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>> Well, welcome to HealthLine.

I'm Jennifer Blomquist.

I'm so glad you joined us this evening.

I get to host the program and I get to learn a lot and so will you.

I know we have a lot of regulars out there.

You kind of know the drill you can call in any time during the show.

That's why we keep the phone number there at the bottom of the screen so that you can call in any time or text a question any time to our guest.

We have an orthopedic surgeon here tonight and the phone lines are open now so you can call anytime now until about seven fifty four people think we go straight up to eight o'clock and we don't.

So last week I think we missed a few people because they called too late.

So call sooner rather than later if you'd like to ask our guest a question, let me just review the phone numbers again.

It's (969) 27 two zero.

That's a toll free call even if you're outside of Fort Wayne just an 866- in front of there and then the next number is a little bit different.

It's (969) 27 three zero if you're going to text, I want to assure you that your phone number remains private but if you feel comfortable maybe just give us your name and location from where you're calling and you can send your question in that way.

Also when you call in we don't just throw you on the air.

You can ask it live on the air if you want or you can relay your question to our call screener.

So just want to let you know how it works so you can get your questions answered tonight we do have an orthopedics surgeon with us which I appreciate he's been with.

This is the first time that he's joining us tonight.

So Dr.

Michael Rosen, please welcome him.

>> Thank you so much for coming.

Yeah, thanks for having me.

I'm excited to be here and we're going to be talking about the shoulder primarily and whether it's issues with shoulder pain maybe related to an injury or possibly overuse different options.

You have this I'm so glad he brought this.

It's a model and I told Dr.

Rosen I said, you know, you look at this stuff all day but for most of us, you know, we may not know what exactly he's referring to when he's talking about parts of the shoulder.

So I'm glad that we have that model with us tonight.

So like I said, please call any time we're going to start talking about shoulder pain and some options.

You may have as a patient maybe your candidate for one procedure versus another but feel free to call him or text with that question any time.

>> So would you say most people those shoulder pain is it does it tend to be more from an injury in most cases or do you think it's primarily more related to overuse?

>> It really depends.

It really comes down to their age sometimes too.

You see a lot of injuries and in younger athletes I do sports medicine subspecialty.

Yeah, we see a lot of injuries with that sometimes overuse as well as your age as the population gets a little bit older, sometimes you get some overuse and then arthritis kind of chips in there as well at the end and that's what we brought the models forward to maybe discuss a little bit later on.

But you get a wide range injuries overuse arthritis.

That's really the kind of the broad spectrum of things we see in the shoulder and it it's really a kind of very wide range of of options there.

>> I'm assuming if you've got an injury you probably should get that checked out right away.

The overuse stuff, the pain I'm assuming that kind comes on maybe gradually.

>> I don't know if if I'm correct about that.

Yeah.

You know, injuries a lot of times that's a more dramatic type of episode.

So it could be you know, for an athlete, you know, during football season here we see him during football games.

It could be a fall at home, something like that.

And a lot of times there's a sudden change in an earlier function or your pain level where you are fine all of a sudden you possibly can't lift your arm up in the air.

You're having pain that's really debilitating.

So this one's a little bit more obvious.

The overuse one sometimes those creep up on people where maybe take several months before they actually seek treatment.

But by that time a lot of people have tried some of the more ordinary things, you know, modifying those activities, things like that.

So if it's been going on for some time, it may be something as well to get investigated and looked at.

>> And I know we've had many orthopedic specialists come on the program over the years and they've all emphasized to our audience that you take a conservative approach.

I think some people you know, they maybe put it off if they have some pain because they'll think I do not want surgery.

I don't want the cost.

I don't want the recovery time.

So I don't know what would be if you know, if you have a shoulder that's bothering you, you know it's not from a particular injury, what are you going to do with that patient?

>> What are some of the maybe baby steps you take to begin with, you know, orthopedic surgeons but it really comes down to the majority of the people we see in the office we treat non surgically.

OK, so it's so it really starts with a conservative approach really for for essentially everyone.

And then you know, as time goes on, if it's an overuse thing and it's been going on for some time, maybe you start to investigate other options.

But but but we really kind of treat everything conservatively from the start and a lot of times patients have started that on their own so they've modified those activities, limit the things that are that are bothering them and then they try maybe acetaminophen or anti inflammatory medicines, maybe some home exercises as well.

I've had patients that have pulled up exercises on the Internet and started doing some of those on their own.

Yeah.

And then if those aren't providing any relief, we have some options that are still not surgical that could really still offer some benefit.

>> I mean are you going to do you start as far as imaging goes you normally just start with an x ray and then if that doesn't show anything then would you do something more like an MRI?

>> Yeah, you know, an x ray is really the first thing we we can get those pretty easily the office that's where the first investigation we can look at and it really tells a lot about the shoulder.

So when a young person a lot of times you'd expect to see maybe some open growth plate so it tells us that they're still growing if they're skeletal, immature or if they're more high school college age you expect to see some pretty normal anatomy not any bone spurs or really signs of arthritis.

Sometimes you see signs of an injury, maybe a sprained where where one of the bones is a little bit usually located or if there's a little bump that maybe signifies if the ball had maybe gone to the socket and popped back in, we can see things like that in an x ray that really give clues.

But but some of the main things we really look at when we when we see someone in the office we ask them what happened as we listen to them because patients if you really listen to them closely, they'll point in the right direction.

They'll tell you what's been going on and it really allows you to kind of hone in on a good physical exam and the x ray is just part of that process.

But yeah, we oftentimes start with that.

It really gives a lot of useful information and we kind of correlate, you know, with what they're saying.

>> Sure.

All right.

Well, we have lots more to talk about but I didn't want to miss this question that somebody called in and wanted me to ask the question for him.

So thank you, Tom from Fort Wayne .

He said he got a flu shot.

This is a very you know, seasonal question here.

>> I got a flu shot in the shoulder and it hurts.

Is that normal?

Yeah.

You know, that's pretty common side effect from the flu shot.

It doesn't necessarily signify there's anything wrong with the shoulder that any damage was done sometimes to local irritation for something like that could be a cause if it's something that really causes a prolonged pain or limitation, maybe be something to investigate but really wouldn't you to to concerning initially just to try to see if the inflammation everything from the injection process can die out.

>> Does it would you even put like a time frame on that?

You know, maybe forty eight seventy two hours I'd say at least you know and if you can kind of get it to just kind of modify your doing so you know, just kind of take it easy if you were otherwise you'd be doing something really active.

Maybe you kind of protect that area for a little bit but I'd say a few days you'd you'd expect that at least then if it's really starting to bother you maybe taking some antiinflammatory medicine, something like that to maybe help out with that process.

But if it's not getting any better after you know, say a couple of days to a week or so, you know, we'd be able to look at it.

But but but I'd really be surprised if there was something that was cutely injured with that.

>> Yeah.

So it really just kind of be a wait and see approach, maybe some physical therapy, something like that that could offer some some benefit maybe next year he'll take the other arm because they usually do ask you you know, do you have a preference and I guess as long as you don't have a reason to do one over the other, you could choose the choose whatever you like.

>> We are also getting a text message right now from somebody this is from well I don't know what the text message keep coming in because it looks like it's a longer question.

Oh, here it is.

OK, let's see this is from Wesley from Fort Wayne .

He said hello.

My mom had a past broken wrist.

Sometimes she will have pain her shoulder OK would would it be from the wrist arthritis or something else?

>> I mean you really could get some some referred pain so that's a possibility but it could also come from the injury that led to the broken wrist in the first place.

>> So if there was a trauma which you used you would expect with somebody that broke the wrist you maybe injured the shoulder as well and the the obvious thing at the time is the deformity you see in the wrist, the severe pain, all that.

But that's healing process takes place sometimes you start to notice some of these secondary injuries and they do pop up from time to time.

So it's very possible it was something could have been injured during that that that that process but referred pain.

>> We see that all the time mean patients talk about their shoulder and kind of going down their arm all the time.

Shoulder pain wasn't paying down the side of the arm.

Sometimes people talk about it going into their forearm, even into their hands even though there's not a great reason for that.

>> Sometimes you do see it from time to time.

So so there is a possibility that could have kind of been related to that injury.

Another one OK.

All right.

Well thank you so much to everyone who's contacted us so far.

Again, it's so easy to send a text we've had a lot of people take advantage of that.

We just started doing that this past winter.

So I hope you continue to do that.

It's like I said, perfectly safe.

We're not sure your phone number or anything like that, just your name and where you're calling from if you feel comfortable sharing that and again the phone lines are open.

We love having that.

I love it because having live interaction if you're willing to call in and you can have a conversation with Dr.

Rosen, he might need to ask you some more questions to give you a better answer.

>> So let's let's go ahead and talk about so somebody comes in, they have pain.

You start conservatively at what like you had mentioned you know, even over the counter medications or I don't even know our injections or steroids help for with the shoulder.

>> Should that be the next step?

Yeah, I mean a lot of times we start with those modifying the activities that hurt the most.

That's kind of the most obvious thing patients I take care of that on their own.

Some of those anti inflammatory medicines over the counter can be helpful but physical therapy is also very helpful.

The shoulder is a really complex joint so there's a lot of muscle attached to the shoulder.

It moves in a wide range of motions and so if there's any abnormality or any dysfunction in any of those muscles it can really start to cost lead to some pain and some overuse and sometimes an injury with that.

So physical therapy can really kind of connect at all and start to get everything to move more in harmony and that can really help out overall injections are also another step of that process.

People call it cortisone.

It's a potent antiinflammatory medicine.

It is a steroid typically we can put that the subeconomy space would be the most common place.

>> That's really a space right above the rotator cuff.

You want to you want to go ahead show us on the model.

Yeah, Where you know on these models these are shoulder replacement models but but essentially the rotator cuff would attach to the greater to Rossotti here.

So this is basically right above that so so we can put an injection right in here so it kind of base the rotator cuff in the steroid to try to decrease the inflammation, ultimately lead to improved pain, maybe allow to participate in the physical therapy more so than you otherwise would have if you were experiencing all that pain.

So it is important to all the music quite often I think, you know, we want everything to be fixed so quickly and people I know who've had shoulder issues it can be take a while.

>> You know these conservative measures are great.

You avoid having to do an invasive procedure but that can take I see people that have had to work at it for a few months, you know, to get better.

>> You had a process of recovery is various for everyone.

It really depends on what you're trying to treat if it's a if it's an overuse thing sometimes just modifying what you're doing is really all it's going to take.

If there is some irritation that's maybe led to worse damage, possibly a partial tear, things like that that might take a little bit longer but for a partial tear typically we're looking at the rotator cuff that can be something that doesn't prove quite well with some conservative treatment.

It gives the body its ability to kind of heal itself.

And so when that tendon is still attached but maybe partially torn, it still has some potential to heal.

But that process can take some time.

It really depends.

That's why sometimes we get more imaging so like an MRI allows us to actually see the rotator cuff, look closely at those tendons, see if it's just irritation, if it's a partial tear, sometimes even a full tear.

A full tear is what we consider when when the when the muscles no longer attach to the bone.

Yeah.

Sometimes you can pick up on that on the on physical exam and those ones don't necessarily heal themselves but a lot of patients will have at least some irritation of the rotator cuff and maybe they're totally asymptomatic.

So we treat the patient, we don't treat the MRI, we do a good exam.

We see how they're doing if they're doing well and even if we have an MRI that shows a small tear, a lot of times we can get by with conservative things.

>> There are surgeries we can do as well.

So there's there's plenty of options.

Yeah, I guess it depends on where you are and what point in your life and whether or not surgery I know from many specialists we've had on before in this field of orthopedics sometimes let's say the patient you tell me if you want to do the surgery or when you know because depends on their pain tolerance, you know.

>> Yes.

Pain and dysfunction it really affects everyone differently.

>> Sports medicine in particular.

We're really interested in trying to let people do the activities they enjoy.

So if there's things that are getting in the way of you doing what you want to do, we can get an evaluation on you, do a good physical exam sometimes get an MRI, see if we need to really offer something that could really speed up the recovery process and not everything we do is is super invasive.

>> You know, there's a lot of minimally invasive things we do in the shoulder.

Shoulder arthroscopy is really one of my specialties.

So it's all minimally invasive sub centimeter kind of poke holes around the shoulder we can go in with with a camera on long skinny instruments.

>> We can repair rotator cuff tendons that way we can address biceps tendons.

That way we can shave off some areas, maybe some bone spurs that can be rubbing.

There's definitely things we can do less invasive that can still offer a huge benefit to patients, especially if they tried other things that they haven't been working.

>> Yeah, no I don't want to talk more about the surgical procedures because I think you know, people are amazed but you know, it's outpatient and so much easier than it was years ago.

So I don't I don't want to be Sirtex though from Dan from Fort Wayne .

He has wrist aches.

He says he's a fit fifty eight year old he's active but not but recently started having wrist aches out of the blue.

So he wants to know if this could be overuse or arthritis.

She said she doesn't recall a specific injury just started to hurt when he was doing his daily activities.

All right.

Yeah, you know, a lot of times in a in something like that it could be an overused thing, something that kind of creeps up, you know, possibly fifty eight years old maybe there was an injury in your youth when you were playing sports or something else like that that maybe predispose you to have something later on.

>> But a lot of times an overused thing would be the first thing we'd start looking at an X-ray would help to identify arthritis.

You can see arthritis on an X-ray so we'd be able to investigate that too.

But but sometimes it's it really could be a couple of different things.

But we could start by modifying what you're doing.

So if there's certain activities that really bother you, you would kind of back off on those and see if overall the pain improves then really we don't have to do anything much more than that.

But if it continues to progress, it really doesn't improve .

And you've tried some of the other things we had mentioned.

You know, an x ray is the first thing we can do to investigate it.

You can still get tendinitis in the wrist.

You can still get arthritis.

So there's there's several things that could still be and there's conservative things we can do for that.

>> Sometimes an injection can accelerate that process if it's really been some time and someone's looking for some relief.

So just something to consider.

>> Yeah.

I mean at least you have some options, you know and things to think about.

So you know, I was interested with the surgery.

Is it robotic surgery that you're doing with shoulder?

>> I don't even know if it's a shoulder replacement you talked about like you know the scoping and things.

Yeah.

So arthroscopy isn't isn't considered robotic.

It's more a minimally invasive approach.

So it's camera is long skinny instruments you go in there we can we the surgery is essentially done by watching a screen and we direct the camera and then we use other portals a little incisions where we bring in our instruments to really accomplish what we're trying to do, whether that's cleaning up something, repairing labrum for example, a rotator cuff, things like that.

We can do that through a scope.

The more the bigger surgeries that people ask about, you know, shoulder replacements there are robotic ways to put some of the components in.

It's not a true robotic procedure.

So you know, in other episodes, you know, you guys have talked about robotic hip and knee replacement in the shoulder.

We don't use it the same way but it does help to kind of guide we put some of the components for me personally the way I use modern technology if we're looking at a shoulder replacement I order a CAT scan for most patients it really helps us to evaluate the shoulder blade and the glenoid which is essentially the socket and what that allows us to do is evaluate that bone.

It's almost like a golf tee so there's some bone right on the top and then it narrows out very quickly.

So we'd like to see where that best bone is really helps to plan out where we'd like to put the components.

So that's our way to really use modern technology in shoulder after plastic or shoulder replacements.

>> But it's not it's not actually a robotic procedure.

We do some computer planning though we do that ahead of time.

Speaking of shoulder replacements, can you kind of refer to the model to show people where you would put the hardware and is it I know we've we had you know, somebody come in talking about knee replacements in the last year and I was shocked at how heavy the hardware was before that.

I mean I thought the person is going to put on ten pounds having the surgery.

So are they like does it take a while after the surgery to get used to that hardware?

>> Is it and I wondered what the material was.

>> I would say a shoulder replacement is typically a little bit less metal than maybe in the replacement and is a little larger joint but a shoulder replacement, you know and this model here we have a anatomic shoulder replacement and that's typically with a essentially a plastic insert and this goes on the socket.

This makes for the new socket in the the actual ball component can sometimes be placed on the stem or in an anatomic replacement such as this a stimulus component.

So it's really just something that sits in the very proximal aspect of the bone.

The bone grows into the parts and so it's a very, very solid way to fix the replacement on the alternative here is a reverse placement where where we put a baseplate which is essentially a component that is screwed into the bone and then a Glennis sphere which is the roundball which which makes up for the lack of a rotator cuff typically so a reverse replacement.

This is good for someone who's got maybe a dysfunctional or a torn rotator cuff or versus placement allows them to really regain some function typically we can fix that fix that with a stem but they're relatively small in this example there there is some length the STEM but it's only a few inches long.

There's shorter ones that we use quite regularly and then you can get to the stimulus component as well where it's really just just an inch or so of component it actually sits within the bone.

>> I am amazed that that is a longer than I thought the stem would be.

I mean you can kind shows you can kind of see where the tip is is like the gray the gray piece in there.

>> Yeah, yeah.

My thumb is you know I would say the the stimulus component that we use oftentimes for anatomic replacement is much shorter.

This is more of a standard length for for a patient that has really good bone quality.

I typically use a shorter stem than this so it may be an inch or two shorter than that maybe to about the mid aspect where you can see where the thumb goes.

But but but really it depends on the patient depends on the bone quality.

It does not affect the outcome of the of of the surgery.

We just want to give the processes a stable foundation.

So when it's when when the process is the healing process of starting, everything stays put when you start moving it around and then the components really get fixated to the bone as the bone grows in.

>> So we just want to make it stable.

So if we have to go a little bit longer that really isn't a problem.

We can do that very easily.

>> All right.

Very interesting.

I'm glad I'm really glad you brought that up for people like us who don't see that every day it helps a tremendous help.

They just flashed the five minute card which is I told you it would go fast.

I told them before the show it goes it's like a blur.

So I just want to let you know if you want to quickly text us a question or call it that's we've got plenty of time to get that in.

So we did have someone else text us a question.

So let's go get to that.

It was from Mary and she wanted to know what causes shoulder impingement.

Yeah, shoulder impingement.

That's really one of the one of the most common diagnoses we see.

It's probably it's very, very common really what that is referring to is the rotator cuff as those muscles are moving they can start to get rubbed down by the bones above them.

The acromion bone is really kind of the bony part of the shoulder.

The rotator cuff is right underneath there.

As you move your arm around, that muscle starts to rub in over time whether it be just from doing something overhead or just just activities down at your side over time that can still start to rub a little bit.

It can cause some irritation.

Shoulder impingement is sometimes synonymous leading to rotator cuff tendonitis or tendon oasis if it goes on for a long time that can lead to some tearing at some points but it really depends on how the patient's doing what their exam is like really what we'd have to do from there to to really help it.

Impingement can still benefit from physical therapy.

It can still benefit from injection if needed if it's been going on for a while or you're looking for something that maybe kind of kick it in the right direction.

But there's times when if it's not getting better we get an MRI.

We really investigate it to see you get to the bottom of it.

Is there a little bit of a tear that could be causing this to still linger around?

Why is it still hurting?

Because some patients have a tear they don't even know it.

You know, they're really quite functional.

And so like I said before, we try to treat the patient not just the MRI and so it really comes down to a good exam and see what see what the patient has tried to really see what the next steps would be.

>> Yeah.

You know, we've had plenty of physicians over the years say, you know, you the patient you know your body better than anyone else.

So if something feels off, you know, it may not show up on some kind of a scan or picture but you can you should relay that to the physician that would maybe help them to better diagnose you.

>> Yeah, absolutely.

I mean the your ability to kind of tell us what's been going on, what you've tried those are all very helpful.

That's why when we see it we start with asking your questions.

We try to figure out what you've done.

If you notice something that's different where bothers you, it really points in the right direction.

>> And if we listen to you, you really tell us the answer half the time and so it's really, really helpful.

You know, the other thing is physical therapy.

I just have my women's group from church where we do a prayer chain and so if anyone has a relative who got an injury or needs a prayer for whatever reason but we had somebody's mom fell the other day and you know, had broken her femur and people started texting in oh no.

I see you know, months of physical therapy down the road but actually physical therapy we are we've done a lot with our children.

It can be a pleasant experience.

I mean I don't I always think they're very happy people.

It's usually I think it's a different environment than what I remember it when I was growing up.

It's very positive and and social.

>> It's a nice way to socially interact with people who are helping you.

They're really the specialists in helping to rehab to get back your function.

>> I mean they like like I said before, the shoulder is such a complex joint there's several muscles attach all around the shoulder if one thing's out of alignment or slightly out of out of whack if you will can start to lead to some problems down the road and so the therapist can really hone in on that, maybe modify some of the things you've been doing and it's not often a long course.

You know, sometimes I see people I say have to go to a therapist maybe once or twice that will give a personalized plan.

You go ahead and do this on your own if it's really not getting better that we can move on to the next steps and so it's not often a huge time commitment, just something that they can maybe check in once or twice, get a good plan and do it on their own if they're willing and able to do that and then it's something that we can investigate further if it's not getting better.

>> Yeah, I was going to say, you know, I think people dread it but our experience has been that, you know, the complete opposite.

>> It's so real quickly we just have a minute left.

But do you find that this can be a hereditary issue?

You know, like you know, when they talk about like overuse not an injury but you know, like maybe your dad you know, maybe you and your dad are in the same line of work.

>> You do a lot of lifting and he had shoulder issues.

Does that do you see any of that?

You do you do see some things that kind of run in the family but sometimes it's in an anatomy difference.

So you know, the socket maybe the socket is a little different alignment.

They lead to some arthritis in certain areas, things like that or maybe a bone spur that develops on acromion.

You know, a curved instead of a flat acromion it could sometimes lead it to irritation of the rotator cuff.

>> Those are anatomic things that could sometimes be genetic and can lead to some problems later on.

So it definitely can happen.

>> All right.

Good to know our time is up sadly but maybe it's a relief for you know, thank you so much for coming on.

Did a wonderful job.

This is first time so you would have never known it again.

Thank so much Dr.

Michael Rosen.

I'm Jennifer Bloomquist.

Take care.

Have a great night and we'll see you back here next Tuesday for another helpline.

>> Bye bye