT A SHOULDER, KNEE, OR HIP?
>> THAT'S ALWAYS A QUESTION, A COMMON QUESTION,
AND I THINK BASED ON THE ORTHOPEDICAL LITERATURE A DIFFICULT
QUESTION TO ANSWER DEFINITIVELY.
WHAT I TELL MY PATIENTS IS IF YOU'RE NEEDING AN INJECTION EVERY ONE OR TWO WEEKS,
IT'S NOT DOING WHAT WE NEED IT TO DO AND WE SHOULD LOOK AT SOME OTHER TREATMENT.
IF YOU NEED TO HAVE A SHOT EVERY THREE OR FOUR MONTHS AND
YOU'RE AT A POINT IN YOUR LIFE WHERE SURGERY IS NOT A GOOD OPTION FOR YOU
AND THE SYMPTOMS ARE SEVERE AND THE INJECTIONS HELP?
I THINK THAT'S OKAY.
>> YEP.
AND I -- THAT'S WHAT I WOULD SAY, TOO, AS AN INTERNIST
AND WE ALWAYS QUESTION EVERYTHING ORTHOPEDIC PEOPLE THINK YOU KNOW,
BECAUSE WE'RE -- INTERNISTS ARE THE ONES WHO -- WE DON'T HAVE ANY KNIVES.
ALL WE HAVE IS NAYSAYING.
SO KEITH, DO YOU AGREE?
>> I AGREE 100%.
IT'S INTERESTING.IF YOU TAKE CORTICOSTEROID,
IF YOU PUT IT ON THIS CARTILAGE CELLS IN A PETRIE DISH,
IT CAN BE TOXIC.
>> CONDRA TOXIC MEANING TOXIC
I CAN TO THE CARTILAGE.
>> TO THE CARTILAGE OR CELLS.
THERE'S A WHOLE QUESTION. DOES THAT DO DAMAGE?
WE'VE NEVER SEEN THAT IN A HUMAN BODY.
WE DID A STUDY AT THE ORTHOPEDIC INSTITUTE AND FOLLOWED PEOPLE FOR FIVE YEARS --
>> YOU'RE DOING SCIENTIFIC STUDIES AT YOUR INSTITUTE, HOW ABOUT THAT.
>> WE ARE, YEAH.
WE DIDN'T SEE ANY EVIDENCE OF PROBLEMS WITH THE CARTILAGE
FROM DOING INJECTIONS OF THE SHOULDER, EVEN UP TO FIVE YEARS.
NOW THERE'S A DIFFERENCE BETWEEN FIVE YEARS AND 20 YEARS
BUT CLINICALLY WE HAVEN'T SEEN THE PROBLEMS THERE
BUT IT'S IMPORTANT TO KNOW THAT THAT'S A POTENTIAL CONCERN
AND YOU HAVE TO USE THE JUDGMENT TO DO THE BEST FOR THE PATIENT
AND DR. LOOBY IS 100% RIGHT.
IF YOU'RE GETTING AN INJECTION EVERY MONTH OR TWO,
IT'S PROBABLY NOT WORKING, IT'S PROBABLY NOT WORTH THE RISK OF THE INJECTION.
IF YOU HAVE AN INJECTION EVERY YEAR AND IT'S MAKING YOUR QUALITY OF LIFE GREAT
IT'S NOT WORTH THE RISK OF HAVING SURGERY BECAUSE YOU FEEL SO
GREAT FROM THE SMALL RISK OF AN INJECTION THEN THE BENEFITS OUTWEIGH THE RISKS.
>> I THINK EVERY THREE OR FOUR MONTHS IS ACCEPTABLE IF IT REALLY WORKS.
>> AGREE.
>> SO WE NEED YOUR QUESTIONS. THE NUMBER,
IF I HAD IT ON THE TOP OF MY HEAD, WAS 1-800 -- OR 888 -- I DON'T HAVE IT HERE.
[ LAUGHTER ]
>> 376-6225.
SO, I MEAN, PLEASE, PLEASE GIVE US YOUR CALL, ASK YOUR ORTHOPEDIC QUESTIONS.
SO ORTHOPEDIC PROBLEMS IN THE SHOULDER OCCUR MOSTLY OFTENTIMES IN NONATHLETES.
THESE FARMERS WHO HAVE BEEN WORKING TOO HARD WITH THAT SHOULDER,
I THINK THE BOOMERS ARE GOING TO BE ROLLING IN ON THEIR SHOULDER.
THEY WANT TO BE ABLE TO DO EVERYTHING THEY WANT TO DO,
AND THAT'S KIND OF THE WAY WE ARE.
I'M A BOOMER AND KIND OF SPOILED, ALWAYS HAD EVERYTHING I WANTED,
AND DO YOU THINK WE'RE GOING TO OVERDO THE SHOULDER SURGERIES
AND THE KNEE SURGERIES AND HIP SURGERIES IN THE TIME COMING
AS BOOMERS GET INTO THEIR 70S AND 80S?
>> I HOPE WE DON'T OVERDO THEM.
I HOPE WE USE THEM WISELY TO HELP PEOPLE TO CONTINUE TO BE ACTIVE
AND HEALTHY AND ABLE TO GET OUT AND HAVE THAT ACTIVE
LIFETIME THEY'RE USED TO AND WANT TO CONTINUE TO DO.
YOU KNOW, KEITH EARLIER IN THE RADIO SPOT MADE THE POINT THAT
A LOT OF THESE THINGS CAN BE TREATED NONSURGICALLY,
AND THAT'S ALMOST ALWAYS OUR INITIAL APPROACH, RICK, AND
THEN USE SURGERY AS A -- IN MOST CASES A LAST RESORT,
BECAUSE -- BECAUSE THE NONSURGICAL CARE IS NOT WORKING WELL.
NOW, THERE ARE -- THERE ARE TIMES WHEN THE PATIENT COMES IN
AND I JUST HAVE TO SET THEM DOWN AND SAY YOU KNOW WHAT WE GOT TO FIX IT.
IF WE DON'T FIX IT, WE KNOW THE NATURAL HISTORY OF THIS PROBLEM,
AND IT'S NOT GOOD FOR YOU.
LET'S GET THIS TAKEN CARE OF AND GO FORWARD FROM THERE.
MOST OF THE TIME WE USE THE SURGERY AS A BACKUP PLAN.
>> I THINK OF IT AS PEOPLE WHO STOP MOVING, THEIR MUSCLES ATROPHY,
AND THEIR CHANCES WITH ATROPHYING MUSCLES, WEAKENED MUSCLES,
THIN MUSCLES, NONFUNCTIONAL MUSCLES TO RECOVER FROM SURGERY GET POORER AND POORER,
SO THAT YOU WANT TO HAVE FUNCTIONING -- YOU'VE GOT TO BE MOVING,
BUT IF IT'S HURTING YOU SO BAD THAT YOU'RE NOT MOVING
AND YOU'RE GETTING INTO A POINT WHERE YOUR MUSCLES
ARE GOING TO START ATROPHYING, YOU NEED TO GET IT DONE.
WOULD YOU AGREE WITH THAT.
>> AGREE 100%.
SO IF YOU'RE HEADING IN THE WRONG DIRECTION,
IF NONOPERATIVE TREATMENT IS NOT WORKING AT SOME POINT
YOU GOT TO CONSIDER SURGICAL INTERVENTION.
WE KNOW IF THE ROTATOR CUFF MUSCLE ATROPHIES,
A CHANCE OF SUCCESSFUL REPAIR IS LESS SUCCESSFUL THAN WITH
SOMEBODY WHO'S GOT FULL MUSCLE AND NO ATROPHY WHATSOEVER.
>> WE'RE GOING TO TALK ABOUT REHAB, BUT I HAVE A QUESTION
FROM ROSCOE, SOUTH DAKOTA, AND SHE WOULD LIKE TO KNOW,
WHAT IS A FROZEN SHOULDER AND WHAT'S THE TREATMENT OF THAT?
>> SURE.
FROZEN SHOULDER IS ALSO CALLED ADHESIVE CAPSULITES.
TYPICALLY AFFECTS MORE WOMEN THAN MEN NORMALLY IN THE AGE
GROUPS OF 40 TO 50. MOST OF THE TIME IT'S WHAT WE CALL IDIOPATHIC.
SOMETIMES THEY SAY DOCTORS AREN'T SMART ENOUGH TO KNOW HOW IT HAPPENED.
>> THE DOCTORS CAN'T FIGURE IT OUT.
>> RIGHT. [ LAUGHTER ]
>> IT'S ASSOCIATED WITH CARDIAC DISEASE, THYROID DISEASE, AND DIABETES.
>> REALLY?
>> MORE ADHESIVE CAPSULE LIGHTS IN THAT GROUP.
>> WHAT HAPPENS IS THE CAPSULES GET INFLAMED AND
FIRST STAGE IS SEVERE PAIN AND SECOND STAGE OF IT IS
SEVERE PAIN PLUS STIFFNESS, AND THE LAST PHASE IS CALLED
THE THAWING PHASE IS THAT THE PAIN GOES AWAY AND YOU START
GETTING SOME OF YOUR RANGE OF MOTION BACK BUT
YOU TYPICALLY DON'T GET ALL OF IT BACK UNLESS YOU GET TREATMENT.
THERE ARE SOME STUDIES THAT SUGGEST IF YOU LEAVE IT ALONE
FOR ONE TO THREE YEARS, IT RESOLVES, BUT WHAT TYPICALLY HAPPENS
IS YOU END UP WITH HAVING A STIFF SHOULDER AND I KNOW VERY FEW PEOPLE
WHO WANT TO WAIT ONE TO THREE YEARS FOR SHOULDER PAIN TO GO AWAY.
>> RIGHT.
SO IT USED TO BE YOU JUST TAKE THEM TO SURGERY, PUT THEM TO SLEEP AND
MAKE THE SHOULDER GO IN WHATEVER DIRECTIONS AND BREAK THE SCAR TISSUE.
>> I NORMALLY DO A CORTICOSTEROID TREATMENT.
>> PHYSICAL THERAPY.
>> COMBINATION.
I THINK IT WORKS TOGETHER.
IN OTHER WORDS, IT WORKS BETTER IF YOU DO BOTH AT THE SAME TIME.
AT ORTHOPEDIC INSTITUTE WE DID A STUDY AND FOUND OUT WE HAD ABOUT
80% SUCCESS RATE WITH NONOPERATIVE TREATMENTS FOR THIS PROBLEM.
NOW IF IT DOESN'T WORK AND YOU GO ON TO DO SURGERY,
WHAT YOU CALLED WAS CALLED MANIPULATION UNDER ANESTHESIA.
WHAT YOU DO IS TEAR THE LIGAMENT.
WE SURGICALLY INCISE THE LIGAMENT RIGHT THE WAY THE SURGEON WANTS TO INCISE IT.
IT'S SAFER AND EFFECTIVE BECAUSE THERE ARE SOME PEOPLE
FRACTURED THE SHOULDER DOING A MANIPULATION.
THE CHANCE OF FRACTURING YOUR SHOULDER AFTER A CAPSULAR RELEASE IS LESS.
>> I'M A LITTLE OLDER THAN YOU SO MY APPROACH IS A LITTLE DIFFERENT.
I CAN'T REMEMBER THE LAST TIME I TOOK A PATIENT WITH FROZEN SHOULDER TO THE OR.
I SIT THEM DOWN, I HAVE A NICE CONVERSATION WITH THEM
ABOUT WHAT THIS THING IS AND WHAT THE NATURAL HISTORY OF IT IS,
AND I BASICALLY TREAT THEM ALL NONSURGICALLY.
I RESERVE MANIPULATION UNDER ANESTHESIA OR THROUGH THE
ARTHROSCOPE FOR MY VERY DIFFICULT PATIENTS,
BUT IT'S BEEN YEARS SINCE I COULDN'T GET SOMEONE THROUGH THIS NONSURGICALLY.
>> IT'S THE TROYED AND THE STEROIDS AND THE PHYSICAL THERAPY.
>> IT'S PHYSICAL THERAPY.
>> THE LESSON TO US ALL, YOU GOT TO MOVE A JOINT OR IT'S GOING TO FREEZE.
I MEAN, IT'S GOING TO STOP WORKING.
IT'S GOING TO GET STIFFER AND DEVELOP PAIN. YOU'VE GOT TO KEEP MOVING.
>> I THINK THAT'S TRUE, BUT THIS CONDITION THAT KEITH AND I
WERE TALKING ABOUT IS DIFFERENT THAN THAT.
IS THIS -- WE DON'T AS -- AS KEITH SAID, WE DON'T KNOW WHAT TRIGGERS THIS,
CAUSES IT, BUT IT'S A REAL PATHOLOGIC CONDITION.
IF YOU TAKE A PIECE OF THAT CAPSULE AROUND THAT SHOULDER JOINT
AND LOOK AT IT UNDER THE MICROSCOPE, IT IS IN DISARRAY.
THEY USED TO HAVE THAT SHRINK ART STUFF, CUT THAT PIECE OF PLASTIC
AND PUT IT IN THE OVEN.
IT WOULD MAKE THIS BEAUTIFUL LITTLE BAUBLE YOUR DAD COULDN'T CARE LESS ABOUT
AND THREW OUT AFTER YOU GAVE IT TO HIM,
THAT'S BASICALLY WHAT HAPPENS TO THE CAPSULE OF THE SHOULDER.
THIS THING NORMALLY IS BILLOWY, GORGEOUS, AND IT JUST
SHRINKS RIGHT DOWN AND CAPTURES THE PAUL OF THE
-- BALL OF THE SOCKET IN SEVERE CASES.
>> WE'LL TALK MORE BUT WE'VE GOT QUESTIONS.
A MAN FROM BRANDON HAD KNEE SURGERY 40 YEARS AGO AND TOOK
OUT HIS ACL, ANTERIOR CRUCIATE LIGAMENT, PART OF THE KNEE.
HIS KNEE HAD BEEN BONE ON BONE SINCE 2006.
IS THERE MORE RISK IF HE WAITS INSTEAD OF SEEKING CARE?
HE DOESN'T EXPERIENCE PAIN BUT DOES HAVE STIFFNESS. PETE.
>> IT'S NOT HAVING PAIN.
I WOULD SAY IT'S REASONABLE FOR HIM TO DO A HOME EXERCISE PROGRAM
TO MAINTAIN FITNESS, RANGE OF MOTION AND STRENGTH.
I DON'T SEE ANY VALUE TO RUSHING TO INVASIVE TREATMENT
FOR AN INDIVIDUAL WHO'S NOT EXPERIENCING PAIN.
>> OKAY.
I'VE GOT A 14-YEAR-OLD NEPHEW, BROKE FOUR METACARPALS ON ONE HAND
METACARPALS MEANING THESE BONES IN THE HAND, FOUR METACARPALS WHILE PLAYING FOOTBALL.
HE'S GETTING A CAST THAT WILL ALLOW HIM TO CONTINUE PLAYING FOOTBALL.
IS THIS WISE, PETE?
>> FIRST OF ALL, I DON'T WANT TO MAKE ANY JUDGMENT WITHOUT SEEING THE X-RAY
OR NOT BEING THE TREATING PHYSICIAN, SO I THINK THAT I WANT TO GIVE SOME
DISCRETION TO THE TREATING PHYSICIAN BECAUSE THEY ACTUALLY KNOW THE CASE.
IT ALL COMES DOWN TO THESE METACARPAL FINGERS.
IF YOU CAN'T MAKE A CLOSED FIST, THEN THOSE NEED SURGERY,
BUT IF YOU CAN MAKE A CLOSED FIST WITHOUT ANY DEFORMITY OF THE HAND,
CASTING IS APPROPRIATE.
WITH FOOTBALL PLAYERS WITH FRACTURES PLAY IN A CAST.
IT'S DIFFICULT TO SAY IN THIS CIRCUMSTANCE, BUT I HAVE DONE IT BEFORE.
>> SO, I MEAN, THE TIME THAT
I'VE SEEN METACARPAL FRACTURES
ARE DRUNK COLLEGE PEOPLE HITTING WALLS.
I MEAN, IT MAY NOT BE COLLEGE KIDS, BUT IT'S YOUNG PEOPLE
WHO ARE OFTEN ALCOHOLICALLY OVERDONE AND THEY'RE IN AN ANGER THING
AND A GIRLFRIEND JUST DUMPED THEM AND/OR THEY'RE A THREAT TO SOMEBODY,
IT WORRIES ME, AND THEN THEY HIT A BRICK WALL OR THEY HIT
A -- YOU KNOW, THEY PUT A HOLE IN A PLASTER BOARD AND BREAK THE METACARPAL.
IS THAT THE MOST COMMON?
>> YEAH, CALLED BOXERS FRACTURE.
IT'S THE ONE THAT GOES FROM THE SMALL FINGER JUST AT THE NECK OF THE FRACTURE.
THOSE ARE USUALLY TREATED NONSURGICALLY.
IF THEY'RE SIGNIFICANT DEFORMITY TO THEM THEY MAY NEED TO BE REDUCED AND PINNED.
>> THAT MAKES ME THINK IT WOULD BE A SURGICAL REPAIR,
BUT YOU'RE RIGHT, LET'S GIVE IT TO THE --
>> THAT CIRCUMSTANCE THEY WERE STEPPED ON OR DIRECT BLOW,
THOSE CIRCUMSTANCES THERE'S VERY LITTLE DISPLACEMENT IN THAT SCENARIO,
BUT AGAIN, I WOULD HAVE TO SEE THE X-RAYS TO GIVE A THOROUGH RECOMMENDATION.
>> OKAY.
SO AFTER YOU HAVE YOUR
SHOULDER REPAIRED, WHAT DO YOU NEED TO DO TO KEEP IT HEALTHY AND FULLY RESTORED?
>> PEOPLE COME TO PHYSICAL THERAPY FOR TWO PROBLEMS.
ONE, PAIN, AND MORE IMPORTANTLY IS LOSS OF FUNCTION.
AT LEAST 25% OF MY DAY IS SPENT SPECIFICALLY ON SHOULDER ISSUES.
WHETHER IT'S POSTSURGERY REHABILITATION, IF IT'S PRESURGERY REHABILITATION
OR MAYBE AFTER AN INJURY OR ACCIDENT.
OFTEN WE WORK IN CONJUNCTION WITH THE ORTHOPEDIC SURGEON,
THE PATIENT MIGHT GO TO SEE THE DOCTOR AND THE SURGEON WILL FORM A THOROUGH ASSESSMENT,
AND OFTEN THEY'LL MAKE A DECISION, HEY,
LET'S TRY SOME PHYSICAL THERAPY TO SEE IF WE CAN AVOID SURGERY.
WE CALL -- REHABILITATION PRIOR TO SURGERY, WE CALL IT PREHAB,
AND THAT IS SOMETIMES WHAT WE'LL DO WITH A PATIENT TO TRY TO STRENGTHEN
OTHER SURROUNDING MUSCLES, TRY TO GET BACK RANGE OF MOTION
PRIOR TO THE SURGERY TO HELP THE OUTCOME AFTER SURGERY.
TRYING TO GET THE ARM MOVING TO THE FULL MOVEMENT TO REACH UP,
REACH DOWN, OUT TO THE SIDE.
ONE OF THE BIG FUNCTIONAL MOVEMENTS WE WORK ON QUITE A BIT
IS REACHING BEHIND THE BACK.
THINK ABOUT HOW MANY TIMES YOU WANT TO TUCK A SHIRT IN OR MAYBE SOMEBODY TO HOOK A BRA.
WE NEED TO HAVE THAT ABILITY TO REACH BEHIND OUR BACK.
IT'S VERY, VERY IMPORTANT.
POSTOPERATIVE REHABILITATION IS SOMETHING THAT WE WORK
IN CONCERT CLOSELY WITH THE ORTHOPEDIC SURGEON.
WE WILL FOLLOW PROTOCOL AND WITHIN THAT PROTOCOL
OFTEN WE START WITH RANGE OF MOTION EXERCISES.
THIS IS A VERY COMMON MANEUVER, POSTSURGERY.
WE MIGHT BE WORKING WITH A PERSON, NICE SHORT RANGE.
WHEN WE HAVE PATIENTS WITH SHOULDER IMPINGEMENT OR A PINCHED TENDON
WE'LL WORK ON THIS DIRECTION OF MOVEMENT.
TO START WITH WITH OUR REHABILITATION AS I MENTIONED BEFORE WE USE RANGE OF MOTION.
WE MIGHT USE AN EXERCISE BALL TO WORK ON FULL RANGE BEFORE WE ACTUALLY EVEN THROW THE BALL,
SO ONCE WE GET TO THE POINT WHERE THEY HAVE THE RANGE OF MOTION,
THEY CAN THROW THE BALL.
OUR NEXT STEPS IN THAT PROCESS WOULD BE, FOR EXAMPLE, USING A PULLEY
OR A STICK TO ASSIST WITH THAT RANGE OF MOTION.
WE THEN PROGRESS TO ICE SO HE PRETTYIC STRENGTHENING, LIKE WITH RUBBER BANDS,
THINGS LIKE THAT, TO HELP BUILD STRENGTHS AND WE WORK TOWARDS FUNCTIONAL THINGS
LIKE REACHING INTO A CUPBOARD.
A COMMON PIECE OF EQUIPMENT THAT WE USE IN PHYSICAL THERAPY IS ELASTIC TUBING.
THIS IS TUBING OR BAND USUALLY NONLATEX, IT'S SOMETHING WE CAN INTEGRITY INTO STRENGTH
-- INTEGRATE INTO STRENGTHENING.
WE WORK ON ROTATOR CUFF STRENGTHENING VERY OFTEN WITH THIS TYPE OF EXERCISE.
MAYBE WE DO A SINGLE ARM. WE CAN DO A DOUBLE ARM.
SHOULDER PROBLEMS TAKE TIME TO WORK ON.
IT'S NOT SOMETHING THAT'S GOING TO GET BETTER OVERNIGHT.
WHEN WE WORK WITH A PERSON, WE WANT TO TEACH THEM AND EDUCATE THEM ON THEIR PROBLEM,
AND PART OF THAT EDUCATION IS GIVING THEM A LITTLE BIT OF A
PATIENCE AND SHOWING THEM IT WILL GET BETTER.
THE KEY IS TO CONTINUALLY WORK ON IT AND NOT GIVE UP.
>> THANK YOU, CHUCK, FOR THAT.
ONE OF THE VERY IMPORTANT PERSONS IN BROOKINGS, SOUTH DAKOTA, CHUCK.
AND HE MENTIONED PREHAB IN THE VIDEO.
SO PREHAB IS BEFORE SURGERY, RIGHT?
REHAB ONLY PREHAB.
EXPLAIN THE VALUE OF PREHAB AND WHAT IT'S ALL ABOUT.
>> IT'S RARE TO HAVE A PATIENT WHO WOULDN'T BENEFIT FROM PREOPERATIVE REHABILITATION.
I GUESS WE USE IT PROBABLY THE MOST IN OUR ADULT RECONSTRUCTION PATIENTS,
TOTAL KNEE REPLACEMENT, TOTAL SHOULDER REPLACEMENTS, TOTAL HIP REPLACEMENTS.
THEY CAN BE AS EXTENSIVE AS FOUR WEEKS OF PHYSICAL THERAPY
OR IT CAN BE A ONE-TIME VISIT TO GET A HOME EXERCISE PROGRAM
TO GET THE PATIENT GOING, JUST KIND OF DEPENDS ON THE PATIENT AND WHAT THEY NEED.
>> OKAY.
AND, I MEAN, YOU'VE DONE RESEARCH ON PREHAB?
YOU'RE RESEARCHING ALMOST EVERYTHING.
>> NOT IN THE SHOULDERS.
I BELIEVE IN PREHAB DEFINITELY WITH ACL TEARS.
WHEN SOMEONE RUPTURES THEIR ACL IN THEIR KNEE,
THERE HAVE BEEN STUDIES THAT SHOW THE OUTCOMES ARE BETTER IF YOU DO PREHAB IN THE KNEE.
I HAVEN'T STUDIED IN THE SHOULDER.
I THINK THAT THERE'S VALUE THERE.
THE ONE THING THAT YOU HAVE TO BE CONCERNED ABOUT IS IF YOU'RE HAVING SURGERY,
SOME INSURANCE COMPANIES LIMIT THE AMOUNT OF THERAPY VISITS SO
I THINK IT'S MORE IMPORTANT TO BE ABLE TO DO IT AFTERWARDS
BUT I THINK THERE'S VALUE IF YOU CAN START IT BEFOREHAND AS WELL.
>> I THINK THE VALUE OF HAVING STRONG MUSCLES WITH WHICH TO -- TO SEW INTO AND FIX,
THERE IT IS.
WE HAVE A BUNCH OF QUESTIONS. WE APPRECIATE YOUR QUESTIONS, THANK YOU.
BUT LET'S DO THE TELESTRATOR FIRST.
WE HAVE A CASE.
>> SO THIS IS A PATIENT OF MINE, 54-YEAR-OLD GENTLEMAN FROM BROOKINGS.
THIS ACTUALLY IS THE SECOND SHOULDER SURGERY I DID ON HIM.
WE FIXED HIS OTHER SHOULDER A YEAR AGO, AND THEN ABOUT SIX WEEKS AGO,
WE WENT TO THE OPERATING ROOM TO REPAIR HIS ROTATOR CUFF
AND WE HAD THE VIDEO CREW THERE AND SO WE CAN KIND OF SHOW A LITTLE BIT
ABOUT -- ABOUT SHOULDER SURGERY.
SO THIS IS ARTHROSCOPIC SHOULDER SURGERY TO KIND OF GET YOU ORIENTED HERE,
WE'RE LOOKING INTO THE SHOULDER FROM BACK TO FRONT.
>> OKAY.
>> AND THE PATIENT IS IN A SITTING POSITION,
SO OVER HERE ON THE LEFT SIDE WOULD BE THEIR CHEST.
THIS IS THE FRONT OF THE SHOULDER HERE.
THIS IS THE OUTSIDE OF THE SHOULDER.
DOWN HERE IS THE HUMERAL HEAD AND THIS IS A LITTLE BIT OF
THE TORN ROTATOR CUFF UP IN THIS REGION HERE.
THIS BIG DARK SPACE YOU SEE IN HERE IS THE ACTUAL TEAR IN HIS ROTATOR CUFF
AND WE'RE GOING TO GO THROUGH THE SURGERY QUICKLY.
YOU CAN SEE DEBRIDEMENT, REMOVAL OF BONE SPURS AND ARTHRITIS.
HERE I BROUGHT A SHAVER IN.
WE'RE CLEANING UP TORN AND LOOSE PIECES OF TENDON AND
OF LABRAL CARTILAGE TO CLEAN THE SHOULDER AS BEST WE CAN.
YOU SEE THE SHAVING TOOL HAS SUCTION APPLIED TO IT SO IT
SUCKS THESE LOOSE PIECES OF TISSUE IN.
IT THEN TRIMS THEM OFF AND SUCKS THEM OUT OF THE JOINT.
IT'S LIKE MERRY MAIDS SHOWED UP AND CLEANED UP YOUR ROOM
OR TAKING A HANDFUL OF GRAVEL OUT OF YOUR WORK BOOT.
ONCE THIS IS FINISHED YOU CAN SEE THE JOINT IS CLEAN.
NOW I BROUGHT THE SCOPE OUT AND I'M PUTTING IT BACK IN.
IN THE PREVIOUS SPACE THE ROTATOR CUFF WAS THE CEILING,
NOW THE ROTATOR CUFF IS THE FLOOR.
AND THIS SHOWS THE TEAR IN THE ROTATOR CUFF, SO THIS IS THE HOLE IN THE ROTATOR CUFF.
YOU CAN SEE HERE, THIS IS THE ROTATOR CUFF TENDON COMING ACROSS,
AND THEN THIS IS THE BONE OF THE PROXIMAL HUMERUS WHERE IT SHOULD ATTACH.
BEFORE WE REPAIR THE ROTATOR CUFF WE'VE GOT WORK.
WE HAVE TO REMOVE A BONE SPUR AND TAKE ARTHRITIS OFF THE END OF THE COLLARBONE.
SO IN THIS PICTURE, THE BONE SPUR IS COVERED BY THIS TISSUE ABOVE HERE,
AND YOU CAN SEE THAT THIS TISSUE IS BADLY FRAYED.
WHAT'S BEEN GOING ON IS THE ROTATOR CUFF DOWN HERE
HAS BEEN COMING UP AND IT'S BEEN IMPACTING THIS SURFACE
WHAT WE CALL IMPINGEMENT FOR YEARS.
THE TISSUE ON THE SPUR HAS FRAYED AS A RESULT OF THAT,
BUT THE BONE IS TOUGHER THAN THE TENDON,
AND IT CREATES THE HOLE IN THE ROTATOR CUFF.
WE'RE GOING TO GET RID OF THAT SPUR.
WE DO THAT FOR A NUMBER OF REASONS AND KEITH COULD PROBABLY TELL YOU BETTER THAN I
EXACTLY WHY THIS WORKS BUT I THINK OF IT AS A COUPLE OF THINGS.
NUMBER ONE IS, IT MAKES THE SURGERY A LOT EASIER IF I CAN GET THIS THING OUT OF MY WAY
AND I'VE GOT A LOT MORE SPACE TO WORK WITH.
SECONDLY, I'M GOING TO INCREASE THIS DISTANCE BETWEEN
THE ROTATOR CUFF AND THE BONE ABOVE IT, AND THAT DECOMPRESSES MY REPAIR
SO THAT THE REPAIR IS ABLE TO HEAL WITHOUT THAT BONE PINGING ON IT --
IMPINGING ON IT.
THIS IS AFTER I FINISH THAT -- HERE WE GO.
WE'RE JUST GETTING STARTED.
REMOVE THE SPUR AND THIS IS AFTER THE SPUR HAS BEEN REMOVED.
SO THE SPUR WAS HERE, AND NOW THE BONE IS UP HERE, AND SO
I'VE INCREASED THAT DISTANCE DECOMPRESSING THE ROTATOR CUFF.
>> OKAY.
>> AFTER THAT'S DONE, WE'VE GOT TO REMOVE THE ARTHRITIS OFF THE END OF THE COLLARBONE,
AND IN THIS PICTURE, YOU CAN SEE THE END OF THE COLLARBONE.
IT'S SITTING RIGHT HERE.
REMEMBER WHEN WE WERE IN THE SHOULDER, THE SURFACES OF THE SOCKET
AND THE BALL WERE COVERED WITH A BEAUTIFUL SMOOTH WHITE CARTILAGE,
AND THIS INSTEAD IS A KIND OF UGLY GRAY AND THIN,
THAT'S WHAT ARTHRITIS -- BONE ON BONE
ARTHRITIS LOOKS LIKE, AND THAT'S BEEN FOUND TO BE PAINFUL
SO WHILE WE'RE IN THERE I'M GUIDING TO GOING TO USE THE BURR TOOL
TO REMOVE THE ARTHRITIS FROM THE END OF THE COLLARBONE.
YOU CAN WATCH THAT GETTING STARTED.
THEN WHEN WE'RE FINISHED WE'VE GOT THIS BEAUTIFUL SURFACE,
WE'RE DOWN TO THE BONE MARROW, AND IN HERE ARE THE STEM CELLS
AND THEY'RE GOING TO COME OUT AND THEY'RE GOING TO
REPOPULATE THAT SURFACE WITH A SMOOTH WHITE CARTILAGE.
>> THAT'S THE COLLARBONE.
>> THAT'S THE COLLARBONE,
THAT'S YOUR CLAVICLE, EXACTLY.
NOW WE'VE GOT THAT DONE, WE'VE GOT TO REPAIR OUR ROTATOR CUFF.
HERE YOU SEE ME PLACING AN ANCHOR INTO THE BONE.
AFTER I SCREWED THE ANCHOR INTO THE BONE AND EXTRACTED THE INSERTION TOOL,
YOU'LL SEE THE SUTURES COMING OUT OF THE BONE.
PEOPLE OFTEN ASK ME HOW ARE YOU GOING TO REPAIR THIS THING THROUGH THE SCOPE,
AND THE KEY IS RIGHT THERE.
NOW I HAVE SUTURES COMING OUT OF THE BONE.
I CAN PASS THOSE SUTURES THROUGH THE BONE AND REPAIR THAT HOLE IN THE ROTATOR CUFF.
SO IF YOU LOOK AT THIS, I'VE GOT FOUR STRANDS OF SUTURE,
AND I'M GOING TO PASS THOSE FOUR STRANDS THROUGH THE TENDON LIKE THIS
AND THEN I'M GOING TO TIE MY KNOT AND THAT'S GOING TO CINCH
THE ROTATOR CUFF BACK DOWN ONTO THE BONE FROM WHENCE IT TORE.
TO PASS THOSE SUTURES WE HAVE A NUMBER OF DIFFERENT TECHNIQUES.
THIS IS THE -- TECHNIQUES.
AS THE NEEDLE PASSES THROUGH THE TENDON, IT PICKS UP THE SUTURE AND PASSES IT THROUGH.
I'M GOING TO DO THAT FOUR TIMES WITH THAT PARTICULAR DEVICE AND THEN WE'LL TIE OUR KNOTS.
THIS WILL BE TYING THE KNOTS.
YOU ACTUALLY TIE KNOTS IN THE TISSUE ARTHROSCOPICALLY.
YOU DON'T HAVE TO GET YOUR FINGERS IN THERE.
YOU CAN SEE THE KNOT PUSHER WE'RE USING TO CINCH THAT KNOT DOWN ONTO THE TENDON
AND THAT PULLS OUR -- THE TENDON BACK DOWN ONTO THE BONE HERE.
NOW YOU CAN SEE THERE'S A LITTLE GAP HERE, AND TO CLOSE THAT GAP,
I'M GOING TO USE WHAT'S CALLED A SUTURE BRIDGE REPAIR.
I'M GOING TO PLACE TWO MORE ANCHORS AND TAKE THOSE FOUR STRANDS OF SUTURE
AND CROSS THE REPAIR WITH THEM, AND THAT REAPPROXIMATES THAT TENDON
DOWN TO THE ENTIRE FOOTPRINT OF THE ROTATOR CUFF WHICH
IS USUALLY TWO-THIRDS OF AN INCH OR SO.
YOU CAN SEE US PATTING THE SUTURE ANCHOR BACK INTO PLACE
AND AFTER I STUCK BOTH OF THOSE ANCHORS DOWN, WE'LL HAVE A GOOD, SOLID REPAIR.
I'VE GOT TO CUT THESE SUTURES, AND WE HAVE A REMOTE SCISSORS
THAT WE'RE ABLE TO ACCOMPLISH THAT WITH AND THAT'S WHAT IT LOOKS LIKE AT THE END.
SO THIS IS THE EDGE OF THE ROTATOR CUFF.
THIS IS OUR BONE DOWN HERE.
THE FOOTPRINT OF THE SUPRASPINATUS OR ROTATOR CUFF TENDON ON THE BONE
IS ABOUT THAT BIG AND WE'VE REAPPROXIMATED THAT TENDON
DOWN ONTO THAT FOOTPRINT AND WE HOPE FOR GOOD TENDON TO BONE HEALING.
>> WOW.
>> THAT'S GORGEOUS.
GREAT REPAIR.
>> THAT WAS WONDERFUL TO SEE. I MEAN, YOU KNOW --
>> YOU JUST DID SEE IT.
>> IT WAS WONDERFUL.
[ LAUGHTER ]
>> IT WAS WONDERFUL.
YOU KNOW, ACTUALLY I'VE NEVER SEEN THAT BEFORE.
I MEAN, I'VE -- I DON'T THINK I'VE EVER BEEN INVOLVED WITH
ANY ORTHOPEDIC SURGERY IN MY TRAINING OR ANYTHING.
I'VE SEEN KNEES REPAIRED BY YOU ON OUR -- OUR CAMERA, BUT THIS IS GOOD.
WE HAVE A QUESTION FROM A FACEBOOK.
47-YEAR-OLD MAN HAD A ROTATOR CUFF SURGERY ON A LEFT SHOULDER
WITH NOT THE BEST RESULTS.
HE HAD A FAIR RANGE OF MOTION BUT PAIN AND WEAKNESS.
I'VE BEEN TOLD MY RIGHT ONE IS TORN BY PHYSICAL THERAPISTS
AND CHIROPRACTOR BELIEVES I TORE IT BECAUSE OF THE TROUBLE AFTER THE FIRST SURGERY.
WOULD IT BE WORTH IT TO HAVE SURGERY AFTER ALL THIS TIME? KEITH.
>> YOU KNOW, I THINK IT SHOULD BE INVESTIGATED.
HE SAID THIS CAUSE WAS IN HIS 40S.
>> YEAH, 47.
>> IF HE'S GOT A FULL THICKNESS TEAR OF HIS ROTATOR CUFF AND A YOUNG PERSON
IN THE MID 40S, YOU'RE LOOKING AT MANY YEARS TO LIVE AND THE
NATURAL HISTORY OF ROTATOR CUFF TEAR, SOME TEARS GET BIGGER OVER TIME.
IF YOU DECIDE TO PUT IT IT OFF NOW AND NOT INVESTIGATE THE FIXING
AND AND COME BACK IN FIVE OR SIX YEARS YOU MIGHT HAVE MISSED YOUR CHANCE.
I THINK IT'S A GOOD IDEA TO INVESTIGATE THAT TEAR
>> ALL RIGHT.
A MAN FROM SIOUX FALLS HAS SPINAL STENOSIS OF LOWER LUMBAR REGION
AND RECEIVED A COUPLE CORTISONE SHOTS.
IS PUTTING A CAGE IN A GOOD OPTION? PETE.
>> WELL, NEITHER KEITH NOR I ARE SPECIALISTS IN SPINE PROBLEMS OR SURGERY.
SPINAL STENOSIS IS A SERIOUS CONDITION, AND IT CAN BE PROGRESSIVE AND DISABLING.
I DEFINITELY THINK IT SHOULD BE LOOKED AT.
I'M OBVIOUSLY NOT IN A POSITION TO SAY WHETHER HE NEEDS A CAGE OR NOT,
BUT IF HE'S CONCERNED ABOUT THE ADVICE HE'S BEEN GIVEN SO FAR,
I WOULD SEEK OUT A SECOND OPINION FROM ANOTHER SPINE SPECIALIST.
>> YEP.
I ENCOURAGE THAT.
I THINK WHETHER YOU'RE AN INTERNIST AND PATIENT IS REQUESTING,
NOT QUITE HAPPY, GET ANOTHER OPINION.
IT DOESN'T MEAN THAT YOU CAN'T COME BACK.
IF A DOCTOR IS OFFENDED BY YOU SEEKING ANOTHER OPINION,
THEN YOU NEED ANOTHER OPINION.
>> AGREED.
>> A WOMAN FROM CHEMISTER ASKS -- CHESTER ASKS
WHAT ARE SOME DAILY HABITS YOU SUGGEST FROM KEEPING TO HAVE ME VISIT A ORTHOPEDIC SURGEON.
PREVENTIVE MEDICINE IS THE BEST MEDICINE. KEITH.
>> BEING FIT AS YOU BROUGHT UP I RECALLIER IT'S PROBABLY ONE
OF THE BEST THINGS YOU CAN DO.
AVOIDING TOBACCO USE IS AN IMPORTANT THING.
TRYING TO MAINTAIN AS CLOSE TO IDEAL BODY WEIGHT IS IMPORTANT.
IT COMES DOWN TO THE THINGS WE CAN PREVENT, BEING FIT'S REALLY IMPORTANT.
>> RIGHT.
AND I WOULD COME BACK, I DON'T KNOW THAT WE HAVE A GOOD ANSWER FOR
PEOPLE WHO DON'T HAVE A IDEAL BODY WEIGHT, BUT PEOPLE WHO ARE HEAVY,
IF THEY'RE IN CONDITION, THEY'RE BETTER.
IT'S NO QUESTION ABOUT IT, AND I WOULD SAY, YOU KNOW, START WITH A SLOW WALK
AND GRADUALLY INCREASE IT AND THERE'S PROBABLY NO BETTER EXERCISE THAN WALKING.
YOU BOTH AGREE?
>> I ENJOY SWIMMING.
>> BUT YOU'RE A SHOULDER GUY.
[ LAUGHTER ]
>> WHY WOULD YOU NOT SAY THAT?
A 55-YEAR-OLD MAN FROM WEBSTER IS A CARPENTER.
HIS SHOULDERS ARE FINE WHILE WORKING; HOWEVER,
HE WAKES UP WITH PAIN IN HIS SHOULDER JOINT. WHAT COULD BE CAUSING THAT?
>> TWO THINGS COME TO MIND ARE ROTATOR CUFF TENDONITIS OR
SUBACROMIAL BURSITIS, WHAT WE CALL IMPINGEMENT SYNDROME, WILL CAUSE PAIN AT NIGHT.
EARLY ARTHRITIC CHANGE CAN WAKE YOU UP AT NIGHT.
IT CAN BE THE LOW JOINT AT THE TOP OF THE SHOULDER
OR IN THE BIG BALLED SOCKET JOINT AS WELL.
I THINK IT'S WORTH A QUICK TRIP TO THE DOCTOR, MAYBE AN EXAM AND AN X-RAY.
>> NOW, IMPINGEMENT, EXPLAIN THAT.
KEITH, HE BROUGHT IT UP. YOU EXPLAIN IMPINGEMENT.
>> SURE.
>> THAT'S A COMMON PROBLEM, ISN'T IT.
>> YEAH.
I THINK DR. LOOBY'S PICTURES ON HIS SURGERY SHOWED IT QUITE WELL.
THERE'S EXTRINSIC IMPINGEMENT WHICH MEANS WHEN YOU RAISE
YOUR ARM UP THE SPACE BETWEEN THE ROTATOR CUFF AND THE BONE
WHERE THAT SPUR THAT DR. LOOBY POINTED OUT BECOMES NARROWED
AND YOU GET CONTACT THERE AND WEAR.
THERE'S ALSO THE CONCEPT OF INTRINSIC -- INTERNAL
IMPINGEMENT WHICH IS SOMETHING WE SEE IN BASEBALL PLAYERS AND
YOUNGER ATHLETES WHEN THEY COCK THEIR ARM BACK IN THE LATE COCKING PHASE
THE BACK END OF THE ROTATOR CUFF HITS THE LABRUM AND CAUSES
FINANCIAL TRANSACTION THROUGH THERE -- FRICTION THROUGH THERE.
THE REASONS PEOPLE SEEK A DOCTOR FOR MUSCULOSKELETAL CARE,
IT'S PROBABLY THE THIRD MOST COMMON REASON ASIDE FROM LOW BACK PAIN
AND CERVICAL SPINE PAIN.
>> PHYSICAL THERAPY CAN HELP?
>> OFTEN IT CAN.
>> WOMAN FROM BRANDON ASKS
DOES PARKINSON'S DISEASE CAUSE SHOULDER PROBLEMS? WOULD YOU KNOW, PETE?
>> PARKINSON'S DISEASE IS A HORRIBLE DISEASE AND CAN CAUSE
PROBLEMS IN MANY DIFFERENT AREAS OF THE BODY.
I'M NOT AWARE THAT PARKINSON'S IN PARTICULAR PREDISPOSES ONE TO SHOULDER PROBLEMS
BUT IT'S CERTAINLY NOT PROTECTIVE.
AND JUST LIKE EVERYBODY ELSE CAN GET SHOULDER PAIN,
PARKINSON'S PATIENTS CAN AS WELL.
>> IF YOU THINK ABOUT A PARKINSON'S PERSON,
THEY'RE AT SO HIGH RISK OF FALLING.
YOU COME DOWN LIKE THIS, IF YOU DON'T BREAK YOUR WRIST YOU DESTROY YOUR SHOULDER.
SO I WOULD SAY THAT.
I MEAN, I WOULD -- I WOULD SAY FALLING IS THE BIGGEST RISK.
I'M A 75-YEAR-OLD AND HAVE ROTATOR CUFF SURGERY SIX YEARS AGO.
IT'S CURRENTLY HURTING ME.
IS IT WORKSHEET GETTING -- WORTH GETTING REPEAT SURGERY? KEITH?
>> MAYBE.
IF YOU'RE HURTING, IT'S WORTH INVESTIGATING THE CAUSE.
POTENTIALLY THERE ARE SOME NONOPERATIVE WAYS TO GET THIS BETTER.
PHYSICAL THERAPY AS CHUCK POINTED OUT WITH.
>> START WITH YOUR PHYSICAL THERAPY AND GO FROM THERE.
>> YOUR PHYSICAL THERAPIST, PRIMARY CARE PHYSICIAN,
SURGEON, THEY CAN GIVE YOU GUIDANCE.
THERE ARE TIMES WHEN PEOPLE CAN HAVE RECURRENT TEARS AND
THERE ARE SURGICAL INTERVENTION AVAILABLE TO FIX THAT.
EITHER REPEAT ROTATOR CUFF SURGERY.
THERE'S TIMES WE DO SPECIAL SHOULDER REPLACEMENTS FOR THIS AS WELL.
SO THERE ARE OPTIONS AND IF YOU'RE STRUGGLING I THINK
THERE'S GOOD IDEA TO GET ADVICE FROM YOUR DOCTORS.
>> WE HAVE EIGHT QUESTIONS, FIVE MINUTES OR LESS. SPEED ROUND.
[ LAUGHTER ]
>> 65-YEAR-OLD -- 65-YEAR-OLD MAN FROM VAGA.
I HAVE A TORN ROTATOR CUFF.
IS THERE A CERTAIN EXERCISE YOU WOULD ADVISE IN THE WEIGHT ROOM?
ARE THERE ANY THAT YOU WOULD NOT SUGGEST?
>> THE ROTATOR CUFF STRENGTHENING EXERCISES YOU
SHOWED US SO BEAUTIFULLY EARLIER WOULD BE GOOD.
THE THINGS YOU WANT TO BE CAREFUL ABOUT ARE HEAVY LIFTING ABOVE SHOULDER HEIGHT.
SO DOING MILITARY PRESSES, DOING INCLINE BENCH,
THOSE WILL PROBABLY JUST EXACERBATE THE PROBLEM.
>> OKAY. THIS THING.
>> ABDUCTION OR SCAPTION,
INTERNAL RANGE OF MOTION, THOSE SHOULD BE -- SHOULD BE HELPFUL.
>> HAD A KNEE REPLACEMENT FIVE YEARS. IT ACHES AT NIGHT. WHAT CAN BE CAUSING THIS?
>> A LOT OF REASONS FOR PAIN AFTER TOTAL KNEE REPLACEMENT.
NUMBER ONE I WOULD SAY IT'S INCREDIBLY SUCCESSFUL PROCEDURE
IF YOU FOLLOW 100 PATIENTS FOR FIVE YEARS,
LITERALLY 99 OUT OF 100 WOULD SAY THEY'D GO THROUGH IT AGAIN.
SO IT'S UNUSUAL AT FIVE YEARS TO STILL BE HAVING PAIN.
INFECTION IS A CAUSE. LOOSENING IS A CAUSE. CAN BE BURSITIS OR TENDONITIS.
VERY, VERY RARELY AN ALLERGY TO THE METAL COMPONENTS.
>> SO GO IN AND BE --
>> GO TO YOUR SURGEON AND TALK IT OUT.
>> CALLER IN HER 60S IS A RUNNER AND HAS DECREASED
MOBILITY IN HER GREAT TOE AND AT TIMES PAIN.
HOW CAN SHE CONTINUE RUNNING WITHOUT PAIN IN HER TOE.
>> YEAH, VERY COMMON, OFTENTIMES YOU CAN GET A SPUR OR ARTHRITIS IN THAT JOINT.
ONE OF THE NONOPERATIVE WAYS TO CONSIDER IS GETTING A
STIFFENED SOLE OR STEEL SHANK IN THE SHOE.
TAKES STRESS OFF OF THAT JOINT. OVER-THE-COUNTER MEDICATIONS AT TIMES.
THERE ARE SURGICAL INTERVENTIONS AT FOOT AND
ANKLE SPECIALISTS THAT WE DO AT TIMES IF THOSE DON'T WORK.
WE CAN DO TREATMENT TO TRY TO HELP YOU RETURN TO RUNNING.
>> MAYBE MY WIFE SHOULD HAVE SOMEBODY CHECK HER BIG TOE, BECAUSE THAT'S WHO --
>> OH, THAT'S WHERE THAT CAME FROM?
[ LAUGHTER ]
>> 75-YEAR-OLD MAN FROM SIOUX FALLS HAD KNEE SURGERY ON THE
LEFT KNEE AND THE OTHER KNEE IS NOW BONE ON BONE.
WHAT OPTION IS BEST? INJECTION, EXERCISE OR SURGERY?
>> START WITH NONSURGICAL MANAGEMENT, PHYSICAL THERAPY TYPE EXERCISES,
TOPICAL ANALGESICS, MAYBE A CORTICOSTEROID INJECTION.
IF THAT FAILS YOU, TOTAL KNEE REPLACEMENT IS A GREAT OPTION.
>> DO YOU LIKE RUBBING TOPICAL SMELLY NONSTEROIDAL CREAMS ON JOINTS?
>> I'M ALL ABOUT WHAT WORKS.
>> I LIKE THAT ANSWER.
A MAN FROM WAGNER EXPERIENCED TINGLING IN HIS RIGHT HAND RING FINGER
MOST OF THE DAY AND SURGERY WAS DONE TO MOVE THE NERVE AT THE ELBOW
BUT THE SURGERY DIDN'T HELP WITH THE TINGLING.
WHAT CAN BE DONE TO IMPROVE THE PROBLEM, KEITH?
>> IT SOUNDS LIKE THE SURGERY WAS SOMETHING CALLED AN ULNAR NERVE TRANSPOSITION.
IT COMES OVER THE INSIDE PART OF THE ELBOW
AND THE PHYSICIANS THERE MOVED THE NERVE TO THE FRONT OF THE ELBOW
SO WHEN YOU BEND YOUR ELBOW, IT TAKES A SHORT CUT AND LESS TRACTION ON THE NERVE.
IS THAT THE SOURCE?
>> DISTRIBUTES DOWN TO THE FINGER.
>> I GUESS THE QUESTION IS WAS THAT REALLY
THE SPOT WHERE THE ENTRAPMENT WAS COMING?
IF YOU HAVE A PINCHED NERVE IN THE NECK,
IT COULD POTENTIALLY CAUSE NUMBNESS IN THAT FINGER.
IF YOU HAVE A PINCHED NERVE IN THE WRIST AS WELL,
SOMETHING CALLED ENTRAPMENT IN THE CANAL THAT CAN DO THAT AS WELL,
I THINK THAT DESERVES FURTHER INVESTIGATION.
>> OKAY, CHECK IT OUT. FOUR QUESTIONS, TWO MINUTES.
MAN FROM WAGNER EXPERIENCES TINGLING IN HIS --
40-YEAR-OLD FEMALE WAS PLAYING BASEBALL, GOT A KINK IN HER SHOULDER.
AT AGE 80 SHE STILL HAS HAD A PAIN EVERY NOW AND THEN.
HOW DOES SHE HELP THIS, PETE?
>> THROWING A BALL AT 40 YEARS OLD AND SHE DEVELOPED SHOULDER PAIN,
PROBABLY ROTATOR CUFF TENDONITIS, POSSIBLY TORN LABRUM,
40 YEARS LATER STILL HAS SYMPTOMS.
IF SHE CAME AND SAW ME IN THE OFFICE
I'D START NONSURGICAL, INJECTION, ANTI-INFLAMMATORY.
>> 80-YEAR-OLD WOMAN HAS REVERSE SHOULDER SURGERY TEN YEARS AGO,
CAN'T GET THAT ARM BEHIND HER BACK OR UP TO HER EAR.
I CAN COPE WITH THIS, BUT WHY IS MY ARM SORE ALL THE TIME
BETWEEN THE ELBOW AND THE SHOULDER? IT'S BEEN TEN YEARS.
>> SHE CAN'T GET HER ARM BEHIND HER BACK
AND THAT'S ONE OF THE LIMITATIONS OF THE SHOULDER REPLACEMENT.
WE DO THIS TO HELP PEOPLE REGAIN MOTION IN THE FORWARD AREA.
>> SO BE HAPPY WITH THAT?
>> CORRECT.
THIS IS A LIMITATION OF THE TECHNOLOGY THAT WE HAVE WITH THAT.
NOW, I GUESS ONE OF MY QUESTIONS HERE IS CAN YOU
POTENTIALLY HAVE A PINCHED NERVE IN THE NECK CAUSING PAIN IN THAT AREA?
WE'LL SOMETIMES GET REFERRED PAIN IN THAT AREA.
THERE COULD BE LOOSENING OF THE JOINT THERE.
IF YOU'RE NOT HAPPY WITH THE QUALITY OF LIFE, I'D INVESTIGATE.
>> WE'VE GOT 30 SECONDS.
I'M OVER 60, FELL ON MY HIP OVER A YEAR AGO,
I'VE BEEN DOING PT RECENTLY. WOULD IT BE WISE TO HAVE THE SHOT?
I DO EXERCISES EACH DAY. WOULD LOVE TO GET BACK TO WALKING
BUT IT BOTHERS ME. PETE.
>> IT'S BEEN LONG ENOUGH, IT'S UNLIKELY THIS IS A FRACTURE AFTER THE FALL,
SO IT'S PROBABLY WHAT WE CALL PROXIMAL IT BAND SYNDROME.
INJECTIONS ARE PROBABLY HELPFUL FOR THAT.
>> AND NOW, FOR THE WINNER OF TONIGHT'S PRAIRIE DOC QUIZ QUESTION.
THE SHOULDER IS A COMPLEX JOINT OF THREE BONES.
CAN YOU NAME THEM?
THE ANSWER IS: 1. THE HUMERUS, THE UPPER ARM BONE.
AND THAT'S NOT A FUNNY COMMENT.
2. THE CLAVICLE, THE COLLARBONE. AND 3. THE SCAPULA, SHOULDER BLADE.
THEY MAKE UP THE SHOULDER AND THE BONES OF THE SHOULDER AND
IT WAS SHIRLEY DAVIS OF CLEAR LAKE WHO ANSWERED THE QUESTION CORRECTLY.
THANK YOU SHIRLEY FOR PARTICIPATING AND
A BOOK WILL BE IN THE MAIL TO YOU SOON!
WE'LL BE RIGHT BACK AFTER THIS.
>> BECAUSE YOU WANT TO BE THERE FOR LIFE'S IMPORTANT
MILESTONES THERE ARE MANY REASONS TO GET LIFESAVING CANCER SCREENING.
MORE THAN 4,000 WOMEN DIE EACH YEAR FROM CERVICAL CANCER BUT
REGULAR SCREENING CAN PREVENT THIS CANCER AND CATCH IT EARLY.
DO IT FOR THE PEOPLE YOU LOVE.
>> PROMISE?
>> PROMISE.
>> PROMISE?
>> PROMISE.
>> MAKE THE PROMISE TO GET SCREENED.
FOR MORE INFORMATION ABOUT LIFESAVING SCREENINGS OR
AVAILABLE FINANCIAL ASSISTANCE, VISIT GETSCREENEDSD.ORG.
>> THE SHOULDER IS AN ELEGANT PIECE OF MACHINERY WHICH CAN
MOVE AND ROTATE IN MORE DIRECTIONS THAN ANY OTHER JOINT IN THE BODY.
WITH SUCH FREEDOM OF MOVEMENT, HOWEVER, COMES LESS STABILITY
AND MORE RISK FOR INJURY.
THE UPPER ARM BONE, OR HUMERUS, AND THE SHOULDER BLADE,
OR SCAPULA, MAKE A BALL-AND-SOCKET-TYPE JOINT.
THE BALL IS HELD INTO THE SOCKET BY A COMPLEX OF ROTATOR CUFF MUSCLES,
TENDONS, LIGAMENTS AND A RIM OF CARTILAGE.
THIS WHOLE SHOULDER-JOINT-MUSCLE SYSTEM IS HELD ONTO THE CHEST
AND BODY BY THE COLLARBONE, OR THE CLAVICLE, AND MORE MUSCLES.
DESPITE MARVELOUS ENGINEERING AND DESIGN, HUMANS WILL OVER-STRETCH
AND OVER-USE THEIR SHOULDERS, AND INJURIES WILL HAPPEN.
MR. AB HAD FALLEN OFF A TRACTOR AND DISLOCATED HIS
RIGHT SHOULDER WHEN HE WAS IN HIS 30S.
HE'S BEEN ACTIVE AS A FARMER FOR MORE THAN 50 YEARS,
BUT OVER THE LAST FOUR TO FIVE MONTHS, HE'S NOTED
A GRADUAL WORSENING PAIN AND DIFFICULTY SHOVELING GRAIN.
HE TOLD HIS WIFE HE JUST CAN'T TAKE IT ANY LONGER,
AND SHE MADE THE APPOINTMENT.
THE PATIENT CAME TO MY OFFICE, LIKE MANY FARMERS,
A BIT RELUCTANT TO EXPLAIN HIS PROBLEM.
A NUMBER OF MEDICAL PROBLEMS CAN MASQUERADE AS SHOULDER PAIN,
AND SOME OF THEM ARE DANGEROUS.
A CAREFUL HISTORY-TAKING AND EXAM WAS NEEDED.
THE PAIN WAS NOT RELATED TO EXERTION AND RELIEVED BY
REST LIKE THAT FROM HEART TROUBLE.
IT DID NOT RADIATE BELOW THE ELBOW AND DID NOT HAVE ASSOCIATED NECK PAIN
LIKE THAT FROM NECK-SPINE NERVE TROUBLE.
IT WAS NOT MADE BETTER BY EATING LIKE THAT FROM PEPTIC ULCER PROBLEMS.
IT WAS NOT MADE WORSE BY A BIG AND FATTY MEAL
LIKE THAT FROM GALL BLADDER STONES.
FINALLY, IT WAS NOT RELATED TO BREATHING,
AND THERE WAS NO FEVER LIKE THAT FROM PNEUMONIA.
MR. AB'S PAIN WAS CLEARLY MADE WORSE WITH MOVEMENT OF THE SHOULDER AND NOTHING ELSE.
WHEN HIS SHIRT WAS OFF, I NOTED BOTH SHOULDERS WERE SYMMETRICAL.
WITH THUMBS DOWN AND ARMS OUTSTRETCHED, IT HURT AS HE RAISED HIS RIGHT ARM.
WHEN I BENT THAT ARM AT THE ELBOW AND ROTATED IT DOWNWARD,
HE WINCED AND PROTESTED.
THIS WAS THE PICTURE OF INFLAMED, SWOLLEN, AND TENDER STRUCTURES RUBBING
WHILE TRYING TO PASS UNDER A TIGHT ARCH OF BONE AND LIGAMENT.
MR. AB WENT TO PHYSICAL THERAPY, HIRED SOMEONE ELSE TO SHOVEL,
RESTED HIS SHOULDER AND, OVER TIME, THE INJURY HEALED AND PAIN WENT AWAY.
WE TAKE FOR GRANTED THE ELEGANT ENGINEERING AND DESIGN OF THE HUMAN SHOULDER.
>> A BIG THANK YOU TO OUR GUESTS, DR. PETE LOOBY AND
DR. KEITH BAUMGARTEN, OF THE ORTHOPEDIC INSTITUTE.
WE APPRECIATE THEIR VOLUNTEERING TO JOIN US TONIGHT. THANK YOU BOTH VERY MUCH.
>> THANK YOU, RICK.
>> WELL, IT IS THAT TIME OF YEAR AGAIN, THE FLU SEASON IS COMING.
NOW IS THE TIME TO START GETTING FLU SHOTS.
REMEMBER, IT TAKES TWO TO THREE WEEKS FOR IT TO BECOME FULLY EFFECTIVE.
THAT DOES IT FOR TONIGHT.
FROM ALL OF US HERE AT "ON CALL WITH THE PRAIRIE DOC,"
UNTIL NEXT TIME, STAY HEALTHY OUT THERE, PEOPLE.
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