hello and welcome to HealthLine this Tuesday evening.

>> I'm Jennifer Blomquist.

I have the privilege of hosting the show tonight.

I'm so glad you joined us.

If you're one of our regulars, you know the you know the deal.

It's a live show.

That's why we have a phone number up at the bottom of the screen so you can call in and ask a question any time between now and just about 8:00.

We have an orthopedic surgeon with us this evening and we are going to talk about shoulder arthritis.

But if you have anything else orthopedic related that maybe you just want to get a little advice on or just maybe an idea of what you should do to handle your situation, please give us a call again.

It's (969) 27 two zero in case you're outside of Fort Wayne it's still free.

Just put an 866- in front of there and it will be a toll free call.

And when you call in you have two options.

You can either ask your question live which is great because um, the doctor can interact with you, maybe get some more information from you that will help him to better answer your question or I completely understand if you would rather just talk to the call screener, relay your question to her and then she can relate to me and I'll ask the question for you either way you'll get your question answered.

>> So let's go ahead tonight and meet our guest this is Dr. David Connor who is an orthopedic surgeon.

>> Thanks so much for coming and giving me appreciate it.

And he brought some while they're not really toys I guess we'll call them props but but bottles.

Yes.

And so that will help a lot because sometimes like for most of us we don't really think about what our shoulder looks like on the inside or what a surgery would involve and so these instruments will help us to better understand so like I said, call sooner rather than later.

Sometimes we get a little backed up toward the end of the show.

We'd hate to miss your call so phone lines are open now we're going to go ahead and start talking about shoulder arthritis in the meantime.

So everybody is familiar probably with what our arthritis is but maybe not so much shoulder.

You know, I always think of it in the knees.

Sure.

And fingers but so arthritis is a very generic term that we use basically to mean any kind of damage to cartilage surfaces within a joint.

So specific to the shoulder there's two main parts of the shoulder the ball portion of the top of the humerus which we call the ball is a humorous and the cup portion is called the glenoid.

And so there's there's really in orthopedics there's two main types.

The first type the most people are familiar with is osteoarthritis or basically for lack of a better term the joint wearing out and that can occur from multiple different reasons people with chronic rotator cuff tears, people with just overuse injuries or traumas.

Those are the basic types of osteoarthritis and then another type that other people are familiar with are basically rheumatoid arthritis or autoimmune type arthritis where the body kind of attacks attacks itself and for lack of a better term destroys the joints surfaces.

>> So those are the two main types that we treat with in orthopedics.

So does it tend to start at a certain age or do you find that it's more prominent men or women or does it really just run the gamut?

>> Yeah, so we see that in both men women I you know statistically I think I see a little bit more women than men but it's not a hard and fast rule.

Men tend to be kind of people who have done a lot of men manual labor their whole lives.

I see those more kind of in their late 50s and early 60s.

>> Women tend to be a little bit later in life in their 60s and 70s and you know, that's that's when we tend to they tend to appear.

But as far as you know, all males are all females.

>> It can be seen in both groups.

So I know just from having many of your colleagues over the years, you know, the philosophy has always been to start as conservatively as possible.

I think there's some people are afraid I'm going to go see a surgeon.

>> He's going to want to throw me into surgery.

But so what is the approach you would take with somebody?

>> Maybe they're having some pain.

So where do you even begin?

Yeah, so I the conversation to have with all all patients is the treatment certain two big categories.

OK, so category one is always nonsurgical type treatment so non-surgical type treatment can include you know medications a lot of medications that we're all familiar with Tylenol, Ibuprofen, Aleve, you know, antiinflammatory those kind of things.

>> Also physical therapy, you know, making sure that the joint stays in motion that physical therapy can be with a physical therapist.

>> It can also be just simply doing exercises at home and you get a little bit more involved in the nonsurgical type treatment that can involve interventions such as injections, a lot of which we can do in the office and those injections are typically steroids.

>> Those steroids are meant to basically put a dose of antiinflammatory directly with inside the joint.

Those injections are not meant to actually cure the the arthritis there's there good injections out there that actually cure the arthritis.

The the injections are meant to help alleviate pain but the pain is really the problem if we a lot of people you know, I look at the x rays and I say gosh, we have a problem but you know, people aren't worried about their x rays.

>> They're worried about how they feel and so if we can make their arm feel better without surgery, then obviously that is always our goal.

Can you pretty much diagnose it was just an x ray or do actually do something more involved like a C.T.

scan for for the most part we always start with simple x rays x rays give us a ton of information about, you know, how bad is the arthritis?

How long is the arthritis existed and then it already starts shaping our treatment options as far as what are we going to do?

How far along is the arthritis and then kind of guiding us if we decide to do something surgically and it starts guiding us towards, you know, one type of surgery or another now with the injections is it kind of like I've heard of some people with some orthopedic issues will get an epidural and it will tie them over?

>> Yeah, I've got some people who say they can go months.

Yeah, I mean I mean is it is that kind of what these other injections could you yeah I'm a bit off for a while.

>> Absolutely.

You know as we give inject as frequenty as about every four months but I've seen people get your relief up to six months nine months of relief from the injections and that's something that we can repeat.

You know, there's no hard and fast limitations to two injections.

Obviously we don't want to do too many injections too close together.

There are some detrimental effects of giving too many injections, too close together.

But you know, if you've gotten an injection you've got six months of relief.

You come back, get another injection, get six more months of relief that doesn't you know, there's not a oh, you've reached the magic number of three or four and now you can't have any more.

Now with injections it tends to be the law of diminishing return in that each injection tends to help a little bit less.

But there's not an actual three or four.

>> You've had too many.

OK, so I mean at some point if you're doing injections like you said, it's going to cure it.

>> Yeah.

Is it kind of just putting off surgery.

Yeah but you know also when we're talking about arthritis, when we talk about the treatment of arthritis a lot of times that involves putting a special type of joint replacement inside there.

You know, when I talk about joint replacements, when I replace people's joints, I tell them I'm handing the keys to the last car you're ever going own to kind of take care of it meaning that you know, this this implant that we put on people has has a shelf life .

So obviously if we can push push off doing that implantation that's helpful for you so that you can get as much longevity out of this implant as possible.

>> Sure.

All right.

Well and I want to remind everybody we have not received any calls yet but we'd love to hear from you.

We're talking about shoulder arthritis, Dr. David Connor and that's why we keep that phone number at the bottom of the screen for you so you can call us any time as (969) 27 two zero again, it's still a free call if you're outside of Fort Wayne.

>> It's just an that you put in front of there.

>> And again you can call and ask the question live or you can really the question to the call screener and we will ask it for you.

So please feel free to give us a call at any time if you get to the point where surgery is really the last option, are there even different types of surgeries that you would do?

>> Absolutely.

So there's two when we talk about shoulder arthritis there are within orthopedic surgery for shoulders there's basically two main types and then and there's a subgroup subgroup.

>> So the first type would be arthroscopic surgery and that would be minimally invasive surgery where we go in with a couple of little pocho incisions and specific to arthritis we can go in and basically clean up some of the damage release some scar tissue and help help with the mobility and help with the pain inside the shoulder as we get out of arthroscopic options.

Then the second option then becomes what we technically use the term Arthur Plasty and what that means is joint replacement.

So within shoulder replacements there's two main types of shoulder replacement.

The first type is what we consider an anatomic shoulder replacement.

>> What does that mean?

That means that in the situation we can see a model here is that we replace the ball with a metal ball and we replace the socket with a plastic socket.

OK, in this situation that eliminates this implant, eliminates the arthritis on the ball and on the socket and but but this implant requires that all of the rotator cuff tendons which you don't see in this model but I can put my finger here and here that's basically where the rotator cuff tendons lie when those are intact that's when we do an implant like this or what we call it anatomic a shoulder replacement.

The second type of shoulder replacement we see a model over here.

The second type of shoulder replacement is a what we call a reverse total shoulder replacement in this situation we reorient the ball and socket.

We put a ball where the socket is at and we put a socket where the ball is at and the reason why we do that in this situation is when people have damage to the rotator cuff tendons, damage to the rotator tendons and necessitates that we change the anatomy and both of these implants, both of these the goal is to remove the arthritis the biomechanics change a little bit when we use these types of implants so that we can help the patient alleviate their pain and function better in the future.

>> Is one of them are they both fairly invasive surgeries if we get to this point?

Yeah.

I mean this is for shoulder surgery.

>> This is about as invasive as it comes.

It involves making the incision over the front of the shoulder.

Typically I would say somewhere in the six or eight centimeters range and we have to move obviously move some of the structures around, move some of that anatomy out of the way.

The shoulder the shoulder replacement surgery itself typically is a one night stay overnight in the hospital and then does involve some physical therapy afterwards that's was going to ask you about the recovery because I'm always amazed when we have the the guys who work on hips and things and they'll say oh my patient standing over that night after a hip replacement I'm still amazed even just one night for something like this seems amazing.

>> I mean do you have to keep it immobilized for a while or so depending on depending on the type of the shoulder replacement for the first the anatomic shoulder replacement because of the anatomy we start physical therapy pretty quickly after surgery we'll start within a couple of days.

>> Most people are in physical therapy somewhere between six weeks and ten weeks just depending on how the recovery process works with the second type of shoulder replacement or the reverse shoulder replacement that is a situation where we don't start physical therapy for another four weeks afterwards.

In my situation we let the kind of a lot of the soft tissues heal before we start physical therapy and I know I've heardpty for people maybe who've done a lot of manual labor for the bulk of their career.

>> You know, I've had some know, I tell patients I I can't turn back the hands of the clock.

You know I can't you may be fifty.

You're not going this surgery is not going to turn you into the way you were at twenty five.

So I mean at this point if somebody having this kind of surgery it eliminates her pain but do they tend to have the same amount of mobility with their arm or usage still lived.

>> Yeah absolutely.

So for for the first surgical option you know these are these are implants that get about as close to normal anatomic motion as you can get.

>> OK, OK.

There are some limitations as far as how much you can lift.

Typically most of the limitations that we put on people as far as you know overhead lifting and things like that, these are amounts of weight.

Most people in these situations aren't lifting to begin with.

OK, you know generically we say about twenty to twenty five pounds overhead this type of procedure with a second it's similar to the second type with which is the reverse shoulder replacement.

>> The limitations with that you do sacrifice some motion with this type of shoulder replacement but the upside is is that it's a more I would say a more reliable implant in that most people who are getting this shoulder replacement likely aren't going to need more surgery in the future.

>> OK, all right.

And everything is probably kind of a custom thing.

I mean I imagine there's not really like a cookie cutter formula.

>> Every patient is unique.

Absolutely.

Well, we do have somebody who wanted to ask you a question, Dr. Carter.

>> So we're going to go head to Judith.

Are you still there?

Yes, I'm still here.

>> Oh, go ahead.

Thank you for your patience.

Go ahead with your questio.

What I wanted to know I have rheumatoid arthritis.

I have a torn rotator cuff.

I've already had set and I've already had physical therapy and kind of just holding my own .

So I just wondered what my next step would be.

I'm seventy seven years.

Yeah.

So certainly you know in in this type of situation these are these you are exactly what we're talking about here you are in the exact kind of age demographic and function demographic that we're talking about as we start treatment.

>> All patients with me tend to start with injections and physical therapy.

But right now the only person in the equation between the doctor and the patient who can really determine whether there is a next up for you as far as surgery is you you know, because I tell people all the time I'm not saving anybody's life by replacing their shoulder and so you know the time to decide to move past what we consider conservative treatment or non-surgical treatment.

The time to consider moving past that that is really up to& you.

I would tell you that in this situation if you say gosh, I really feel like my function is not where I want it to be, I and I can't tolerate the pain.

>> That's when I tell people OK, it sounds like you are moving toward you know, you making a very personal decision about moving forward with surgery.

But there aren't any hard and fast rules as far as like oh you're this age and you've had this many injections and you've tried this much therapy.

You know, I can I can tell patients in this situation well gosh, it doesn't look like, you know, another injection or more therapy is going to is going to help you.

But really the decision to move forward with surgery is really a personal decision based upon kind of how you feel and how your shoulders function.

>> Judas, did you want to ask Dr. Conner anything else?

No, thank you very kindly.

>> OK, well good luck to you.

Thanks so much for calling in.

It's interesting I was going to ask you that question because I've you know, we've had other of your colleagues on who do need replacements.

>> I've heard them say that, you know, the patient will say well when do I need to get surgery?

>> And the doctor says You tell me yeah, You'll see the same thing here.

>> Yeah, absolutely.

I mean it's just you know, so much of this I what I love about orthopedics is that it's I would say pseudo elective meaning that, you know, I'm I'm helping people improve the quality of their life .

I'm certainly helping them improve function.

But certainly I wouldn't say I'm sustaining anybody's life .

I'm not saving anybody's life by by replacing a knee or shoulder or whatever.

>> But it certainly is improving their quality and really it's it's a personal decision for the patient to say by quality of life is so poor now it's time for me to move forward.

>> Yeah, it's nice when you feel like you have a little control over that kind of situation as the patient.

So we have another caller we'd like to ask you a question, John.

>> Are you still there?

Yes, Thanks for waiting, John.

>> Go ahead with your question, Doctor.

I have a while.

I did have a question I think you may have answered it will cover it real quickly but have time I want to make first I had a number of bone spurs in my right shoulder.

No, this is going back ten or 15 years and it was so painful I could barely move my shoulder like not even an inch or two and I had that shoulder replaced and I've had no roblem since I went from incapacitated to to use for healthy again that shoulder I'm I'm a few years older right now and my left shoulder I was told that I have no rotator cuff in there that somehow was injured and reabsorbed by the body.

But I and I think you covered part of this I I don't have any pain in it and I was my question would have been would you suggest that I had surgery and as I was listening to you and the moderator you were saying that without pain it's really up to the yeah.

The patients and what kind of well my reason for hesitation for having surgery is not only the factor of pain but also I'm afraid to have surgery and then fall on it.

I unfortunately I'm in more advanced age now and that's a problem once in a while.

I appreciate you.

I appreciate your time.

>> I hope I haven't wasted you know you certainly have.

I mean there's two main reasons why people tend to have surgery.

No one is pain and number two is function, you know, and if you you know you've answered the first question.

So if you don't have any pain, I you know, it's hard I tell people all the time it's hard for me to take you from no pain and improve improve on that situation.

I can only make you different in that scenario.

But the second reason then is is function, you know?

And so I you know, my only caveat here is is as your shoulder starts to deteriorate from function, as you progress, as the function gets worse and worse even without pain has the function goes down.

I would say, you know, as you get to the point where you can't lift your arm off your body, you can't start you know, I ask people all the time can you get things off the top shelf, you know, lift I would say basic items around the house as those functions are deteriorating.

That's a situation where I would say it's at least time to go have somebody take a look at because there are times when when I've had patients go from hey, I can you know, I can fix this.

>> I can certainly improve this to gosh sometimes this is this situation is just too far gone .

John, I don't know if you're still on the line.

Did you want to ask Dr. Khan or anything else?

Well, I do.

Yes, ma'am.

Thank you.

I'll go ahead, doc.

I do have some loss of function .

I can't put my arms straight up but I can get by with other with other parts I mean with other with using my shoulder or the other parts of the day.

I don't consider incapacitated at all just point in time ok know it's how much pain is too- much pain.

That's a personal question and you know what what kind of functional function is acceptable is again another personal question where people say hey if I can get by making accommodations to my life then that's that's certainly something that is worth waiting on surgery for .

>> All right, John.

Well, it sounds like he's got some decisions to make for sure contemplates so good luck to you, John.

Thank you so much for your for your questions.

So it's always nice when they can interact with you and you know, get some get the advice that way.

So we do have one one more call from somebody who was wanting me to ask the question for you.

So a woman called named Allison she says her granddaughter has and I'm not sure how to pronounce this Ellers Isla's the most dangerous OK syndrome.

>> Does that ever get better?

I am not familiar with that.

Sure.

So Isla's Aiello's is a connective tissue disorder that affects different tissues in the body basically these people with yellers their loss have what we call hyper mobility or their joints or ligaments.

>> Lileks It is a genetic disorder.

>> There are some other problems that can occur in and the situations that I address- are hyper mobility you know, shoulders, knees in hips because it is a genetic disorder.

There are treatments for it that address the symptoms of the problem but there's no there's no pill.

There's no injection.

There's nothing at this time to actually cure cure and there's you know, there's downloads now I see specifically that she's asking about this problem on her shoulder now.

>> Yeah.

Specific to your granddaughter shoulder a lot of times kids and I see a lot of them in kind of their adolescent you know, teens the later years you can see these kids with hyper mobility or shoulders that kind of pop in and out of the socket the beginning of the treatment always for these kids because they have connective tissue disorder.

>> The beginning is always physical therapy.

So stretching exercises strengthen exercises to help the body kind of acom accommodate for the disorder.

But as far as you know, again a cure for it there is is not a cure.

But you know, if you if you're not specific to your question of does that get better I've seen lots of patients specifically without surgery get significantly better from a pain and function standpoint with you know, with nonsurgical type treatment, you know, physical therapy, you know, over-the-counter medications.

>> What do they have a lot of restrictions.

>> Children with that syndrome typically not I mean, you know, obviously if a you know, adolescent teen is participating in a sport where they're you know, sports where they're repetitively injuring themselves while this is this is where I always remind parents a sports are, you know, elective elective events.

>> So if your granddaughter was playing basketball and she's dislocated shoulder ten times or participating gymnastics or other sports where she's repetitively hurting hersel, then yeah, I would I would say it's time to stop these activities.

But as far as have I had patients who've participated in ootball and basketball and a myriad of other sports with the other the unless I would say relatively normal lives.

>> All right.

Good to know and there are lots of other things to do besides sports.

His words are wonderful sometimes there's a big focus on that but there's also banned and all sorts of other performing today we were talking about marching band movement that is but it is fun.

So sadly we are out of time as Dr. Connor, thank you so much.

I appreciate you bringing the models that was extremely helpful and we have a great audience.

We always have good good callers.

Good question.

So thank you so much to everybody who called in this evening and we will have another HealthLine of course one week from tonight Mr. Mark Evans will be hosting that program right here.

>> And I want to remind you if you ever want to watch like little clips of this show or previous lines, they do have that on YouTube.

>> So if you go to our Web page you can access it there.

I'm Jennifer Bloomquist.

>> Take care.

Have a wonderful rest of your week and we'll see you back here or Mark will next Tuesday.

Thank you