WDSE WDSE ♪ DR. NALIN: GOOD EVENING AND WELCOME TO DOCTORS ON CALL.

I'M DOCTOR PETER NALIN, PROFESSOR AND HEAD OF THE DEPARTMENT OF FAMILY MEDICINE & BIOBEHAVIORAL HEALTH AT THE UNIVERSITY OF MINNESOTA MEDICAL SCHOOL, DULUTH CAMPUS.

I AM YOUR HOST FOR OUR PROGRAM TONIGHT ON “UPPER EXTREMITY: SHOULDER, NECK AND BACK PROBLEMS."

THE SUCCESS OF THIS PROGRAM IS VERY DEPENDENT ON YOU, THE VIEWER, SO PLEASE CALL IN YOUR QUESTIONS TONIGHT OR SEND THEM IN AHEAD OF TIME TO OUR EMAIL .

ASK@PBSNORTH.ORG.

THE TELEPHONE NUMBERS CAN BE FOUND AT THE BOTTOM OF YOUR SCREEN.

OUR PANELISTS THIS EVENING INCLUDE DOCTOR JOSEPH BENERT, AN SPORTS MEDICINE SPECIALIST WITH ASPIRUS SAINT LUKE'S.

DOCTOR TOLGA HANHAN, A FAMILY PHYSICIAN WITH ASPIRUS LAKE VIEW TWO HARBORS CLINIC.

AND DOCTOR BRAD KUZEL, AN ORTHOPEDIC SURGEON WITH ESSENTIA HEALTH.

OUR MEDICAL STUDENTS ANSWERING THE PHONES TONIGHT ARE: OLIVIA HOFF FROM RUSHFORD, MINNESOTA.

ALISON PULST FROM ALEXANDRIA, MINNESOTA.

AND ELLIE THIEN FROM CLARA CITY, MINNESOTA.

AND NOW ON TO TONIGHT'S PROGRAM, “UPPER EXTREMITY: SHOULDER, NECK AND BACK PROBLEMS."

WE HAVE OUR FIRST QUESTION ALREADY.

WHAT ARE TREATMENTS FOR SHOULDER DISLOCATIONS?

>> IT DEPENDS ON A COUPLE FACTORS.

I THINK THE AGE OF THE PATIENT MATTERS AS WELL AS THEIR HISTORY.

SO AS A RULE, YOUNGER PATIENTS AND THOSE WHO HAD A HISTORY OF DISLOCATIONS ARE MORE SUSCEPTIBLE TO RECURRENT DISLOCATIONS.

SHORTLY AFTER INJURY OF THE FIRST GOAL IS TO GIVE THE SHOULDER SOME REST.

THAT MAY BE BEING IN A SLING AND LETTING THINGS CALM DOWN.

WE START WITH A COURSE OF PHYSICAL THERAPY.

FOR THOSE WITH A HIGH RISK FOR RECURRENCE, IT MAY BE MORE PRUDENT TO TALK ABOUT SURGICAL INTERVENTION.

DR. NALIN: WHAT HAS CHANGED REGARDING BACK STRAINS AND RECOMMENDATIONS FOR BEDREST?

DR. HANHAN: THERE WAS AN ERA WHERE PEOPLE WHO HURT THEIR BACK -- AND WHEN WE TALK ABOUT BACK INJURIES, THERE IS A LOT OF THEM, BUT THE MOST COMMON WOULD BE BY STRAINING THOSE BIG BACK MUSCLES.

IT MADE YOU FEEL BETTER, REALLY, UNTIL YOU GOT BETTER.

HOWEVER, THAT IS REALLY THE LAST THING YOU WANT TO DO.

IS KIND OF COUNTERINTUITIVE, BECAUSE WHEN YOUR BACK HURTS, YOU ARE IN A LOT OF PAIN.

THE LAST THING YOU WANT TO DO IS START WALKING, START DOING ALL THE ACTIVITIES THAT YOU NEED TO BE DOING IN LIFE, BUT REALLY THAT IS THE BEST THING WE NEED TO DO, KEEP MOVING.

WE HAVE TO KEEP LIMBER.

IF YOU THINK OF THE BACK ANATOMY, WE HAVE THESE BONES WITH DISCS SANDWICHED IN BETWEEN THEM, AND WE HAVE TO KEEP THAT MOVING, EVEN WHEN YOU WANT TO JUST RELAX.

WE KNOW PEOPLE WHO ARE ACTIVE HEAL FASTER AND HAVE A BETTER RECOVERY.

DR. NALIN: THANK YOU.

WHAT IS A FROZEN SHOULDER AND WHAT CAN BE DONE ABOUT IT?

DR. KUZEL: FROZEN SHOULDER IS SOMEWHAT RARE A CONDITION THAT CAN HAPPEN TO PATIENTS.

USUALLY THE MAIN REASONS THEY HAPPEN, ONE IS TRAUMA.

PATIENTS CAN GET A STIFF SHOULDER AFTER TRAUMATIC INJURY.

SOMETIMES THEY JUST HAPPEN WITHOUT AN INJURY.

PATIENTS WHO HAVE DIABETES OR THYROID ISSUES CAN HAVE A HIGHER CHANCE OF GETTING A FROZEN SHOULDER.

OFTEN TIMES THEY GO UN UNDIAGNOSED FOR A WHILE -- GO UNDIAGNOSED FOR A WHILE.

THE PATIENT WILL HAVE THIS STIFF SHOULDER.

THEY SEE A LOT OF PHYSICIANS AND NOT KNOW WHAT IS GOING ON.

THE INITIAL TREATMENT OF A FROZEN SHOULDER IS LIKE THE BACK, WE WANT TO START MOVING IT.

SO IF YOU SEE SOMEONE THAT IS ABLE TO DIAGNOSE THE CONDITION, THEY WILL START WITH A CORTISONE SHOT TO DECREASE INFLAMMATION, THEN START SOME PHYSICAL THERAPY.

ONE OF THE MOST IMPORTANT THINGS WITH A FROZEN SHOULDER IS TO REASSURE THE PATIENT THAT IT WONT LAST FOREVER.

IT WILL EVENTUALLY GO AWAY.

IT WILL EVENTUALLY RESOLVE.

I THINK RELIEVING SOME OF THE ANXIETY RELATED TO IT CAN HELP A LOT.

AS A SURGEON, I WILL SEE PATIENTS WHO HAVE THIS GOING ON FOR SIX MONTHS.

I HAD A PATIENT THAT HAD IT GOING ON FOR TWO YEARS, WHICH SEEMS ON THE FAR END OF THE SPECTRUM.

IT IT HAS BEEN GOING ON FOR OVER SIX MONTHS AND YOU HAVE TRIED THERAPY AND CORTISONE SHOTS, SOMETIMES WE WILL DO SOMETHING CALLED A MANIPULATION.

IT CAN BE PRETTY EFFECTIVE QUICKLY.

ANOTHER TREATMENT IS TO DO AN ARTHROSCOPY.

FINALLY THERE IS ONE LAST OPTION DONE UNDER ULTRASOUND GUIDANCE CALLED HYDRO DILATION.

STUDIES ARE PRETTY EQUIVALENT IN TERMS OF THEIR EFFICACY.

I THINK THE KEY THING IS MAKING THE CORRECT DIAGNOSIS.

DR. NALIN: THANK YOU.

WHAT IS THE CONNECTION BETWEEN KNEE PAIN AND A BACK PROBLEM?

DR. BENERT: WE KNOW EVERYTHING IN THE BODY IS INTERCONNECTED, SOMETHING WE REFER TO AS THE KINETIC CHANGE, WHICH MEANS PROBLEMS IN YOUR ANKLE AND KNEE CAN TRAVEL UPSTREAM TO YOUR BACK.

IF YOU HAVE ANY PAIN AND IT IS CHANGING THE MECHANICS OF HOW YOU WALK OR DO STAIRS, THAT CAN HAVE UPSTREAM EFFECTS WHERE YOUR BACK HURTS OVERCOMPENSATING FOR THE KNEE.

DR. NALIN: THIS QUESTION FOR YOU, WHAT IS CERVICAL RADICULOPATHY AND HOW DOES IT FEEL TO THE PATIENT?

DR. HANHAN: I THINK MOST PEOPLE ARE FAMILIAR WITH THE TERM SCIATICA, WHICH IS BASICALLY A NERVE THAT MAY BE GETTING PINCHED OR UNDERGOING SOME STRESS COMING FROM YOUR BACK AND ENDING UP IN YOUR LEG.

CERVICAL RADICULOPATHY IS ESSENTIALLY THE SAME THING, BUT IT IS COMING FROM YOUR NECK AND ENDING UP IN YOUR HANDS.

IT IS UNIFORMLY UNPLEASANT TO PEOPLE THAT HAVE IT.

IT CAN BE FOR ANY NUMBER OF THINGS.

MOST OF US HAVE GOT SOME TYPE OF ARTHRITIC CHANGE IN OUR NECK AFTER AGE 30 OR SO.

JUST BECAUSE OF THAT, YOU MIGHT HAVE AN AREA WHERE IT IS HARD FOR THAT NERVE THAT LEAVES THAT NECK TO EXIT WITHOUT GETTING PINCHED BY SOME BONE.

THE SAME CAN HAPPEN IF YOU HAVE ONE OF THOSE DISCS THAT CAN PINCH THAT NERVE.

THE NERVES FROM THE NECK GO DOWN AND FEED BASICALLY YOUR WHOLE HAND.

THERE ARE DIFFERENT NODES FOR DIFFERENT PARTS OF THE HAND.

WHEN YOU GET CERVICAL RADICULOPATHY, THAT WORD RADICULOPATHY IS LATIN FOR RADIATING.

THAT IS WHAT IT FEELS LIKE.

IT CAN BE A TINGLING OR LIGHTNING BOLT SENSATION.

IT CAN BE VERY UNCOMFORTABLE.

THAT IS HOW THE HAND AND THE NECK ARE RELATED.

THE GOOD NEWS IS MOST PEOPLE WHO GET A CERVICAL RADICULOPATHY, IF YOU DON’T HAVE A MUSCULAR PROBLEM ASSOCIATED WITH IT, THEY TEND TO GET BETTER WITHIN SIX TO 12 WEEKS.

IT CAN BE VERY UNCOMFORTABLE IN THE MEANTIME.

DR. NALIN: THANK YOU.

DR. KUZEL, THIS QUESTION IS FROM A CALLER IN DULUTH.

JUDY WANTS TO KNOW WHAT ARE THE BEST EXERCISES FOR SHOULDER BURSITIS AND IMPINGEMENT SYNDROME?

HOW LONG DO THESE CONDITIONS TAKE TO HEAL?

DR. KUZEL: THAT IS A GREAT QUESTION.

THAT IS SOMETHING I TALK WITH MY PATIENTS ABOUT ROUTINELY.

ONE OF THE MOST IMPORTANT THINGS FOR SHOULDERS IS THEY LIKE TO MOVE.

EVEN IF YOU HAVE AN INJURY, IT’S OK TO LET IT REST FOR A FEW DAYS.

THEN AS SOON AS, YOU CAN START TO TRY TO MOVE THE SHOULDER.

SIMPLE MOVEMENTS LIKE STRETCHING IT OUT ON A TABLE, WALKING UP A WALL, THOSE ARE REALLY EFFECTIVE WAYS TO MAINTAIN AND KEEP RANGE OF MOTION IN THE SHOULDER.

SPECIFICALLY FOR BURSITIS OR IMPINGEMENT, I LIKE EXERCISES THAT FOCUS ON MOTION, BUT ALSO STRENGTH OF THE MUSCLES IN BETWEEN THE BONES THAT ARE CALLED THE SCAPULA OR WING BONES.

KEEPING THOSE MUSCLES STRONG AND KEEPING THE SCAPULA OPEN, EXERCISES LIKE THIS ARE VERY EFFECTIVE FOR TREATING BURSITIS AND IMPINGEMENT.

THERE ARE DEEPER MUSCLES AROUND THE SHOULDER CALLED THE ROTATOR CUFF.

EXERCISING THE ROTATOR CUFF MUSCLES ARE IMPORTANT AS WELL.

I AM SURE YOU HAVE SEEN THE BANDS, OR USING LIGHT FREE WEIGHTS, ONE OR TWO POUNDS.

SHOULDERS LIKE TO MOVE.

IF YOU HAVE A SORE SHOULDER, EVEN IF YOU THINK THERE IS SOMETHING TORN IN THERE, IT IS VERY SAFE ALWAYS TO MOVE YOUR SHOULDER.

AN EFFECTIVE WAY TO TREAT THE PAIN.

DR. NALIN: THANK YOU.

DR. BENERT, A CALLER WANTS TO KNOW HOW IMPORTANT IS POSTURE IN PREVENTING AND MANAGING SOME OF THESE PAINS?

AND DO YOU HAVE ANY TIPS FOR IMPROVING POSTURE?

DR. BENERT: POSTURE IS SUPER IMPORTANT FOR EVERYTHING WE ARE TALKING ABOUT TODAY, FROM THE SHOULDER DOWN THROUGH THE BACK OUT INTO THE EXTREMITIES.

WITH THE CONNECTICUT CHAIN -- KINETIC CHCAIN, IF ONE SPOT IS OUT OF ALIGNMENT, THAT WILL CAUSE PROBLEMS THROUGHOUT THE WHOLE SYSTEM.

YOU REALLY DO WANT TO WORK ON POSTURE.

UNFORTUNATELY OUR SOCIETY IS VERY SCREEN FOCUSED, LOOKING 6 TO 12 INCHES IN FRONT OF US A DAY.

THAT CAN CAUSE A LOT OF PROBLEMS ON THE CERVICAL SPINE.

GIVING BREAKS IN YOUR POSTURE THROUGHOUT THE DAY TO STARE OFF INTO THE DISTANCE, GIVE THOSE NECK MUSCLES A BREAK, IS IMPORTANT.

FROM A POSTURE PERSPECTIVE, IT STARTS IN THE CORE, GETTING TO THE LOWER BACK.

YOU WANT TO HAVE STRONG CORE MUSCLES SUPPORTING YOUR PELVIS AND LOWER BACK, BECAUSE ALL THE REST OF YOUR MOVEMENT WILL START FROM THERE.

DR. NALIN: AND THE NUMBER OF PATIENTS PRESENTING WITH SCREEN ISSUES CONTINUING TO INCREASE OR LEVELING OFF?

DR. BENERT: SCREENS HAVE BEEN PART OF OUR LIFE LONG ENOUGH NOW THAT IT HAS BEEN FAIRLY STABLE ON THAT FRONT, BUT WE DEFINITELY SEE CONDITIONS EXCLUSIVELY RELATED TO THE ADVANCES IN CELL PHONES AND PERSONAL COMPUTERS COMPARED TO 10 OR 20 YEARS AGO.

DR. NALIN: THANK YOU.

SORRY, NOT THAT QUESTION.

WE DID THAT ONE ALREADY.

PARDON ME.

WHAT MAKES THE SHOULDER JOINT SO DEPENDENT UPON MUSCLE STRENGTH?

DR. HANHAN: GREAT QUESTION.

IF YOU REALLY THINK ABOUT THE SHOULDER, DR. KUZEL OF COURSE DOES ALL KINDS OF SURGICAL INTERVENTIONS ABOUT IT, BUT I THINK IT IS AN AMAZING JOINT.

IF YOU THINK, WHAT CAN YOU DO WITH THIS ARM?

WHEN IT IS HEALTHY, YOU CAN DO ALL KINDS OF MOVEMENTS.

IT IS ALL MUSCLE.

WE HAVE OTHER STRUCTURES IN THERE, BUT TAKE AWAY THE MUSCLE FOR A MOMENT AND YOUR ARM WOULD ESSENTIALLY FALL OFF.

IT IS THIS BALL AND SOCKET THAT EXISTS, BUT IT IS THE MUSCLE HOLDING YOUR ARM IN PLACE AND WORKING WITH ALL THESE MECHANICS THAT ALLOW US TO DO THESE AMAZING THINGS.

COMPARE THE SHOULDER TO THE ELBOW OR THE KNEE AND IT IS MUCH MORE MUSCULAR DEPENDENT.

DR. NALIN: THANK YOU.

THIS QUESTION IS ABOUT ROTATOR CUFF TEAR.

A CALLER FROM DULUTH WANTS TO KNOW, CAN A ROTATOR CUFF TEAR BE TREATED OR REPLACED OR IMPROVED WITHOUT USING ANCHORS?

DR. KUZEL: THAT IS A GREAT QUESTION AS WELL.

WE KNOW THAT THERE IS A LOT OF PATIENTS WHO HAVE ROTATOR CUFF TEARS, EVEN SIZABLE ONES WHO DON’T HAVE A LOT OF PAIN.

THERE WAS A VERY LARGE NATIONWIDE STUDY THAT SHOWED THAT PATIENTS TREATED NOT OPERATIVELY FOR ROTATOR CUFF TEARS CAN BE SUCCESSFUL 73% OF THE TIME.

THE CAVEAT WAS THAT THE PATIENT HAD TO BELIEVE THAT THERAPY COULD WORK.

THAT MAY NOT BE FULLY ANSWERING THE QUESTION, BUT YES, ROTATOR CUFF TEARS CAN BE TREATED NON-OPERATIVELY.

THE ANCHORS WE CURRENTLY USE ARE THE BEST ANCHORS WE HAVE EVER HAD.

MOST SURGEONS USE ANCHORS THAT ARE ALL SUTURED.

THEY ARE ABOUT 2.5 MILLIMETERS IN DIAMETER, SO THEY ARE HARD TO SEE ON AN M.R.I.

THEY DO VERY LITTLE DAMAGE TO THE SHOULDER.

THE SUTURE MATERIAL ITSELF IS NYLON AND IS VERY SAFE.

IT HAS BEEN USED FOR DECADES.. YOU DON’T HAVE TO WORRY ABOUT SETTING OFF METAL DETECTORS IF YOU HAVE A ROTATOR CUFF REPAIR.

THERE IS ALWAYS RESEARCH BEING DONE.

THEY ARE LOOKING AT BIOLOGICAL AUGMENTATION, LIKE HOW DO WE MAKE THE ROTATOR CUFF REPAIR STRONGER?

TRADITIONALLY THAT HAS BEEN THE WEAK LINK, A PATIENT’S QUALITY OF TISSUE.

THERE ARE A NUMBER OF THINGS BEING STUDIED AND EVEN BEING DONE, BUT ULTIMATELY THE ROTATOR CUFF REPAIRS WE ARE DOING NOW ARE, AGAIN, THE IMPLANTS WE USE ARE THE BEST WE EVER HAD.

I’VE BEEN DOING ROTATOR CUFF REPAIRS AND PRACTICE FOR 12 YEARS AND RESIDENCY FOR SIX YEARS BEFORE THAT.

DR. NALIN: SOMETIMES IN MEDICINE WE USE WORDS THAT HAVE OTHER MEANINGS.

WHEN YOU ARE SPEAKING TO PATIENTS, HOW DO YOU EXPLAIN TO THEM WHAT IS THIS ANCHOR?

WHAT IS AN ANCHOR?

DR. KUZEL: I WILL SHOW THEM A PICTURE BECAUSE IT IS EASIER TO UNDERSTAND.

BASICALLY THE ROTATOR CUFF, IF NORMALLY IT IS ATTACHED TO THE GREATER PART OF THE BALL OR HUMERUS, WHEN IT TEARS, THE MUSCLE WANTS TO PULL IT BACK.

THE MUSCLE FIBERS NECESSARILY PULL THE TENDON BACK.

IT TRIES TO HEAL ON ITS OWN SOMETIMES, BUT IT IS HARD WITH THAT MUSCLE POINT BACK.

WHAT WE DO IS WE USE ANCHORS.

THEY ARE LIKE CLIMBING ANCHORS, IF THAT HELPS.

WE WILL PUT THE ANCHORS IN THE BONE AND THERE WILL BE SUTURES COMING OUT OF EACH INDIVIDUAL ANCHOR, PASS THOSE THROUGH THE MUSCLE AND PULL IT BACK OVER.

THAT HELPS HOLD THE TISSUE ON THE BONE UNTIL IT BONDS AND HEALS.

WITH MY CONTRACTORS, I WILL TELL THEM YOU CANNOT WALK ON THE TILES FOR 24 HOURS.

YOU HAVE TO WAIT FOR THE GROUT TO SET.

SAME IS TRUE FOR THE BODY.

IT IS MORE LIKE 24 TO 26 WEEKS FOR COLD BONDING WHEN YOU DO A ROTATOR CUFF REPAIR.

THAT DOES NOT MEAN YOU DON’T DO ANYTHING DURING THE RECOVERY.

WE HAVE A VERY ACTIVE RECOVERY.

WHAT WE REALLY WANT WHEN WE DO THE REPAIRS IS TO GET THE MUSCLE TO BOND BACK TO THE BONE.

DR. NALIN: THANK YOU.

THIS QUESTION IS ABOUT A HEALTHY BACK.

HOW MIGHT ONE MILE OF WALKING EACH DAY BE GOOD FOR ONE’S BACK?

DR. BENERT: JUST IN GENERAL WE KNOW THAT STAYING HEALTHIER, STAYING ACTIVE IN GENERAL IS GOOD FOR OUR HEALTH.

IN THAT SENSE, WE KNOW WALKING HAS A LOT OF BENEFITS FROM OUR CARDIOVASCULAR PERSPECTIVE, HELPING TO OXYGENATE THE MUSCLES.

IT CAN HELP IN MAINTAINING A HEALTHY WEIGHT.

BEING OVERWEIGHT CAN PUT A LOT OF EXTRA STRESS ON THE BACK AND LEAD TO FURTHER DEGENERATION AND ARTHRITIC CHANGES AS WE AGE.

IT IS GOOD FROM THAT PERSPECTIVE.

LIKE ALL YOU WERE TALKING ABOUT THE SHOULDER, WE KNOW THAT MOVEMENT IS GOOD.

WE WANT TO KEEP MOVING THE BACK AND TRAINING THOSE MUSCLES.

WHEREAS WHEN YOU GO TO A GYM, YOU DO SPECIFIC SQUATS FOR YOUR LEGS OR CURLS FOR YOUR BICEPS, THE BACK MICHAEL’S GET WORKED OUT BY THE DAY TO DAY MOVEMENT WE DO.

THEY ARE ENGAGING AT A MICROSCOPIC LEVEL AS OPPOSED TO THESE LARGE BURSTS OF ENERGY.

THINGS LIKE LOCKING OR CREATING THOSE MICRO MOVEMENTS THAT ARE TRAINING THOSE MUSCLES TO FUNCTION MORE EFFECTIVELY AND DO THEIR JOB MORE EFFICIENTLY.

DR. NALIN: THIS QUESTION ALSO ABOUT THE BACK, BUT SPECIFICALLY THE DISCS.

IS IT POSSIBLE TO HAVE A DISK SURGICALLY REPLACED, AND HOW LONG WOULD THE RECOVERY BE?

DR. HANHAN: THEORETICALLY, YES, IT COULD BE REPLACED.

I DON’T THINK THERE IS A WHOLE LOT OF THAT GOING ON.

I AM NOT A SPINE SURGEON, SO I CANNOT ANSWER THAT QUESTION ABOUT HOW LONG IT WOULD TAKE TO RECOVER FROM AN ARTIFICIAL DISC, BUT I CAN TELL YOU FOR OTHER MAJOR BACK SURGERIES LIKE FUSION MIGHT TAKE SIX TO 12 MONTHS TO COMPLETELY FUSE, WHICH IS MORE COMMONLY DONE SURGERY.

DR. NALIN: THANK YOU.

A QUESTION ABOUT ROTATOR CUFF SURGERY FROM A CALLER FROM DULUTH.

WHAT CAN BE DONE FOR TINGLING THAT GOES DOWN THE ARM WHICH SEEMS TO HAPPEN MOSTLY AT NIGHT?

DR. KUZEL: IS IT AFTER A SURGERY?

DR. NALIN: AFTER A ROTATOR CUFF SURGERY.

DR. KUZEL: TO ME, THAT SOUNDS LIKE SOMETHING THAT MAY BE THAT CERVICAL RADICULOPATHY THAT WE WERE TALKING ABOUT, WHEN A PATIENT THAT HAS NUMBNESS AND TINGLING RUNNING DOWN THE ARM.

THERE ARE SOME EXERCISES THAT CAN HELP.

THINKING ABOUT HOW YOU ARE SLEEPING AT NIGHT, HOW YOU ARE POSITIONING YOUR ARM.

I HAVE PATIENTS THAT SOMETIMES DON’T DO WELL WITH THE SLING.

I WILL TALK WITH THEM.

AS LONG AS THEY ARE NOT MOVING A LOT AT NIGHT, IT IS VERY REASONABLE TO POSITION YOUR ARM IN A STRAIGHT POSITION.

TYPICALLY WE CAN GET NUMBNESS IN OUR FINGERS WHEN OUR ARMS ARE BENT UP AT NIGHT LIKE THIS.

WE’VE ALL HAD THIS HAPPEN.

THEN YOU STRAIN YOUR ELBOW AND ALL OF A SUDDEN IT FEELS -- STRAIGHTEN YOUR ELBOW AND ALL OF A SUDDEN IT FEELS BETTER.

MAYBE HAVING PILLOWS UNDERNEATH IT IF YOU ARE SLEEPING ON A RECLINER, THINGS LIKE THAT CAN HELP.

PEOPLE CAN HAVE SYMPTOMS LIKE THAT AFTER SURGERY.

ALMOST ALWAYS THEY WILL RESOLVE OVER TIME.

DR. NALIN: THANK YOU.

THIS QUESTION IS ABOUT A 72-YEAR-OLD WHO HAS HAD A CORTISONE SHOT SHOULDER ABOUT FOUR TO FIVE MONTHS AGO.

THROBBING SORENESS FROM THE SHOULDER TO THE ELBOW AT THE END OF THE DAY.

IS THIS SOMETHING THAT SHOULD BE CHECKED OUT BY A DOCTOR?

DR. BENERT: I’M GOING TO INFER A LITTLE BET THAT THE THROBBING HAS STARTED MORE AFTER THE INJECTION AS OPPOSED TO PREDATING IT.

CERTAINLY IF THE INJECTION HAD HELPED AND THEY ARE GETTING RELIEF, AND NOW FOUR TO FIVE MONTHS LATER THAT THROBBING HAS RETURNED, IT WOULD BE REASONABLE TO FOLLOW UP WITH THE PHYSICIAN.

THE SHOT CAN LAST AN AVERAGE OF THREE TO FIVE MONTHS, SO IT MAY BE TIME FOR A RECURRENCE.

THE OTHER PIECE IS THERE ARE MULTIPLE SPOTS A STEROID SHOT THAT CAN BE GIVEN INTO THE SHOULDER.

IT IS POSSIBLE IF THE THROBBING TO NOT RESOLVE FROM THAT FIRST SHOT, IT MAY HAVE NOT BEEN THE RIGHT TARGET, AND FOLLOW-UP WOULD BE APPROPRIATE TO MAKE SURE IT’S NOT COMING FROM ONE OF THOSE OTHER SPOTS.

THAT SAID, ASSUMING IT IS A NEW SYMPTOM THAT DEVELOPED AFTER THE SHOT AND HAS BEEN GOING ON FOR FOUR TO FIVE MONTHS, IT IS REASONABLE TO FOLLOW-UP WITH THE PERSON WHO GAVE THE SHOT TO GET AN EVALUATION AND SEE IF IT IS A CASE OF A REACTION TO THE SHOT OR ANOTHER ISSUE GOING ON WITH THE SHOULDER THAT STARTED AROUND THAT SAME TIME.

DR. NALIN: IN CONTRAST TO FRACTURES IN THE LIMBS, GENERALLY HOW ARE FRACTURES IN THE BACK TREATED?

DR. HANHAN: I THINK IT PROBABLY DEPENDS ON WHERE IN THE BACK.

THE BACK IS PRETTY COMPLICATED.

YOU CAN HAVE A LOT OF DIFFERENT FRACTURES.

THERE IS KIND OF A WING ON THE BACK OF THE BACK BONDS.

WHEN THEY FRACTURE, JUST TAKING IT EASY IS GOOD ENOUGH.

BUT YOU CAN ALSO HAVE -- THERE ARE IMPORTANT STRUCTURES THAT GO THROUGH THE BACKBONE, INCLUDING THE SPINAL CORD.

IF THAT SPINAL CORD IS THREATENED, THAT ALMOST ALWAYS NEEDS SURGERY.

SOME PEOPLE CAN GET WHAT THEY CALL COMPRESSION FRACTURES, WHICH IS A CRUSHING OF THE BACKBONE, WHICH IS MUCH MORE LIKELY TO HAPPEN WITH ELDERLY AGE OR OSTEOPOROSIS.

THOSE ARE ALSO MANAGED, JUST WATCHING AND WAITING TO MAKE SURE THAT THE NERVES ARE NOT AFFECTED.

DR. NALIN: THANK YOU.

HOW IS A DISLOCATED SHOULDER PUT BACK IN PLACE?

DR. KUZEL: KIND OF DEPENDS A BIT ON THE DISLOCATION.

ONE LITTLE PLUG I WILL MAKE IS IF SOMEONE HAS A SHOULDER DISLOCATION, THE SOONER YOU CAN REDUCE IT, THE EASIER IT IS.

THE LONGER YOU WAIT, THE MUSCLES START TO SPASM AND CONTRACT AND IT CAN GET MORE CHALLENGING.

OFTEN TIMES HE WILL NEED SEDATION AND THE EMERGENCY DEPARTMENT TO REDUCE IT.

THERE ARE A NUMBER OF HER NEW VERSE -- A NUMBER OF MANEUVERS.

MOST DISLOCATIONS ARE TO THE FRONT.

SOME ARCH OF THE BACK.

THERE ARE FRACTIONS SOMETIMES ASSOCIATED WITH THE DISLOCATION.

THE TECHNIQUE DEPENDS ON THE TYPE OF DISLOCATION.

DR. NALIN: THANK YOU.

THIS QUESTION ABOUT ELBOW BURSITIS.

IS THERE ANYTHING THAT CAN BE DONE FOR ELBOW BURSITIS THAT OCCURRED FROM TRAUMA TO THAT ELBOW?

DR. BENERT: I AM ASSUMING ELBOW FOR SITUS, -- BURSITIS, REFERENCING THE POINTY PART OF THE ELBOW.

THERE IS NOT A LOT OF GREAT OPTIONS FOR IT.

WE USED TO THINK ABOUT PUTTING A NEEDLE INTO THE BURSA AND TRYING TO DRAIN SOME OF THAT FLUID OUT.

THERE HAS BEEN MORE RECENT RESEARCH THAT THAT CAN INTRODUCE INFECTION INTO THE BURSA.

THERE ARE SURGICAL OPTIONS TO TAKE THE BURSA OUT, BUT THEY CARRY RISKS OF INFECTION, AS WELL AS HEALING.

WE TREAT IT VERY CONSERVATIVELY, WHICH IS USING MEDS LIKE TYLENOL, OVER THE COUNTER FOR PAIN RELIEF, THEN PUTTING COMPRESSION TO REDUCE THE SIZE OF THE BURSA, AND PATTING THE ELBOW TO REDUCE THE RECURRENCE.

EVEN IF IT GOES AWAY, IT IS AT A HIGHER RISK OF RECURRENCE GOING FORWARD.

DR. NALIN: THIS QUESTION ABOUT SCREENING FOR OSTEOPOROSIS PRIOR TO SHOULDER SURGERY.

IN A POST MENOPAUSAL WOMAN.

WOULD A NEXUS CAN BE ORDERED BEFORE SHOULDER SURGERY?

DR. KUZEL: WE TYPICALLY WANT.

OFTEN -- WE TYPICALLY WON’T.

WE HAVE SCANS ON THOSE FALLING FROM A STANDING HEIGHT, INJURIES LIKE THAT.

MOST OF THE TREATMENTS THAT WE OFFER NOW, EVEN PATIENTS WITH OSTEOPOROSIS, WE CAN STILL DO THE TREATMENTS THAT WE RECOMMEND.

THERE ARE TIMES, HOWEVER, WHERE IF SOMEONE LOOKS LIKE THEY HAVE SEVERE OSTEOPOROSIS, WE WILL MAKE A DIFFERENT RECOMMENDATION OR NON-SURGICAL RECOMMENDATION.

DR. NALIN: THANK YOU VERY MUCH.

I WANT TO THANK OUR PANELISTS DOCTOR JOSEPH BENERT, DOCTOR TOLGA HANHAN AND DOCTOR BRADLEY KUNZEL AND OUR MEDICAL STUDENT VOLUNTEERS: OLIVIA HOFF, ALISON PULST AND ELLIE THEIN.

PLEASE JOIN ME AGAIN NEXT WEEK FOR A PROGRAM ON “LOWER EXTREMITY: KNEE, FOOT AND HIP PROBLEMS” WHEN MY PANELISTS WILL BE DOCTOR TAYLOR PAZIUK AND DOCTOR PHILLIP THOMAS.

THANK YOU FOR WATCHING.

GOOD NIGHT.

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