hello.

I'm Jennifer Blomquist.

Thanks so much for tuning in this Tuesday evening I have the privilege of hosting our HealthLine program tonight.

This is a live show in case you're not familiar with it.

So we are actually here in the studio and our guest is in the studio so nice this summer we can bring people back into the building and so we have an orthopedic program tonight and a familiar face, Jodi Chambers who is a physician assistant.

She's been with us before.

She's totally awesome and I'm biased because she's a friend but but she is wonderful offers a wealth of expertize and knowledge.

So please feel free to call us anytime there's a phone number.

The phone lines are open now and they'll be open until a little before eight o'clock.

So it's (969) 27 to zero if you're outside Fort Wayne still free call if you put in 866- in front of there and again it's Jodi Chambers and she works in orthopedics and she even has some props tonight that she wanted to focus on.

We're going to talk about tendonitis and bursitis but she could talk about other things or even if you are having some other kind of concerned orthopedic wise, you know, Jodi could point you in the right direction, maybe talk about some tests or things you need to take care of .

>> So everyone has heard of tendinitis in bursitis but I bet most people don't really know what it is.

>> So from from a orthopedic standpoint, what I typically call Titus's is is an inflammation of whatever is in front of that word.

So OK, tendonitis is an inflammation of tendon.

Bursitis is an inflammation of the versus back.

So I'm going to use this as a model for example.

So muscles connect, muscles connected, tendons would attach to bones, ligaments connect bone to bone.

So that's the the differentiation as when tendons go across joints there's typically a little sack of fluid called a burst of sac.

Yeah.

And we have them in a lot of different areas in front of our knees.

They're not on these models but we have one on the front of the knee on the side the hip underneath the rotator cuff in those bursts the SEC's job is to help with friction control.

So if it's outside of the bone, it's outside of the bone usually between the tendon and the bone, OK, or it's it's base occupying structure to help with friction control.

So if let's say somebody decided they wanted to start walking and they walked out and they started to get some lateral hip pain, some people would call it bursitis, some people call it tendonitis.

Those are both the appropriate terms.

It's just differentiating the structures.

But we treat them both basically the same.

OK, so that's the difference between a tendonitis and a bursitis a lot of times it's just a district descriptive word of where there's an inflammation which is what tinnitus is.

So we don't really necessarily treat them differently in the fact that we we treat inflammation typically with anti inflammatories, physical therapy injections if that's appropriate.

>> So that's kind of the basic difference between tendonitis and bursitis.

So if somebody comes to see you because this is another thing you know, they'll say, you know, do I do an x ray or I think you know, people hate doing the MRI is because they're more expensive and sometimes you know, more of a copay with your insurance.

So if somebody came into you and and was complaining of this kind of pain, what's the what would you would you go to an x ray first or it depends on where it's bothering him so we'll stick with the hip so if somebody comes in my job is to is to be a sleuth, a medical sleuth.

So you when does it hurt?

How does it hurt?

What makes it hurt?

What makes it get better?

And so you kind of have to put those pieces of the puzzle together where where does it bother you?

So like if somebody says I have hit pain or is it truly hip pain or is in the buttock is it in the side?

So the most common thing I see clinically is probably trochanter bursitis.

>> So your trochanter is this big structure on the side of your hip and so there's a little bursa sac that sits here and then your IT band goes from here and goes all the way down and so that band lays like this and it rupp's if I suspect that somebody has trochanter bursitis I'm probably not going to get an x ray because it's probably not going to help me.

There's some places and there's some practitioners that get an x ray and everyone who walks in the door and I don't think that's inappropriate as well.

>> But I tend to have the conversation with the patient.

You know, this is what I think it is.

I don't feel like I need x rays but if you would like them I'll absolutely get them for you so I don't actually is on every person but it depends on their presentation in their clinical exam and a lot of times then if you if you're not going to do the x ray, can you just go ahead and treat without phisit you wouldn't have to resort to an MRI.

>> You know, so typically the course of of treatment is the this is the insurance corsetry .

>> So typically they want you to have to do physical therapy first for six weeks and then they may say you always want to x ray before they'll get an MRI and I think that's a there's a there's a clinical correlation in a clinical marriage between those two pieces of information.

So we're not just getting an X to to make the insurance company happy.

An MRI is a a big tube and it's a big magnet.

So the magnetic rays, so to speak, bounce off tissues at different at different frequencies and so how it bounces off gives us the differentiation in the symptoms.

So if I'm looking for a soft tissue injury yeah.

Such as a rotator cuff tear ACL tear in wrist we would be looking for ligament tears.

There are some bony problems that we look for with MRI's like stress fractures and things like that.

But an MRI is to me is is not until we've we've ruled out the other things because one it's expensive and number two , if I'm not going to do anything with that piece of information and it's a redundant piece of expensive information and so you know, my job is to educate the patients about that and then also just talk about you know, here's my job is to lay out the options and you pick off the menu what you feel is appropriate.

>> Yeah, in our eyes it takes a while to do it for one thing and then there's a whole host of you know, do you have any metal in your body?

And you know, we've had kids with braces are like a big screen into a big screening paper that goes through making sure you don't have metal in your eye because if you've ever had a foreign object that metal could get pulled out in the MRI unit.

So yeah, if you have a pacemaker you can have an MRI.

So CT scans are more in orthopedics.

The CT scan is more specific x ray so I use a CT scan more so for fracture alignment let's say I have like a pelvis fracture and that's a three dimensional structure.

X rays are two dimensional images so sometimes we need that three dimensional picture and so from an orthopedic standpoint we kind of treat an x ray like a very excuse me a CT scan like a very specific x ray.

If you're talking in general surgery, they're going to use for lungs and bellies and things like that.

>> That's not my area of expertize.

Right.

Well, I did not interrupt you.

We could talk about this all night but we only have half an hour sadly.

I just want to remind everybody to call and there's the phone number (969) 27 two zero.

We did have somebody, Jodi who called in and wanted me to ask a question for so I'll get to that was a gentleman named Wesley.

He wants to know what's the difference between tendonitis and a sprain?

>> So so tendonitis is an overused injury and so we already talked about the difference between tendons and ligaments.

A sprain is an injury to a ligament so we typically think of sprains and ankles probably the most frequently.

So a ligament is a bone to bone structure and so when you sprained a ligament you tend to stretch it or maybe even tear it with ligaments though they have a really good blood supply.

So a lot of times with ankle sprains we can let that ligaments heal and scar down and structurally re purposive self not regenerate it but repurpose itself and it'll structurally work.

>> Tendons do not have a good blood supply and that's why when you see a picture in a book in the muscle is red and the tendon turns white.

Yes, because it doesn't look a blood supply so tendons typically have to be fixed rotator cuff tendon tears, Achilles tendon tears those are things that tend to need to be fixed surgically whereas ligaments a lot of times we can let those heal by just immobilization in time even if they're torn.

>> That's OK. Yeah.

And then you're going to have to play the game of you know, is it did it completely heal?

Is it functional?

You know, sometimes people want to know was it a partial tear or is it a full tear?

Well it partial tears livin in paper but they don't really live in life because either it works or it doesn't.

So if it's two fibers or two hundred fibers holding it together, either it works or it doesn't.

>> So it's interesting.

Yeah, it's all the stuff that we hear all the time and sometimes I feel like we don't really understand what we're talking about.

We feel we like we're we're familiar with it and so we're going to keep talking about tendonitis and bursitis.

But again I want to remind you that Doty's only here till eight o'clock and typically what happens is the phone lines fill up toward the end of the program.

We hate to miss your question so call sooner rather than later and feel free to interrupt us at any time.

What is the other I can't even see from here the other so you've we've got to hit it.

>> We've got a knee and we've got a shoulder.

OK so from from my standpoint I typically see the most is knees because obviously it's a weight bearing structure and so a lot of times we see young people because they've had an athletic injury.

The most common young injury I would see is definitely ACL tears especially this time of the year with football coming and then in adults probably arthritis.

So you know, I think one of the most common questions that I have and one of a lot of the time that I spend educating or maybe educating someone is that the the stem cell injections and and all those things.

>> And so just because something is an option doesn't always mean it's a good option.

>> So stem cell injections are very expensive.

They're not covered by insurance, I wondered and so they are a good option but they're not very helpful for somebody who has like bone on bone arthritis.

You know, if we had a fix for that we wouldn't be doing total knees and yeah, that's a pretty common surgery that we do here in town all the time.

>> I said that and never torn ACL or just every day.

Yep.

This time of the year now that football's in I'll be seeing them by couple week really and that's for well it's always better to have an injury like that when you're younger because I've met so many kids that have had that may continue they might have to sit out a season or part of a season but then they're up and about later it seems like for somebody who's older my dad had that issue when he got older meniscus which I think is kind of similar and so a ligament on the inside of the knee and then your meniscus is the shock absorber cartilage that keeps the bathroom touching so when we say cartilage we can mean the meniscus or the shock absorber or we can talk about the white shiny cartilage on the end of the bone like if you were to look at the end of a chicken bone.

Yeah.

So meniscus injuries are typically more of I'm going to call it a young person's injury but more of a healthy knee injury.

But if you have a meniscus tear and you have arthritis then you have to kind of throw all of it in the arthritis box because treating the meniscus without treating the bone issue would be like putting paint on rust.

OK, so we're not really you know or people are not going to be happy with the result because we didn't treat the underlying problem well and some you know, people who've who've done things like torn their meniscus or torn their ACL I mean adults some of them even older and they kind of hobble around for a while.

They don't go in right away.

Is there any harm in not getting it checked out right away for ACL tears in young people the disadvantage of not getting is like continuing to play on is because the knee doesn't have any stability interior to post here.

That's how that ACL tears these aren't real quick in their knees shifts forward and the ligament tears that's the pop that they took.

Yeah.

>> So if they continue to play they're going to have that trick me that's what you know I think older people think it was a trick knee.

>> Well, they probably have an old ACL tear that they never fixed.

Well, every time that knee shifts in gives out it hits the cartilage and so over time it's going to damage the cartilage and then you're going to have early arthritis that you may not have had had you fixed the stability of your knee by reconstructing ACL.

>> What about a torn meniscus?

Is there any harm in because my dad was walking around in his for a while finally my mom forced him to go in and get it taken care of , you know, so a lot of people people are like well you know, is this going to heal typically not because it doesn't have a good blood supply after the age of like twenty twenty five.

OK, a lot of people have a meniscus tear but I don't see those people because they're not symptomatic.

You know I'm the one that are the ones I see are the ones that are symptomatic meaning patient is having pain at night or they can't plant or twist.

So if that's the meniscus if we can shave down and just trim it off so I always explain meniscus tears like a a snake in your fingernail that piece gets flipped up and then it gets caught in the joint and then that causes really significant inflammation.

So they go in and do is file off that that that flap that's moving around.

>> Well we want to maintain as much as we preserve as much meniscus as we can because that's what you have the rest of your life back in the 70s they used to take it all out because that's what they thought was the thing to do well and then they figured out in the mid eighties everybody had bone up on arthritis because they took it as being OK. >> All right.

So that's the disadvantage of waiting is you can make that meniscus tear bigger and then they have to take more out, which means you have left less left throughout the rest of your life .

>> OK, well long story short, in case anyone cares about my dad's story, he did get it fixed in his but you know, it was a hard I mean he's in his 70s.

You know, it was a hard, hard time.

He had a hard time.

Is it healed?

Yes.

You know, slowed him down.

We have one other person who called in.

I'm going to ask their question for them.

But again, I want to remind you Jody does not bite.

So if you want to call and ask your question love she's a lovely person and feel free to do that.

So there's the number (969) 27 two zero or were you more than welcome to have me ask the question for you.

That's what Brad wanted me to do.

So Brad is asking can you talk about peptides with tendonitis and bursitis?

>> I'm not quite sure what he's meaning by peptide.

I don't know if it's in regards to a supplement is my guess is what are you talking about?

And there and there are supplements I think that can help.

I think one of the simplest things that everybody can do is take collagen because it's inexpensive, it has no flavor.

You can dump it in your coffee .

You can put it in a smoothie and every every cell in your body has collagen.

So is it re building some things?

Probably not.

Is it helping to structurally make it a little bit better?

I think so.

Our our job is to treat your symptoms.

You know, we're people always have the question well am looking at a knee replacement in the future.

I said I don't have a crystal ball.

I don't know but you're going to come to a point we're going to want to have one because your pain is bad enough and I can't control it with injections or modifications or or Walker or whatever.

And so you'll get to the point where you want to do it because in most orthopedic problems I'm not talking about your life and death situations.

I'm talking about quality of life.

That's what and get a lot of your colleagues have come on and I know I've heard many doctors say, you know, the patient will ask well, you know, when when should I get the knee replaced?

And the doctor says You tell me when is your life enough that you're sick and tired of it and it's you know you know you're not able to do what you like to do exactly.

So it sounds like it's just kind of patient driven in that regard.

Yeah.

And I think that's true for backs as well.

I mean we see back pain so much and you know, 80 percent of adults in their lifetime are going to get back pain.

So when patients like I don't know why this happened I'm like I don't either.

But you had 80 percent chance of it happening at some point in your life .

So again, I think people get very driven by their treating their X-rays and their MRI's and that's not what our goal is.

You know, you may have seen something on your MRI that doesn't have anything to do with your your clinical presentation and so patients will read the MRI reports and say well you didn't mention this this this and this.

Well, that was clinically significant, you know, and reading those things are catastrophic because they're they're commenting on every little detail that may have nothing to do with anything could just your I guess the way you are everybody is a little bit different I guess so I'm just wondering does tend to be hereditary.

I mean I know maybe your parents lifestyle may be different than yours would be or level of physical activity but you know, if you had relatives or family members that had these issues tendonitis in bursitis, would it make you any more susceptible to something?

>> So if a patient has rheumatoid arthritis, which is an autoimmune arthritis meaning your body is kind of fighting against itself and so that's definitely hereditary osteoarthritis just general wear and tear arthritis can be a also hereditary however if you had an ACL when you were eighteen you could you have arthritis later on in life because you had a trauma.

So osteoarthritis is either traumatic or post traumatic patient genetics tendon things probably not.

So I would say that the more common problem that you see with tendons are there's certain medications that can cause tendon ruptures like quintillions or one.

So if somebody comes in and they have like this really weird mechanism that was very minor and I'm like, you know, why do they tear the and that's the first question I ask him have you received any antibiotics and sometimes they have to use is it's a really big strong antibiotic so we don't use them, you know, for strep throat or something like that.

Yeah, So that's become one a lot of times people come in with tendon pain because they're on cholesterol medication and so, you know, if patients are going to do anything right now my tendons are in this part and then that's a question to ask, you know, because that's a common side effect of the medication.

>> So again, it's that medical sleuthing that basically is is what my job is.

Yeah, I like solving a mystery like Scooby Doo.

Yeah right.

Oh we have a gentleman who called in mind to ask this question live so thank you Paul for calling in.

>> Do you want to go ahead and ask Jodi your question?

Sure.

What is the most common cause of rotator cuff damage and how do you avoid that?

So the most common reason for rotator cuff injuries is that they fall.

The other problem could be overuse problem.

So rotator cuffs don't really start working until you get in an overhead position.

>> So people who do a lot of overhead activity but typically you don't see rotator cuff injuries in young people because they have really good elastic tissues and the way to prevent it is making sure that just the rotator cuff is very balanced, that your strength is good, that your flexibility is good and you know, having good proper mechanics when you're doing activities.

But I would say the number one reason for rotator cuff tears would be falls rotator cuff irritations would probably be overuse.

All right.

Good question, Paul.

Paul, did you have anything else you wanted to ask?

OK, I don't think he's there anymore.

Are you Paul?

Thank you for calling in wanting to get to somebody who had and wanted me to ask a question for her.

She wanted to know what you would suggest for arthritis in the fingers.

>> That's a little bit trickier because they're really tiny joints.

So you know, we can easily inject a shoulder and a knee for arthritis and do that every four to six months and get by fingers you can inject.

But they're really tiny and you don't want to go through know eight injections in your joints.

So a lot of times for arthritis and joints you tend to use all anti inflammatories sometimes Epsom salts soaks taking a collagen may help if you can do a lot of little things they may add up to big help.

Surgery for arthritis and fingers isn't really successful because you still have a really stiff finger afterwards and usually stiff fingers are painful so you get to choose your shoes.

>> Why it's stiff and painful.

So you know do people tend to get my grandma used to have it was several fingers so I don't is that typically how it is or are all of them typically it's most of them OK yeah.

>> And so taking a supplement may help using topical cream is one of those where I've seen some in the store and I didn't know yeah there's there's so many the problem is the FDA doesn't regulate those like they do drugs.

>> They have to get FDA approved and so they don't have the the ability to you know, we can't we don't know we're not comparing apples and apples so it's just a kind of a trial and error thing.

>> So I always tell people to try it.

It may it may not help but it may hurt your pocketbook.

>> That's yeah.

Yeah.

Those over-the-counter ones I I didn't know if those were worth anything or not I think well there's some that are coming off prescription that are available so ok yeah I think they're worth a try.

Sure well yes you know check with your doctor first I would imagine is probably the best thing to do.

We just have a few minutes left.

We could squeeze in a question so nobody's waiting on any of the phone lines right now.

We five of them open.

They're showing me the card.

This is three minutes so that's still enough time to squeeze in a quick question if you want to ask.

So feel free to give us a call real quickly (969) to seven to zero.

Just wonder if you have any advice for folks because we're getting into a changing of seasons.

I mean today I like this weather where it's really hot and high humidity actually I think it feels good but people will tell me they have arthritis or you know, issues with their tendons and stuff that they feel like the weather impacts it.

>> I don't know that they've ever come up with a really good reason but I do know that people who have post arthritic problems or let's say they broke their ankle I always tell them the first year you're really going to notice those weather front changes that barometric pressure change.

>> And so it's I think that there is there is truth to that .

I don't know you can do it to help now because people will say it gets pretty uncomfortable.

Yeah.

I don't know.

>> I mean just taking extra medication at that time or you know but I don't know that gave us ever given us a really good physiological reason but it's to insistent that it's not true.

Yeah.

And so it's something that you just kind of have to maybe prepare for or some people who have like a certain autoimmune problems have to move to a different climate because they just they just can't tolerate the stress on their symptoms.

>> Yeah, well and it's extreme when you think about the heat index it was up to one oh nine and some parts of the area today and then we've got days where we've had thirty below windchills actually that's a huge variation with the course of a year or so we are about out of time so I'm going to go ahead and wrap up the show.

But Jodi, thank you so much for all the information.

Really appreciate many thanks to everybody who called in tonight, especially Paul.

He's the man since he called in live and asked his questions so we deeply appreciate that.

And I want to remind you that we do have another HealthLine one week from tonight.

So tune in for that and when your opportunity to ask your questions live during the program.

Thanks so much for tuning in on this Tuesday.

>> I'm Jennifer Blomquist.

Take care and have a good rest of the week