Episode 035: Shoulder Injuries, Treatment, & Prevention

Dr. Hill is a board-certified shoulder and elbow specialist. Dr. Hill completed his orthopaedic surgery residency training at St. Louis University and following his residency he was fortunate enough to complete a fellowship in shoulder and elbow surgery at the prestigious Rothman Orthopaedic Institute / Thomas Jefferson University Hospitals in Philadelphia, PA. There he learned the most advanced techniques in modern reconstructive and arthroscopic shoulder and elbow surgery from many of the world’s experts.

In this episode of the Taylor Method for Pain Free Living podcast, Dr. Derek Taylor talks with Dr. Brian Hill about his journey to becoming an orthopedic surgeon. Dr. Hill shares how his own experiences with injuries as an athlete led him to pursue a career in orthopedics. He also discusses the most common shoulder conditions, symptoms, and treatments.

Dr. Hill explains the difference between shoulder bursitis and shoulder tendonitis. 

Both Doctors discuss maintain healthy shoulders is crucial to one’s well-being. They talk about overhead activities, weight lifting, and even how lower impact sports such as Pickleball effect the shoulders.

To learn more about what Dr. Hill you can visit his website https://www.brianhillmd.com

Connect with Dr. Derek Taylor on https://www.drderektaylor.com

Transcript

0:00  

Okay, well, this is Dr. Derek Taylor here. I'm here with Dr. Brian Hill. Welcome to the Taylor method for pain free living podcast. Dr. Brian hills, a doctor, a medical doctor, orthopedic board-certified orthopedic surgeon has been practicing for the past 10 years and he's here in Palm Beach Gardens at the Palm Beach orthopaedic Institute. That's correct. And I appreciate you having me on. It's been a long time. Right? They have your I've been wanting to have you on the show here for a while. So how did how did you get into being an orthopedic surgeon? I mean, what what's what motivated that when you were a young man? Yeah, so good question. So I mean, with like most typical orthopedic surgeons,

1:23  

I had my fair share of injuries as an athlete in high school, and had my fair share of injuries. And one instance I remember in particular, where I was, my dad was a wrestler, I wanted to be a basketball player, but somehow he talked me into going out for the wrestling team. And I was trying to wrestle a guy that was quite a bit bigger than me and he broke my finger. And, and so that that day, we went into the office of a local orthopedic surgeon, Dr. Andy Desmond and, and he was able just to give a local injection and then reset the fracture and then put me in a splint. And I thought, holy cow, this is the coolest deal. fluoroscopy and I thought this is this is awesome. This is what I want to do. It's great. In medical school, I tried to talk myself out of it. I tried to do cardiothoracic stuff and everything. But I always gravitated back towards orthopedics. See that? Just the nature that people get better? The you know, like most surgeons, we like instant gratification. And so you definitely get that in orthopedics. Yeah, great. Now, you played a number of different sports you wrestled and then you played football, correct? Yep. And

2:37  

you're telling me we had a conversation earlier this week? How you you went out for the college football team there and can you who is that quarterback? Your nose? So starting there above his name? Yeah. So Ben Rothelisberger. So I thought I was a pretty good quarterback. My high school. Our team was ranked number one in state and, and, you know, I had decent statistics, but it was mostly because I had a ton of talent around me.

3:08  

And then, so I went to Miami of Ohio and realized, with Big Ben being a redshirt freshman at the time was, what real talent was, then my day is pretty early.

3:19  

Like I told you, you pick the wrong school to play college football. You probably want to start anywhere else, but we're behind that. Well, hey, I wanted to talk about shoulder issues here. And that's what our listeners are here for. I mean, so what are the most common shoulder conditions that you see in your practice?

3:39  

Certainly, so most of the time, most people come in with either bursitis or tendinitis, okay, just to inflammation of the rotator cuff tendon. And that's, that's definitely the most common and, and people either say they wake up with it, or they've been playing a lot of tennis or some sport, and just kind of started feeling some soreness on the lateral aspect of the shoulder. Because of my practice, I also see quite a bit of arthritis as well. And so that's where the, certainly the bones, the cartilage between the bones wears down. And then less than frequently, we actually see rotator cuff tendon tears or long head of the bicep tendon tears.

4:21  

Alright, so you mentioned tendinitis and bursitis. So somebody is dealing with shoulder pain here. What are some of the common signs and symptoms they're going to see in a bursitis tendinitis condition? And how can you tell the difference between the two? What are what are some of the things that you can tell our listeners that would maybe give them some clues that they either have a bursitis condition or a tendinitis?

4:43  

Yeah, so differentiating between the two is difficult and it's even tough for me. But both are sort of treated the same and, and have the same remedies and prognosis and so most of the time, what patients complain of is either lateral sided shoulder pain or almost arm pain, a lot of times they say it's more down here in the in the humerus or the arm bone. And they complain about it reaching out reaching overhead, trying to put on a jacket reaching back in their seat belt. And then also it bothers them at sleep, they say blocked during the day, it's not too bad, but at night, it just really keeps on waking me up. And then so that's a telltale sign as well.

5:28  

Now why is it at nighttime that they? Patient says to Dr. Hill, why is it at nighttime this thing really bothered him during the day? I don't really notice it too much.

5:40  

Yeah. Well, so we have theories, we don't have any proof thus far. And so what we think is a couple of factors, one, you're doing things during the day, where you don't seem to notice and not you're you seem to develop more of a kind of a focus on that pain, to also when you lay down and start relaxing, your shoulder is almost like a golf ball on a golf tee. But most of the constraints are soft tissue constraints, the rotator cuff or the muscles. And so when you start relaxing like that, it starts having to kick in those, those muscles that are irritated, or tendons to keep that ball in place. And so that's another reason we think, possibly that when you're laying down at night, seems to bother you a little bit more.

6:30  

So they have the you had mentioned, that's interesting. So they have a tendinitis or bursitis. You see the structures over here, but you're saying that the pain will sometimes be here in the lateral arm? So do you see a lot of that in your practice where you have a referral of pain from different areas? And you want to talk about that a little bit?

6:49  

Yeah. And so it's interesting, because most people, when you when you say, Hey, I think this is your rotator cuff, they say, Well, you know, I looked at pictures, and my rotator cuff is actually up here and my my shoulder, but really where my pain is, is kind of almost my mid arm or upper arm. And so I would say the majority of patients kind of have the referred pain down there. And it's almost if you can feel that bone on the lateral spec to the arm, it's almost one hand Brett, below that, where they get quite a bit of that pain. And so that's, that's common. And that's even common with tears and other things as well.

7:26  

So what are some of the common tests that they can do by themselves, like wringing their arms up here your hair and lifting them up here as far as, as a way to determine whether or not one of those structures are being impinged or irritated? What are some common things that?

7:43  

Yeah, so you hit it. So most, most of the time, the first thing that I do, and patients can do the same thing is just Raise both arms up overhead and see if they have any limitations. Also, I then I test them is reach out across the body. And what they can do is they can put some light resistance on that as well and see Does that bother them, when they kind of tried to raise their arm, but with some light resistance, if that does not seem to bother them too much. The one other thing is when they raise up, try rotating that arm and seeing if by changing the rotation of the humerus, that seems to, you know, check for the impingement or tendinitis as well up there. And so people that have some slightly posterior tendency, sometimes just the rotation will cause them to have pain and, and so that's the patients can easily do that as well and kind of see if that's what they're suffering from.

8:38  

And what are the typical age ranges that you see with people that are coming into your office with these types of conditions.

8:45  

So most of the time, it's, it's about probably 42, since we live in Palm Beach, 90 year old. You know, it's lots of times it tends to be more active people. But other times, it's just somebody that they woke up one day, and they started noticing this discomfort and pain and it didn't go away.

9:08  

And what are some of the common things that you see people doing activities that are that are causing that condition in the first place.

9:17  

So any overhead sports can cause it, so a lot of tennis players develop shoulder issues, swimmers also develop shoulder issues. And then any throwers or anything like that as well. People that like to play softball, even recreationally or, or football for fun, seem to have issues as well.

9:39  

And this is probably a big reason why a lot of people are switching over from tennis to pickleball because there's a lot less overhead, right? You say yeah,

9:47  

I 100% So I mean, one big factor for the explosion of pickleball and people with shoulder problems who had difficulty playing tennis and couldn't play tennis anymore. Were able to man It's pickleball. And so that's certainly a factor in why it's become such a popular sport.

10:06  

What's a big difference when you have that big huge tennis racket versus that smaller compact pickleball racket? It's a lot forgiving on the joint, isn't it? Great? Definitely. And so what are are the most common surgical procedures that you do in your practice? Yeah.

10:26  

So for just bursitis and tendinitis, most of the time we they don't require surgery. And so that can be treated with physical therapy. And the goal of physical therapy is really to strengthen all the muscles around the shoulder joint and to decrease that inflammation get back to the normal mechanic. Also some a short duration of anti inflammatory medications like aleve, ibuprofen or some other prescription medications. And then every once in a while, we also do cortisone injections, a high dose of an anti inflammatory agent right there to the spot of inflammation, which which helps to alleviate that discomfort and pain to surgically most of the time, I'm seeing patients with rotator cuff tears. Arthritis where they need actual shoulder replacement surgery, or fractures, trauma injuries. Somebody was out skiing in Colorado and broke the shoulder or they were out biking and Jonathan Dickinson and sustained a clavicle fracture. I see that quite a bit too.

11:28  

Now, so you mostly see the when it comes to the shoulder most of the fractures are occurring I dig it in the clavicle is because it's going to be more it's going to be easier to fracture than the scapula.

11:39  

Yeah, the clavicle or proximal humerus is pretty common here as well. And so a lot of you know, proximal humerus fractures are a osteoporotic fracture, fragility fracture. So a lot of our older patients down here, slip and fall, they fall on their shoulder, they break their proximal humerus, or the upper arm bone,

12:01  

do you just set that bone or put a pin in it sometimes? Or do you do a shoulder replacement? If they're osteoporotic? I mean, how do you handle that?

12:11  

So good news is about 85% of those do well without surgery alone. And so most of the time, what we do is we put them in a sling, there's a cast or anything that you can, you can cast that, and you let the bone heal, but you start, again, early range of motion, because it's important not only to let it heal, but then you want to keep the shoulder motion as well. Because if you just keep it at your side and let it heal, it may heal, but then you'll never get your motion back. And so it's kind of a delicate balance. Rarely, if they're younger, we have to fix it. And so, you know, for example, next week, I have a 35 year old that's coming in with the proximal humerus fracture, that's going to require surgery. And then other times, if they're older, or the fracture is bad enough where we're concerned about the blood supply to the head, can we replace it?

13:03  

Got it. So a lot of the shoulder fractures, I mean, you're just gonna put them in a, you can't really put a cast on that. So they're just immobilized. And so I'm interesting what I wanted to ask you, what made it what made you gravitate toward the shoulder, you know, some sort of surgeons, you know, gravitate toward the knee or the hip or the spine? What was it about? Was it because you play quarterback? Is that why you get shoulder now?

13:33  

So in orthopedic residency, we do everything right, we rotate through every single subspecialty. So pediatric spine, trauma, sports, put an ankle. And the neat thing about shoulder surgery, is you do the whole spectrum of surgery. But on the shoulder, so we do sports injuries, arthroscopic procedures, minimally invasive surgery, we do fractures, like I said, trauma, but on the shoulder, and then we also do replacement. So my typical practice is anywhere from about 11 to 13 year old’s all the way to 95-100 year old. And it's tough to see that in any other subspecialty you don't get that breadth of variation, but then also focusing on just one or two joints, which is which is awesome. I mean, it's been a great set of specialty. The other factor selfishly is I liked not having to be in the hospital all the time. So I like surgery centers or clinic. And so because shoulder patients, their legs still work. After surgery, they can get up and go home, it's easy for them to walk so they're not in the hospital multiple days after shoulder replacement. In fact, now most go home the same day.

14:48  

Wow. Okay, that's great. Had there been a lot of new advances that you've seen with the new surgical procedures in the shoulder world here in the past few years?

14:59  

Yeah, in the past few years, not as much, but there's still a lot of innovation going on with shoulder. So just 20 years ago, in the United States, the reverse shoulder replacement was introduced, which is where instead of replacing a ball with a ball, we replace the socket on the ball side, and then put a ball on the socket side. And so that has really exploded. And we found out as we get more information, more research on that how well patients do with that. Other factors that we've gotten better at our know our surgical techniques, and also pain management. But to say all that, we still, we still need to have some advancements, I mean, rotator cuff tendon tears, we are probably about the same rate of re tears, just as they were 10-15 years ago, we haven't really improved that. And so we're now really trying different biologics, and that sort of type of treatment modalities to get those tendons to heal better after we repair them. But there's certainly a lot of innovation that needs to happen.

16:11  

What is the recovery period for a surgery like that, depending on what kind of surgery you're doing, whether it's a total replacement, total shoulder replacement, or just something arthroscopic? What's the range of recovery time for somebody that has one of these procedures?

16:27  

Yeah, so the quickest fractures heal about three months, and most of the time like clavicle fractures. If they require surgery, you can plate those, and then they can get back on a bike pretty quickly, within a couple of weeks. Even rotator cuff tendon tears are tough. I mean, it takes quite a long time to get back to pre injury level. And so we found between about six and 12 months is where that improvement hits pre injury level or 100%. Same thing with shoulder replacement surgery, it's about anywhere between six and 12 months. So it takes a while until patients really feel 100% Again,

17:06  

and they're getting PTO throughout that whole time and to

17:09  

Yeah, at first I'm pretty conservative. So at first I have them do home exercises. And then, and then I do send them to guided therapy. And then I tried to talk to him and most with most patients, after they've been in therapy long enough. They know the exercises. So I just haven't checked in with a therapist to make sure they're doing everything correctly.

17:33  

Are there any potential risk or complications of surgeries that that patient should know about?

17:40  

Yeah, 100%, I mean it every and every surgery has complications, right. And so anytime you make an incision, there's always a risk of infection. And so we try to prevent that with antibiotics. And then it really depends on the type of surgery so arthroscopic rotator cuff repair, the risks are minimal. Besides infection, the biggest risk is probably read tear and that healing that tempo, but it's just with small little incisions. And because of that we've minimized our risk. With bigger surgeries, fractures or replacement, there's much more risk, there's risks to nerves. There's risks to vessels as well or bleeding. And then also, you can always break something when you're trying to put a metal into a bone. And so, you know, we always have a long discussion about the positive the pros and cons of both surgery and now without surgery.

18:40  

Can you share any success stories or patient testimonials? Where somebody had a real positive outcome from the, you know, working with you and you're having a shoulder surgery?

18:53  

Certainly. So, one that stands out the young lady believe she was around 6870 and had fallen and had a proximal humerus fracture. And it healed but it left her pretty debilitated without much motion. And so she came and she was referred to me from another surgeon and came to see me and told me Look, I really don't have much function at all on my shoulder there anything you can do for me. And she's done phenomenal. She's about a year and a half out now and has full function of her shoulder she's back to playing golf. And really, she was tough but told me she had no pain did not take any pain medications after surgery as well. And that's it. That's a big thing that I try to do is limit the amount of narcotics that we give or give opioid sparing treatment. And with most people, they don't need the strong stuff. And so that's the big deal too. But she's done great.

19:56  

And don't you find that the healthier the patient Isn't the better the attitude they have going into the surgery? They're going to have a better outcome than somebody who's, you know, don't take care of themselves. They're not in well, they're not well conditioned.

20:11  

Yeah. 100% mean people that are healthy and, and have a strong mental help as well. Have a good mindset definitely do better. And so taking care of yourself prior to having an injury or surgery is definitely a benefit. And we've seen that in multiple studies as well. Yeah.

20:35  

Yeah. And lastly, what are some preventative measures that you can give me you've been dealing with patients for over 10 years? What are some common things that you see patients doing that are sabotaging their shoulders? And what advice or tips can you give our audience as we close our interview time, together that can maybe help them avoid seeing you all together and regain or in the future and minimize reducing that risk in the future,

21:02  

right, so I'd love for everybody not to have shoulder issues. And so the biggest deals that they can do is stretching is huge. And as we age, we get more constricted. And so having a stretching routine, doing yoga or something like that, especially as we get older is, is great for the body. The second thing is, is doing some either light exercises, to help strengthen the rotator cuff and the muscles around the shoulder blade muscles. Until especially in this day and age where we either sit on computer a lot, or we have our phones in front of us, all of us have become almost protracted, all of our shoulders come forward. And so if we can work on the muscles that keep our shoulders back, as well as our shoulders in good alignment, most of the time, they don't start acting up. And so people can prevent a lot of these injuries. The other thing is I see a lot of athletes that like to work out. But they do kind of the wrong exercises, or they do exercises that aggravate their shoulders. And so people with shoulder issues, I try to tell them to avoid bench-press with a straight bar. Also, push ups are pretty hard on the shoulders. The hips are also hard on the shoulders, and then anything overhead pressing overhead can also aggravate that. And so if people have shoulder pain or issues, but they want to work out, I tried to tell them look, avoid these activity, you can still work out your chest, but try to avoid some of these exercises that seem to make it worse.

22:41  

Yeah, I mean, you got you got a young man who's you know, in high school, they maybe they play a sport like football or baseball or the rustle and they're lifting weights, carries on in their 20s into their young adulthood. And now they're 40 or 50. And they they're still trying to get a maximum bench-press I had a patient that did that. I mean, the guy was like in his late 40s. And he's trying to max on his bench and he just totally blew out his shoulder completely. You can't you got to get smarter, don't you as we age, I mean, they become less elastic. And they they're still thinking that they can lift weights like they did back when they were 20. And I think that's really getting in trouble. Right. And

23:21  

that's, that's all too common. I mean, we all most of us work out like we did when we were in high school. And we go back to doing the same exercises, and really don't modify it. Yeah, much. Although our body is much different. It's much less like you said elastic, and we're doing exercises that make it even less elastic, it tightens up more. And so really trying to find some things that stretch out those ligaments stretch out those muscles versus contracting a Mars is important to stay in healthy. Yeah.

23:53  

Very good. Any last closing thoughts you want to end in as we conclude our time together here, Doc?

24:00  

Now I appreciate being on and, you know, really appreciate this opportunity. And I think if we could all incorporate some of these practices to prevent shoulder and elbow issues, it's better for everybody, because then I have less people that are getting injured for poor reasons or even waking up with pain. But more people are being active. And that's what I'm all about.

24:28  

Yeah, well, I really appreciate the work that you do. And the fact that you're here in Palm Beach Gardens, I had a few patients that have consulted with you, they really had a real positive experience with you and they've really enjoyed working with you. How can our listeners get a hold of you? What's the best number to reach out or a website that they can look at if they want to find out more about your practice and what you do?

24:51  

So our practice website is ww.pboipalmbeachorthopaedicinstitute.com And then also I have a personal website. That is www.BrianHillmd.com. And both of those websites have links that you can actually schedule an appointment right there online. And so they also have numbers that you can call but the links are much easier to find a date and time that you can schedule your own appointment.

25:22  

Great. While you've been with Dr. Brian Hill, medical doctor, orthopedic surgeon deals with specifically with the shoulder. It's been a fascinating show. Thank you for your time and expertise. And I'm sure our listeners are going to glean a lot of great information from this. Thanks so much for being on the show, Doc.

25:39  

I appreciate it. Thank you.