Can You Avoid Shoulder Surgery... Discover the Truth w/ Dr. Tiedeken

Ready to finally understand the complexities behind your shoulder pain? In this insightful episode, we invite Dr. Nate Tiedeken back to explore everything from common shoulder issues to the fictional narratives we create around pain. Get ready to unravel the intricate web of shoulder health as we discuss not just rotator cuff tears but also touch on the often overlooked connections between neck issues and shoulder pain.

The episode dives into the nuances of arthritis, clarifying the distinctions between primary and secondary conditions, and highlighting why this knowledge is essential for effective treatment strategies. We challenge the misconception that surgery is the only answer, providing listeners with valuable insights on how to manage pain through conservative treatments and lifestyle modifications.

With humor and relatability, we tackle all the questions you’ve had about shoulder health in an engaging format that feels like a conversation with friends. You’ll leave feeling equipped with actionable advice and the understanding that surgery is not always the first option. Tune in now, and don’t forget to subscribe and share to keep the conversation going!

---
Welcome to The Brad Weisman Show, where we dive into the world of real estate, real life, and everything in between with your host, Brad Weisman! 🎙️ Join us for candid conversations, laughter, and a fresh take on the real world. Get ready to explore the ups and downs of life with a side of humor. From property to personality, we've got it all covered. Tune in, laugh along, and let's get real! 🏡🌟 #TheBradWeismanShow #RealEstateRealLife 

Credits - The music for my podcast was written and performed by Jeff Miller. 

Transcript

Speaker 1 0:31

All right, you guys ready? Yeah, all right, we're ready. Here we go, from real estate to real life and everything in between, the Brad Wiseman Show and now your host, brad Wiseman. All right, we are back and we have a repeat guest. You're going to love this. Yes, you might see a little bit of what's on the desk there, and no, we are not going to be talking about dinosaur bones. It might look like that from what you see here in front of me, but we brought somebody back who was here before to talk about my wrist. I have carpal tunnel, thinking what's going on and everybody has to have a Dr Oz. So, my Dr Oz, I'm going to call you Dr T. What do you think, dr T? I like that Dr T is in the house. Yeah, so, dr T, I like that Dr T is in the house. So, dr Nate Teetigan, how are you doing?

Speaker 2 1:15

buddy, good Been. Great. I can't believe I got invited back after the first time. Yeah, I thought you and Hugo talked. There was a lot of words back and forth.

Speaker 1 1:23

Hugo said no, I said yes. Split vote.

Speaker 2 1:26

Split vote. Yeah, split vote, since it great to be back. Yeah, you guys changed some of your angles around here.

Speaker 1 1:37

I guess we changed some angles around and there's still a book on the table here too, hugo, the book's just laying there from another show. I didn't have to say that, and you know what's funny, my phone's over there on the table too. Gotta get used to it. You gotta get used to the new angles. My game, everybody's gotta have a new angle. You know what I mean. You gotta have a new angle.

Speaker 2 1:58

I hope it's my good side it is, it is yeah, from what we were told um, but no, so you brought.

Speaker 1 2:02

We talked about um shoulders right a little bit last time, just a little bit, I think. We talked about the rotator cuff or whatever, something like that, and um, mostly what we talked about was the carpal tunnel thing. By the way, I'm still doing great. I don't have to wear the brace anymore, which is wonderful and it worked out great. And I didn't have to have surgery. Everybody, everybody, thinks you have need to go to surgery and, and you know, you know you will tell people that you don't have to always right.

Speaker 2 2:25

My goal I say a surgeon's goal should be to try to keep you out of the operating room. Yeah Right, Sometimes it's when everything else fails. That's your last result, but that should be your main goal, Right.

Speaker 1 2:34

Now, you don't want to cut unless you have to. Yeah, absolutely yeah.

Speaker 2 2:37

Surgery is surgery, no matter how big or how small, so you have to treat that with respect. Exactly, that's a big thing, in my practice at least. Make sure you've exhausted all other treatments first, gotcha.

Speaker 1 2:55

Yeah, that's cool, that's really cool. So we bad issues and has gone through. The same physical therapist that I am Also went to your practice to get the work done and he's very, very happy. And he had something which I never heard of before until my father-in-law and my brother had this done called a reverse shoulder replacement.

Speaker 2 3:13

I guess A reverse shoulder replacement. Yep, you can get a total shoulder replacement or a reverse shoulder replacement.

Speaker 1 3:19

Okay, so what? What is the difference? Because I know what, I know what the reverse is, and it to me. It just freaked me out when I realized what it was.

Speaker 2 3:27

So so you know, people study this for like five years and you're giving me like 10 minutes, yeah, yeah.

Speaker 1 3:31

Just just set the table top here. Okay, I'll give you the cliff Give us the cliff note version.

Speaker 2 3:37

So shoulder pain can happen for a number of reasons. Okay, People will always associate shoulder pain with I must've tore my rotator cuff. Gotcha, that's what it is, but it's not. You can have inflammation in the shoulder, bursitis, tendinitis you don't have to have a tear. One of the problems which I think we'll talk about today is arthritis of the shoulder. Okay, so there's two types of arthritis in the shoulder primary arthritis, which is just wear and tear over time right, Grandma and grandpa get arthritis. Or their secondary arthritis Something happens in the shoulder. You tear your rotator cuff.

Speaker 2 4:09

Maybe you don't know about it, or you live with it for a long time and that can result in arthritis from a secondary reason, not just because it's wear and tear gotcha. So the first thing and I don't know how deep you want me to get, no, but the arthritis thing is that's from just getting older not, necessarily not necessarily have a fracture of your shoulder, which then results in post-traumatic arthritis.

Speaker 2 4:30

Okay, so a trauma okay or you can have a rotator cuff tear, and and I'll explain that a little bit to you guys and that can result in a very common form of arthritis in the shoulder. Oh wow, so you can see an x-ray and immediately know that this person has what we call rotator cuff tear arthritis. Oh wow, so the way you treat them, though, is different, gotcha, so that's why it's important to have the correct diagnosis before you start a treatment plan, because treating rotator cuff tear arthritis versus treating regular arthritis- Now, when you say treating it, do you mean operating or talk about physical therapy?

Speaker 1 5:00

A little bit of both, okay, right, because some of this stuff, once again, can be solved or not solved can be, can work better or can get past the pain with doing physical therapy.

Speaker 2 5:11

One of the first options for arthritis is treating it with either cortisone injections to lower inflammation and therapy and, honestly, activity modifications. So a lot of people who have arthritis if you try to stop doing what's causing the pain, like painting your ceiling or things like overhead work that can really actually improve some of your inflammation because, arthritis is not your problem right, it's the.

Speaker 1 5:33

It's a result of a problem inflammation.

Speaker 2 5:35

Arthritis causes gotcha. So if you can treat the inflammation which is causing your pain, yeah, well then what?

Speaker 1 5:41

exactly is arthritis? Is it? Is that a tissue swelling? Is that what it is? What is it? So? It's part of your body, is it? Is it how?

Speaker 2 5:49

can you give me like an analogy of what it might be, I guess? Uh, it would be like I don't know here, I don't know here we go with the now.

Speaker 1 5:54

Now he's showing stuff. So if you're watching, if you're listening to the podcast, you're not going to know. It's a little tough to get these angles, so look here is it's opposite.

Speaker 2 6:01

Usually there, there we go. Okay, so this is the ball of your shoulder right. So we're looking at it. If it were right here on me, yep holds the ball and the socket and they wear together nicely. Okay, so it's a smooth surface. Gotcha, all arthritis is is the breakdown of that cartilage layer.

Speaker 1 6:22

Okay, so when they say you have bone on bone arthritis, you've worn the cartilage, down Okay, and then when you have bone on bone, that starts to cause pain, because that's where the nerve fibers are in the bone.

Speaker 2 6:34

The cartilage itself won't cause pain. It's the bone underneath it which will sense pain.

Speaker 1 6:40

So once you wear that, down.

Speaker 2 6:41

That can cause the inflammation and that can cause the pain. Gotcha.

Speaker 1 6:45

So you got to get. So the inflammation is what's really becomes the issue, Correct. And that's why you know ibuprofen or or doing different things that you can do to to reduce the swelling. The cortisone shot, like you said, that reduces the swelling in the form of like a steroid.

Speaker 2 6:57

I guess, yeah, a steroid. So it's a very powerful anti-inflammatory, a steroidal anti-inflammatory.

Speaker 1 7:02

And sometimes that'll do the trick. Oh yeah, because what does it do? It knocks it down. It gets it down and then it doesn't come back up again.

Speaker 2 7:09

I mean it usually does right because it's arthritis. So what you do, the idea behind cortisone is to lower the inflammation. The arthritis is still there, oh, got it. So over time, as you use it again and the cortisone wears off, then the arthritis will kick in again. But I mean, I have patients who I see, you know, every year and they get a cortisone shot and that's all they need for arthritis well, that's cool that way.

Speaker 1 7:28

Well, if that works, it works right, that's good. That's the best treatment if it works, yeah, amazing, very cool. So let's go back to this whole shoulder the shoulder reversal versus the shoulder replacement on all that. Sure, let's talk about that, because this is something new, right? So, reversal or no, when I say new 10 years 15 years really.

Speaker 2 7:48

Oh yeah, I'm much older. Okay, but the problem is when I was doing surgery back in the day, back in your day.

Speaker 1 7:53

We just didn't do that. We just didn't do that. I use Band-Aid actually.

Speaker 2 7:57

So when I trained about 10 years ago, we actually were doing these fairly often. But their technology has gotten so much better for shoulders I think in the last 10, 20 years that it's really been a good option for people now, before they used to break down in five, six years or they'd have a lot of failures. But you know, through failure you learn and you have but I think there's a lot of confusion out there regarding a regular shoulder versus a reverse shoulder, and so I wanted to try to clear that up.

Speaker 2 8:29

I'm going to clear that up for all your, for all your viewers. So I don't know. Hugo, here's our angles your viewers.

Speaker 1 8:36

So I don't know. Hugo, here's our angles. Yeah, now now. Nate also was an elementary teacher at one point, so you can see his drawings are very good, so very good, I'm not an artist, but this is about as good as it gets, okay, cool I like it and if you're listening to this and not seeing it, he's got a picture of a shoulder, basically the it's a very crude diagram of yes, yes, now you're gonna yell it could be a hair dryer too.

Speaker 1 8:52

I'm not sure, hug not sure it looks like a hairdryer, Like if you look at it this way. Like if you hold the handle of the hairdryer there, this is not bad.

Speaker 2 8:58

Okay, go ahead, sorry, so, anyway. So here is your. Your head will be up here, okay.

Speaker 1 9:03

Okay, we'll draw it like this Okay, oh wow, that's really nice, that is not?

Speaker 2 9:07

to scale. All right, we'll put it there, gotcha. So here is the, the rotator cuff, coming in Now. Hugo, he's been yelling to me about the mic, so I'm going to have to move this a little bit here.

Speaker 1 9:15

That's right. You want me to hold this, I can hold it, maybe two. Okay, got it, that's perfect. That's perfect. We'll knock this out. That's actually really good.

Speaker 2 9:21

So here is your shoulder, here is the socket part of your shoulder. Gotcha, the rotator cuff sits atop the shoulder and it actually comes in front. You don't need to worry about that one. But the big rotator cuff muscle attaches to the ball right. The function of the rotator cuff, in addition to moving your shoulder, is to keep the shoulder centralized in the socket. Oh right, so you can imagine on the outside. So you know, we're color-coded.

Speaker 1 9:48

Yeah, so this is not blood. This is actually just redness here, not yet, not yet. So here.

Speaker 2 9:54

Let's say these are the cartilage layers. Oh yes, very good. So there's the cartilage holding it. Now what happens is this is, if you have arthritis, the red goes away, right.

Speaker 1 10:05

Oh, the red goes away.

Speaker 2 10:08

And now you're wearing bone on bone. So if you want to do a shoulder replacement, you have to treat the arthritis, gotcha. The good news is you still have a rotator cuff that's keeping you centralized in the socket, gotcha. So it's still moving nicely and smoothly Right. So what you can do is so, if your rotator cuff is okay.

Speaker 1 10:23

This is the way you do it.

Speaker 2 10:24

You do a total shoulder, total shoulder, okay. Shoulder, total shoulder, okay, not the reverse, gotcha, okay. Yep, so what you do is you go in, you make an incision and you would actually cut the ball out, gotcha. Then you would grind the socket down, gotcha.

Speaker 2 10:48

So now you've taken away the arthritis here and there then what you do is you put in a new metal ball so the new metal goes down the shaft of the bone yep, I've seen, and it forms this here and so now you have a new ball and then you put a actually a plastic, technically component in the socket I've seen that for the new socket?

Speaker 2 11:10

amazing. So that is a total shoulder. Okay, gotcha. And the reason you can do a total shoulder is because the rotator cuff is still intact. So here's the why, if your rotator cuff isn't intact, why you would work on changing this up. So let's say you have a rotator cuff tear right, it rips off of the bone. Now your rotator cuff is sitting up here.

Speaker 1 11:30

Oh gosh, that doesn't look good.

Speaker 2 11:32

What do you think, hugo? It looks like jaws.

Speaker 1 11:34

I think is that a shark bite that happened.

Speaker 2 11:36

It looks like a shark bite. It looks like that's what happened. That is gone.

Speaker 1 11:38

Yeah, so swimming with the sharks is not a good idea because it takes your rotator, cuff.

Speaker 2 11:42

Definitely not for this one. Yeah, okay, definitely not for this.

Speaker 1 11:44

No, this makes so much sense now. I totally am getting this now See, I mean this is good stuff.

Speaker 2 11:48

I told you I'm not a real doctor.

Speaker 1 11:49

This is good. It's good drawing. You can explain it with a first grade diagram it.

Speaker 2 11:56

Now we know why you do a total shoulder. Let's say you don't have a rotator cuff right. So what happens? There's other muscles here that I'm not showing right. One of the big shoulder muscles, your deltoid, will pull your shoulder because you're still using your shoulder all day, right, and it is not keeping it centralized in the socket Because your rotator cuff is gone, correct. So what happens now is that begins to pull up.

Speaker 1 12:23

Oh not good. Good, so what happens is you get what we call the dreaded high riding humorous. Oh, this doesn't look good how bad does that?

Speaker 2 12:26

and it's not in the socket. Not so at that point it is still in the socket, it's still inside.

Speaker 1 12:28

But it's on the top edge of it, eccentrically moving. So does it pop then? And stuff do you start to feel popping? You don't have to.

Speaker 2 12:35

okay, some people can't. The more you know, the more advanced it gets. But you know, it's just's just painful, painful, very painful. So then imagine if you went and put a total shoulder in there. It wouldn't work, it wouldn't because?

Speaker 1 12:45

No, because you still don't have the rotator cuff holding it in place.

Speaker 2 12:48

That's what we used to do oh gosh, so we'd put a total shoulder in and people would do terrible. Obviously yeah, Because we were not understanding the biomechanics of I get it so some smarter people than myself came along.

Speaker 1 13:00

This is the part that blows my mind, hugo, this is good stuff here.

Speaker 2 13:03

And said well listen, if we don't have a rotator cuff, we can still keep everything centralized if we flip the ball and the socket.

Speaker 1 13:13

That's the part that blows my mind. Reverse total shoulder yeah, so you're basically putting the ball where the socket was you put the ball.

Speaker 2 13:19

Now. You put the ball there here, right when the socket was. So you put the ball now. You put the ball there here, right With a big old screw right down your scapula Okay, unbelievable. So now the ball stays here, mm-hmm. And then the socket part. You guys make a socket there. Well, it's made out of metal Unbelievable. Now you put the plastic component here. Now, this one's obviously not in place get.

Speaker 2 13:38

You get better movement than from that or better so what people will do is is they will usually get better movement with it, but it is a pain operation. More than anything, it's a pain operation, your pain should greatly improve.

Speaker 1 13:52

Got it, got it, got it. So less pain. Yes, now there are people who do. I'm thinking you're doing this operation to have more pain. You're like this is what we do to give people more pain. This is the goal.

Speaker 2 14:01

This is the goal. The goal is pain.

Speaker 1 14:03

No, but that, that to me is brilliant.

Speaker 2 14:05

Yeah, and it and it is. It's a brilliant idea because it just it may. It's such a simple idea, right? But the best ones are always the most simple, right? Yeah, all I need is one simple.

Speaker 1 14:13

Could you imagine the guy pitching that though? At the doctor's meeting. So last night I was drinking and I came up with this crazy idea we're going to switch the ball and the socket and they're sitting there like you're kidding me and they did it and it's worked.

Speaker 2 14:33

And it's worked great and it works great for people who even have bad fractures of the shoulder. You can't fix it. This is a great way to give them mobility with decreased pain.

Speaker 1 14:44

Amazing, yeah, so I know two people with that my brother and my father-in-law. Is that crazy, or what?

Speaker 2 14:48

Because rotator cuff tears. Believe it or not. If you took an MRI of a hundred people outside random people about 40% would have some form of a rotator cuff there. They don't know about it's amazing, right. So it doesn't mean you have to operate on every rotator cuff there. They don't know about it's amazing, right. So it doesn't mean you have to operate on every rotator cuff tear you see?

Speaker 2 15:02

no, but you operate on the symptoms and a lot of times over time those rotator cuff tears can increase right and people. I see a lot of people that come to my office with shoulder pain and they didn't even know they had a rotator cuff tear.

Speaker 1 15:11

Well, they already have arthritis in their shoulder because it's been decades where they've accommodated gotcha and eventually the body made it work, the body makes it work, the body makes it work and it tries to right Up to some point Right, you said there's that. I remember the last time with the carpal tunnel, you said it won't hurt, it won't hurt, it won't give you problems. And all of a sudden it starts to give you problems. It falls off of that one spot, yeah.

Speaker 2 15:34

And that's true for almost anything in the body. I think Other muscles fire, but I see a lot of people they'll have a fall and they'll flare up arthritis that they never even knew they had because it was an acute traumatic event.

Speaker 1 15:44

Yeah, amazing, when you looked at my back, you you did a x-ray of my back and we looked at that and you were even just showing me like, look at here's your, here's your discs coming down through. And it was interesting, like I don't have really any issues down there, you know, like I don't have any bulging discs or anything like that. Your mind's stretching.

Speaker 2 16:00

Your problem is, I think there's too much muscle mass holding your back up. Yeah, so you got to work on that muscle mass.

Speaker 1 16:05

Yeah, that that's weird. I don't think that's the problem. I think I have. I have little muscle mass right here. Yeah, that's not muscle. Yeah, yeah, no, but I'll tell you, the stretching's working.

Speaker 2 16:15

Yeah, it works it works a lot, and that's why I say a lot of these things. You don't have to have surgery for yeah, you just have to be able to be patient with it. We're not very patient sometimes. No, we're not at all. We want to get better fast.

Speaker 1 16:26

So that was an excellent explanation of that and I totally get it. Now let's talk about a little bit about more of the other pains you can have Bursitis, is that having to do with the bursa sac bursitis? So it is. And here we go. See this is, let's see, this is arts, and crafts, you're not going to use your t-rex.

Speaker 2 16:45

Uh bones, I get nervous with the t-rex bones.

Speaker 1 16:46

All right, these are probably your kids bones, aren't they? Well, you take these from their room my kids, they sometimes they like the.

Speaker 2 16:52

They're like what did you hear about today, dad? What'd you see today?

Speaker 2 16:55

I'm like oh man, that's funny so let me show you what bursitis would be okay. Okay, now this is back to where we were. Okay, there's the ball and socket part, got it. So, bursitis, there are bursa sacks You're exactly correct that sit on top of the rotator cuff muscle, okay, and they act as like oil in an engine, right, so move it. It helps everything glide, cause, right. The problems is if you're doing a lot of overhead work. I see in a lot of overhead work, uh, you know, drywallers, drywallers, seriously, construction painters painters.

Speaker 1 17:33

I can totally see painters.

Speaker 2 17:34

They'll have very serious pain in the front part and the outside part of their shoulder and what happens is they get bursitis. This gets acutely inflamed, just like you would get an Achilles tendonitis, and it can be one of the hardest ones to get rid of. Because what do you do? All day You're moving the shoulder Right, and so you've got to be able to get this thing to calm down. But now you're sure, what do you do when you have Achilles tendonitis? You're in a boot for six weeks.

Speaker 1 17:56

You don't run, you don. You can't do that with your shoulder.

Speaker 2 17:57

You can't be in a sling for seven weeks. You'll be so stiff.

Speaker 2 17:59

Yeah, exactly, so then you also start to atrophy, then too right, for sure, yeah for sure, and so you have to find a way in the shoulder to get things to heal but still be functional while you're healing, which is difficult. Yeah, so people can have shoulder pain, like I think I tore my rotator cuff, but no injury, sign of, just bursitis in the shoulder, and that is where actually usually a cortisone injection in that area works wonders for people. Interesting Because it will really lower that acute inflammation.

Speaker 1 18:26

Yeah. So when that thing's inflamed, is it still doing its job, though, or no? If it's?

Speaker 2 18:30

inflamed, it's still doing it.

Speaker 1 18:32

It's still doing it, but it hurts. It hurts.

Speaker 2 18:33

It hurts. I mean I just had Achilles tendonitis and I mean it was brutal.

Speaker 1 18:37

I've heard that is brutal.

Speaker 2 18:38

I heard it is so I mean, you got to take it easy and the problem is in the shoulder. It's the most mobile joint, right, it's the most mobile joint in the body, so there's no way that you're gonna.

Speaker 1 18:45

So there's and isn't, isn't. So when you say most mobile, like it, it does more things. It can go like if you think about your knee. Your knee goes back and forth.

Speaker 2 18:53

Your knee is a hinge joint yeah, this is like oh, it goes all over, all over the place, all over. Yeah, it's crazy. So people get really people can get really inflamed with bursitis, but they'll all. Everyone thinks it's a rotator cuff tear. Right, and remember, I just said there's a lot of people out there with a rotator cuff. Yeah, the problem is is that if you get an mri on that, yes, and it shows a small rotator cuff tear, they're gonna they're gonna say it's that, that's what's causing my pain. Yeah, and, and maybe it is, but there's a lot of things you got to go through before you in my opinion. Yeah, you can fix the tear. Oh, yeah, rotator cuff surgery is one of the most common, so you can fix the tear and then put it back where it needs to be.

Speaker 1 19:30

Oh yeah, so. So here you go. Is that where you drill through the bone and like with a little washer?

Speaker 2 19:33

So it's it's almost like a drywall anchor.

Speaker 1 19:35

Yeah, okay, I think I yeah.

Speaker 2 19:41

So if you have a tear, let's say you have a tear right here, right in there, the top part what you would do is you come in here with us and this is where you do it arthroscopically, right, no big incisions wow small stab incision so you can move a camera and shuttle your sutures around.

Speaker 2 19:54

So then you say, all right, we got to get this back down to the, to the x's yep. So you take a little drywall anchor and you literally put it back in. You put it into the bone. Amazing, there's sutures that come out of there. Okay, take those stitches, pass them through the rotator cuff, yep, yep, and then that will, once you tie it down, yeah, it'll advance it back.

Speaker 1 20:13

Unbelievable repair that will that attach, then eventually, oh yeah, it'll, it'll actually attach about six weeks.

Speaker 2 20:19

That's it six weeks for that to heal. Now, remember, for surgery, you're just showing scar tissue where to go. Right, you're showing scar tissue because that's how you stimulate a healing response, right? Okay, surgery is controlled trauma. To show scar tissue where to go? Oh, I get it now. So, you want that scar to overlap the tendon and the bone so it heals.

Speaker 1 20:40

Not where it is up there.

Speaker 2 20:41

Correct. Yes, you want to make sure that Got it.

Speaker 1 20:44

Wow, never heard it like that before either. That's great, great, uh way to look at it.

Speaker 2 20:49

Yeah, you learn something new every day.

Speaker 1 20:50

I'll tell you this is see, this is, this is good stuff, yeah, so let's go into um tendonitis right.

Speaker 2 20:56

So, just like we said, you can have a bursitis. You can actually have an inflammation around the tendon itself. So one of the other options is the tendon itself can become inflamed. Now that's a little bit more difficult to treat because you don't want to keep putting cortisone into a tendon itself, obviously because that repeated cortisone injections and I hear it all the time I don't want to do a cortisone injection because I heard it eats away all your tissues. Oh right, that's not true. I mean, if you're a baseball player and for 162 games you're getting one before that's, that's bad yeah, but you know, here and there if you need a cortisone injection, there's no long-term effects, right.

Speaker 2 21:30

But tendinosis, or tendonitis really is the same as bursitis, is just involving the tendon. Tendon got it and, once again, though, you can get an mri on that and you'll see that the tendon looks thickened, looked angry and there's a small tear. And people say I saw my mri report, it's a tear, I need fix, it's here. Well, no, let's not get there yet. Now there are some tears you have to fix right, like you fall and that's pulled off. You want to get to those sooner, but the average run of the mill shoulder pain that you see, that walks through the door you hear someone complain about, is not because they fell outside, it's. This has been bothering me for a year. It it hurts me at night overhead motions when I try to scratch your back.

Speaker 2 22:05

I can't do it. Those are very commonly seen for bursitis, tendinitis and sometimes small rotator cuff tears, but more so the latter. Yeah, it's amazing.

Speaker 1 22:14

Do you have any questions yet, Hugo?

Speaker 2 22:16

No, I'm just impressed, did you say depressed or impressed?

Speaker 1 22:21

No, no, I'm just mad. Pretty amazing, right, yeah, that's pretty amazing.

Speaker 2 22:26

The shoulder is a very difficult thing to really conceptualize, but once you do and you can dumb it down, there's only so many things that can really cause shoulder pain.

Speaker 1 22:37

Yeah, it is amazing, totally amazing. So let's talk about the misdiagnosis is one of the things that we kind of chatted a little bit about. Some people will come in and they'll say it's neck pain or shoulder pain, or it's not shoulder pain, it is actually neck pain. I mean, what, what do you see with that?

Speaker 2 22:53

So I think one of the things you always have to look at when you're looking at shoulder pain is you got to look a little bit higher, okay. And what I mean by higher is you got to look around the neck, because a lot of people will have mild neck pain it doesn't bother that much. But you got to remember all the nerves that come out and go to your shoulder start up in the neck Right. So if those nerves come out and let's say, you have arthritis in your neck and it's pinching that nerve or it's inflaming that nerve, that can fire around the shoulder. So there can be some people. I've seen people come in. They're like both of my shoulders are killing me, I don't know what, and I'm like both of your shoulders Both of them yeah, right, right and so.

Speaker 2 23:25

I don't know what it is, it's just been bothering me for such a long time. And you look at their neck and they actually the nerves that are giving sensation and pain to the shoulders are inflamed. Oh wow, and so it presents in the shoulders.

Speaker 1 23:37

Yeah, and people like I don't have that where it terminates to the nerve or some of them wherever it terminates.

Speaker 2 23:48

Right, and I'll have people where you can have both. Right, you can have both. Some people come in and they have neck pain and shoulder pain. Oh geez, those poor people that's where you're exactly.

Speaker 1 23:53

Do you say hey, you know what, if I were you, I would just, uh, it might be time to.

Speaker 2 23:56

Yeah, I don't know, like a horse you know, you take him out to a field.

Speaker 1 24:00

I'm not in that part of medicine, but there was another guy that was doing that for a while, yeah, he, he done.

Speaker 2 24:07

I think he's in jail. He's dead. Actually, he's dead. Yeah, he died. Yeah, I think he killed himself in prison.

Speaker 1 24:11

Yeah, something there goes the family show, all right.

Speaker 2 24:16

This is where you turn it off, if you have kids.

Speaker 1 24:17

Yeah, exactly, so it can be misdiagnosed with a neck.

Speaker 2 24:21

It can.

Introduction and Guest Welcome

Speaker 1 24:23

You know what's funny? I looked under shoulders today and then I looked at. Sometimes people misdiagnose a heart attack for shoulder pain.

Speaker 2 24:34

See, this is where I tell people I'm not the real doctor.

Speaker 1 24:37

Dr Traer.

Speaker 2 24:38

We'll bring Dr Traer in. I'm on the phone and I call a real doctor and they go.

Speaker 1 24:43

But seriously, that could be. People sometimes go oh, it's my shoulder, but if it goes into your jaw and down your left arm, that could be. People sometimes go, oh, it's my shoulder, but if it goes into your jaw and down your left arm, that could be.

Speaker 2 24:49

It's funny you mention that because there was just an article I read where someone had chronic shoulder pain and then it was actually presenting in that fashion. Get out of here it was more of a cardiac issue than it was a shoulder issue.

Speaker 1 25:02

Oh jeez, can you imagine that you keep thinking it's your shoulder and next thing you know that's not good. No, that's that's that's every orthopedist nightmare yeah, absolutely, and, like they said that, there's other things that usually go with that like the fever like sweating and and the drawl and down the arm and all that stuff and usually your.

Speaker 2 25:17

Your physical exam right should show you that yes, exactly if you move the shoulder and it hurts, that's shoulder, that's shoulder pain. Move the shoulder and they're like I'm sweating and I have palpitations that's's probably not a.

Speaker 1 25:26

I don't think you need to go to medical school. I'm thinking not the reversal.

Speaker 2 25:30

I'm thinking the reversal is not going to work for you at that point we're not signing that person up for total shoulder Put it that way.

Speaker 1 25:34

Dr Nate, I have a question. What?

Speaker 2 25:36

profession I was thinking maybe is the baseball pitcher, but what profession suffers more, given their work from?

Speaker 1 25:43

shoulder injuries.

Speaker 2 25:44

Honestly, there's a ton of stuff out there for baseball players, especially pitchers. I mean, the shoulder is not meant to rocket a projectile. 95 miles an hour 100 times every five days? Obviously not. What you see with pitchers is a lot more soft tissue injury than really arthritis. So they'll have bursitis, they'll have impingement, which is where the bone can kind of push down on the rotator cuff. All of those things are much more common in baseball players and pitchers. But you'd be surprised any type of overhead Like I even see volleyball players.

Speaker 1 26:17

Oh, because you're doing this. Yeah, right.

Speaker 2 26:19

So the serve a lot, a lot of rock climbers, believe it or not.

Speaker 1 26:23

Oh, yeah, because they're hanging from their shoulders a lot of time. They're always up here. Yeah, because they're hanging from their shoulders a lot of time. They're always up here. It's this, yeah, it's all that.

Speaker 2 26:28

So they end up getting a lot of stuff too, and rock climbing is a big deal now around here. Yeah, I'm back.

Speaker 1 26:32

There's like a couple places over here.

Speaker 2 26:33

You'll never see me do that. No, I don't do heights? No, no I don't like going downstairs. Nah, nah, nah your hand and you could just close your eyes looking for the railing.

Speaker 1 26:45

I got nervous, right now, no, but I'll tell you.

Speaker 2 26:48

You're right, those guys rock climbing and it's, and that's all exerting on your show.

Speaker 1 26:52

I'm always amazed how they can hold on with just their fingers, like their fingers, their whole bodies on their fingers.

Speaker 2 26:57

It's not I mean a little off topic, but I saw. Do you ever see the one guy who does it without a uh, oh, not a rope? Yeah, I've seen that guy. It's unbelievable that that's a whole documentary.

Speaker 1 27:07

I sweat when I watch him. My palms are sweating the whole time. I remember Like I actually I'm stressed out when I watch him and he was like I couldn't make it up this time, so I came back down.

Speaker 2 27:16

I'm like that's probably a good decision.

Speaker 1 27:17

Yeah Well, did he go down the fast way or the slow way? And they make? We're not doing that.

Speaker 2 27:24

No, it's not happening. Not happening. I do the rock climb at the YMCA and I get two up. I'm like I'm good. Yeah, this is where I thought I was going to start crying.

Speaker 1 27:33

Mom. Where's my mommy? So is there anything else about the shoulder?

Speaker 2 27:41

I mean you got these nice little things here, but I guess we did most of it on the whiteboard right. These are where muscles attach or come off in the shoulder, so you can see how much is involved with. You know the anatomy.

Speaker 1 27:54

Whoa, that's a lot.

Speaker 2 27:56

There's a lot of things that can go wrong. There's a lot of things that can go wrong and that's why your physical exam is most important. In the shoulder, you got to look at the neck. You got to make sure everything's going up here. You know there's a lot of other smaller joints, not just the ball and socket joint, that can reproduce a lot of pain.

Speaker 1 28:09

Unbelievable Crazy. So not about shoulders, but let's just talk real quick about the flu. That's really rampant right now. You were talking about on the phone. We talked about how and we've all heard this a lot of times as they basically they, they kind of do a crap shoot and go okay, this is what we think the flu is going to be.

Speaker 2 28:28

And there's a bunch of versions in that shot right. What's also crazy is so you know, we got over flu maybe two, three weeks ago in my house. We had three kids get it right and then I didn't get it.

Speaker 1 28:37

Now, does that mean that you had that my?

Speaker 2 28:39

wife says that's because I'm not around the kids enough. Oh, that sounds like something. Oh, you know what we go to dinner.

Speaker 1 28:44

I'm going to say that. You know, I heard you didn't get the flu.

Speaker 2 28:47

I wonder if it's because he's not around the kids that much. I told her the other day I'm like you know, I never get their sicknesses and she goes. Oh really that sounds like something you don't say that's because when our kids are sick, I'm like get that away from me, Stay away. I didn't get it. Yeah, I don't know what it is.

Speaker 1 29:05

That was a while ago.

Speaker 2 29:06

Remember the whole thing with COVID too, Some people got it, some people didn't, I never got it. You don't think you had it.

Speaker 1 29:11

I probably did, hey, if you don't test, does that make it that you didn't get it? Yeah, you never tested, that's why. Yeah, exactly. Well, you know, that was all.

Speaker 2 29:31

They oh that was negative.

Speaker 1 29:32

Yeah, it was negative. All right, listen. Is this a fun show or something? Because I have a. I have a shoulder pain is one thing, but I got a, I got a question.

Speaker 2 29:35

I would like to go ahead, go ahead. This is a question back on us all, right? So listen, I go to this one place and I get a haircut every every couple weeks, right, yeah, it's just one of those places you walk in, you just sure like it's easy, it's? So I go in there on a friday, I get my haircut. I come home I think we had something next week so my wife's like, hey, you got to look presentable.

Speaker 1 29:49

So I go get the haircut.

Speaker 2 29:51

I come back and my wife's like ooh, it's not a good haircut. Oh, whoa, it wasn't.

Speaker 1 29:56

All right. Okay, it wasn't All right.

Speaker 2 30:01

It wasn't blended. Are you planning on going?

Speaker 1 30:03

back there, okay, okay.

Speaker 2 30:04

Okay, and here's why, and that's why I'm gonna get your what, get your opinion on it, you go. So that was Friday, okay, this past Friday, your hair looks fine.

Speaker 1 30:11

No, no, no, oh, a couple of Fridays ago, I'm still.

Speaker 2 30:12

I'm still processing it, okay, got it so so four days later I said, hey, listen, I can pick up one or two of the kids, take them with me, that way you don't have all four there. She's like, oh awesome, thanks. So I drive over, okay. The guy who cut my hair Okay, is there. Okay, I walk in. He acknowledges me. Hey, hair looks great. I said thanks, man, and I sit down. My wife looks over me and, nate, while you're here, can you get another haircut? Oh gosh, no, no, no, no. Oh man, that's terrible. So let me set the scene. No, no, so let me set the scene. Okay. So I'm sitting there, okay. The guy who cut my hair four days ago acknowledged that he saw me, commented on how good my hair was which it wasn't okay, it was

Speaker 1 31:03

not a great cut, but I don't care, yeah, whatever, yeah, it goes back, and so my wife goes.

Speaker 2 31:09

Can you get a new haircut? Oh, no. And I looked at her and I'm like you know, like he, you know she doesn't know it's him, so she doesn't know, oh gosh.

Speaker 1 31:16

She doesn't know.

Speaker 2 31:17

And so she's like, hey, you should get a new haircut. I'm like, keep your voice down. He cut my hair. She's like it looks like crap from before and she said she said, well, she goes, just you don't have to go to him.

Speaker 1 31:33

but how are you not going?

Speaker 2 31:35

to go to him.

Speaker 1 31:36

Go to somebody else how I could never do that.

Speaker 2 31:40

So I start panicking because I'm like did you start sweating? I can't have this conversation with him right there no, he just told me, I look good take it out.

Speaker 1 31:47

You gotta take that one out start texting her.

Speaker 2 31:49

So my question is this okay, what's the? What do you do? Your wife is saying hey, brad, this haircut, you got to get a new one. The guy who just cut your hair four days ago right says oh, you look good, good haircut. Yeah, recognizes me. What do you Do? You get a new haircut With him.

Speaker 1 32:09

I don't know how I With him, or no, no, I would say I'm not getting a haircut. I would text my wife and say I'm not getting a haircut. This is very uncomfortable. That's what I would do. There's no way I'm going to somebody else after he just said it looked good. Okay, I respect that. I will tell him the truth, I will say hey man, you know, my wife said that I personally like it. But my wife doesn't.

Speaker 2 32:34

She's right there. Throw the wife under the bus. That is the best answer. Throw the wife under the bus. No, it's the truth though.

Speaker 1 32:42

Yeah, my wife would kill me if I did that.

Speaker 2 32:45

Kill me, so I panicked what did, you, do, do I got a haircut by someone else oh my gosh what did he say? Did he say anything? Yeah, he did. What'd he say? So I got up and I walked by him and I acted like it wasn't happening. Right, you just act like it was and he looks at me where you going.

Speaker 1 33:01

I was like oh, oh my gosh, this is so uncomfortable I'm just getting a new haircut.

Speaker 2 33:06

uh, and he goes why I just cut your hair four days ago Like wouldn't let me off the hook.

Speaker 1 33:12

Oh man, you should have just taken off running.

Speaker 2 33:14

I said you know, I'm just getting it freshened up. He goes it was four days ago and I'm like, and I panicked and I just sat down. I said clipper number three on the. You went and sat down. Oh yeah, he's asking me as I'm going to the chair I thought you meant after it was cut as I'm going to the new chair. Oh, my gosh, dude, so I can't go back there. No, yeah, no, I can never go. I would never go back. No, you can't, absolutely not. No, so you were, I could never go back.

Speaker 1 33:39

See, I would you know what I would done. I would have text jess and I would have said this is where it's funny, we're a little different. Uh, I would text her and I would say this is not happening right now, but she's right next to you, I would text her. If you're in a situation like that, just text her, and you know what I do. I go check your phone.

Speaker 2 33:55

Check your phone no, you can tell that you have diarrhea or that you have to fart.

Speaker 1 33:59

You go outside real quick and then you text her from outside that's a good one.

Speaker 2 34:05

When I'm in this situation, I'm texting Hugo. Hugo's definitely got the answers right he does.

Speaker 1 34:09

Oh my God. All right, We've got to wrap this up Longest podcast ever?

Speaker 2 34:12

I think, yeah, sorry about that. I wanted to ask you about life situations. I love the stories, love the stories.

Speaker 1 34:27

That's a good one.

Speaker 2 34:28

We'll talk about that next time.

Speaker 1 34:29

All right, that's it. Dr T was in the house. That was a good time, all right, so come see us every Thursday at 7 pm. You can find us on Facebook, instagram, youtube wherever you want to find us, we'll be there. All right, that's about it, see you.