August 20, 2023 • 26 mins
The Healthy Matters Podcast
S02_E18 - Shoulders, Elbows, Knees, and the "Funny Bone"...
Tennis elbow! Golfer's elbow! Rotator cuff, trigger finger, and ACL injuries! We've all at least heard of them, and many of us have actually suffered through them. But what's the scoop? What is actually happening and what can be done to help? And what the heck is the (not so) "funny bone", anyway?
It's a fact that being active is good medicine, but of course, it can open us up to the possibility of injury, too. In Episode 18, we'll break down the most common conditions associated with Summer activities with two of Hennepin Healthcare's orthopedic surgeons - Dr. Jackie Geissler and Dr. Nancy Luger. These top docs will go over the most effective treatment options (not always surgery!) and the best preventative strategies to help keep us in the game. Join us!
Got a question for the doc? Or an idea for a show? Contact us!
Email - healthymatters@hcmed.org
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Speaker 2 (00:04):
Welcome to the Healthy Matters podcast with
Dr. David Hilden , primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health healthcare and
what matters to you. And nowhere's our host, Dr. David
Hilden .
Speaker 3 (00:21):
Hey everybody, it's Dr. David Hilden, your host of
the Healthy Matters podcast.
Welcome to episode 18. Here inMinnesota, most of us are
soaking up every last littlebit of our most precious
summer. And for many of us,this is the most active time of
the year. And while that'salmost always a good thing, it
does open us up to thepossibility of injury. But what
(00:41):
exactly is, say golfer's elbow,what's tennis elbow and why do
so many people end up withshoulder injuries? Well, today
we're gonna get to the bottomof some of these more common
injuries that interrupt oursummer fun. Hopefully come up
with some options for ways toprevent them altogether.
Joining me today are orthopedicsurgeons, Dr. Jackie Geisler,
(01:02):
who specializes in hands, andDr. Nancy Luger, who
specializes in sports injuries.
So one we hear about all thetime, Dr. Geisler is tennis
elbow, what is it?
Speaker 4 (01:12):
Yes. Tennis elbow goes by two names. It goes by
tennis elbow and it goes bylateral epicondylitis. So it's
a common disorder on theoutside of your elbow. It's
pretty painful. It's atendonitis or a tendinopathy,
sometimes considered adegenerative condition, often
seen for overuse and sometimesathletics as well. A misnomer,
(01:33):
you do not need to be a tennisplayer to suffer from tennis
elbow. So
Speaker 3 (01:37):
Why is it called that?
Speaker 4 (01:38):
Uh , 'cause it's common in tennis players with
the overhead serves, they'redoing that repetitive, actually
wrist motion as well as theelbow motion that will really
aggravate that the tennis elbowis a problem with actually the
wrist extensors where theyoriginate in the elbow. And so
anything with that wristextension can really aggravate
that condition.
Speaker 3 (01:56):
Is it common? I mean, even in non chemist
players ,
Speaker 4 (01:59):
It's so common. I , it's probably the number one
condition I get stopped in thehallway for my colleagues to
ask me about. Everybody has it.
It doesn't matter if you'redoing stuff for hobbies on the
weekends, if you're an athlete,if it's part of your job. We
see it a lot in manuallaborers. We see it in people
doing their everydayactivities, cleaning their
house, things like that.
Speaker 3 (02:17):
And so, I know a guy works in the hospital with us.
He swears he doesn't playtennis. His outside of his
elbow has been hurting him forweeks, maybe even a month or
two, and he doesn't know how hegot it. So in addition to
tennis and those things thatyou've mentioned, you can get
it just from your normal lifeor from sports, totally normal.
But what , what are youfeeling? What does it feel
like?
Speaker 4 (02:34):
People complain that it feels like hot or even
burning there. It's extremely ,um, not only point tender, but
almost burning when they movetheir wrist or do their elbow
activities. And it's, it'sright adjacent to that point of
the elbow on the outside there.
Speaker 3 (02:49):
So other than not doing the things that led to it
mm-hmm. , isthere anything people can do
for it?
Speaker 4 (02:55):
Yeah, there's lots of things you can do from it.
So , uh, I will say you're ontosomething if it, if it hurts,
don't do it is totally atreatment. We even put a name
on it, it's called activitymodification. It sounds super
fancy, but the idea is , is youwanna pull back from your
activities a little bit so thatyou can allow that area to rest
and to heal. And then thetreatment is, is, has so many
(03:17):
options in part because theyall work a little, but none of
them will reliably cure yoursymptoms necessarily on their
own. I
Speaker 3 (03:24):
Love that activity modification, Jackie . That
pretty much just means when ithurts when you do this, stop
doing that. Yeah. You got it.
So quit doing what you'redoing. What makes it hurts?
When do they need to see you?
You're a surgeon. Yeah.
Speaker 4 (03:35):
So I would say if it continues to get worse, instead
of continuing to get better,despite the obvious home re
remedies. So, you know, thefirst thing to do is to pull
back on your activities.
Usually people say like, when Ido these three things, it's
really painful. So scale backon that, do some rest.
Ibuprofen, Tylenol over thecounter , both help with pain
and inflammation. Um, so thosecan be really helpful. You can
(03:56):
even go on, this soundsridiculous, but like, you can
buy over the counter likearmbands, you can like Google
tennis elbow and they'll showyou an armband that you can
buy. You wanna be careful notto apply those two tightly to
solve one problem and make anew problem. But if those
things are really not servingto make you better, that's a
great time to schedule anappointment with with a
provider.
Speaker 3 (04:14):
How long does it last? And , and , and let's say
you don't do anything. I I'mjust, okay. I stopped playing
tennis, I stopped doing work ata jackhammer or whatever it was
that caught brought it on.
Mm-hmm . , howlong can you expect it to still
bother you?
Speaker 4 (04:26):
Uh, in good news, 80% of people have their
symptoms resolved by a year.
But
Speaker 3 (04:31):
That's the good news. That's
Speaker 4 (04:33):
A long, I know I was blasted
Speaker 3 (04:34):
Time.
Speaker 4 (04:35):
I was being a little facetious. Yeah, it's, it's a
difficult, difficult condition.
Most people don't have theirconditions last that soon. I
think if you get on it rightaway and try to intervene and
interrupt that cycle, you canshorten the course of it. But
some people just have a reallydifficult time with it. It
doesn't mean that it's notgoing to get better. It's just
really difficult in theinterim. Is
Speaker 3 (04:55):
There a surgery that's helpful?
Speaker 4 (04:57):
There is, but the good news is most people don't
need the surgery. So justbecause you see a surgeon,
don't be surprised if they havea whole menu of options that
they offer to you beforesurgery. Surgery's really a
last resort.
Speaker 3 (05:10):
So maybe I'm not gonna make it as a Wimbledon
champion , uh, with my tenniselbow, but I want to golf. I'm
gonna win the US open golftournament. What is golfer's
elbow?
Speaker 4 (05:20):
Yeah, good question.
So that's basically a verysimilar condition on the inside
of the elbow. So on the side ofyour elbow next to your body.
And it's the same kind of idea,but using different muscles
that aggravate the condition.
And so that side , um, can feellike very similar, can be
aggravated by similar butslightly different activities.
Treatments are very similar.
(05:42):
The one thing that's a littlebit different is there's a
nerve, your funny bone nerve issitting right next to there ,
also known as your ulnar nerve.
And that can be associated withthe condition sometimes and
that can cause numbness andtingling in your fingers. And
so some people have those twoconditions together.
Speaker 3 (05:56):
Okay , so I can't let that one go. People do talk
about the funny bone. Mm-hmm.
, you called it anerve. Tell us
Speaker 4 (06:02):
About that . Oh yeah. So the funny bone, when
you bang your elbow, you getthat electrical shock
Speaker 3 (06:06):
Hurts like a big dog hurt .
Speaker 4 (06:08):
Yeah. We call it the funny bone. The bone it
actually runs next to is calledthe humerus, which in my head
the humorous is funny. And so Ithink that's probably how it
got its name, but there'sreally nothing that that
laughable about it. It reallyis sore.
Speaker 3 (06:22):
Oh, it just like d when you get that dinger on the
inside of your elbow, it's theworst
Speaker 4 (06:26):
And it is the nerve that causes that problem that
is really painful. So the,
Speaker 3 (06:30):
The golfer's elbow, the tennis elbow or the medial
and lateral epicondilitis,they're treated roughly the
same, right?
Speaker 4 (06:38):
Yeah, very similar treatments. So for example, we
talked a little bit about somethings you can do at home. So
you can scale back on some ofthe activities that you enjoy.
You can or that aggravate yoursymptom. You can take
ibuprofen, take tenol, both tworeally great medications that
you can get without aprescription over the counter .
You can get what's called acounterforce band and that can
help with uh, redistributingthe stress that's on the area
(07:02):
that hurts, which can be reallyhelpful. A lot of people do
benefit from an occupational orphysical therapy course. It's
conflicting whether thatactually changes things. But
what I find most helpful aboutthat is they can serve as a bit
of a coach to help you identifythe activities that are
aggravating your condition andhelp you understand where to
scale back. They can continuehelping you be active while
(07:24):
also avoiding the things thatare giving you trouble. And
then there's more invasivetreatment options as well. So
injections can be very helpfuland there's a variety of
injections that can be useful.
So steroids are pretty common.
They seem to help in the shortterm , maybe not as much in the
long term . There's some otheroptions like you can inject
some blood or you can use somep r p, platelet rich plasma has
(07:46):
a little bit of evidence for itstill sometimes in the
experimental phase. But thoseare all things that can be
helpful. And then of course ifthose things fail and your
symptoms are really limiting,it could be that you need to
see a surgeon and we could helpyou with that
Speaker 3 (08:00):
Heat or ice, what should you use? Good
Speaker 4 (08:03):
Question. So that's a pretty dynamic area right
now. So I would say in general,ice is good when there's a
component of inflammation andwith the, the conditions that
we're talking about, there's anunderstanding that they might
actually be more degenerativethan they are actually
inflammatory. And so I would,this is the way I recommend it.
I say try the ice and if ithelps you feel better than
(08:25):
that's what you're gonna use tohelp the pain. It may not
overall help your conditionnecessarily get better faster
or shorten your coursereliably, but it's gonna help
you feel better and toleratethose symptoms better. I like
heat in the morning when you'rea little bit stiff, warm it up
a little bit just like aprofessional athlete, they're
gonna warm up in the beginningand then they're gonna cool
down at the end. But you wannabe careful that you don't, you
(08:48):
know, immobilize or hold thingsstill too long. 'cause that'll
solve one problem and make anew problem. And we know that
movement is important forhealing.
Speaker 3 (08:56):
Motion is the lotion, somebody is the lotion
. Have you ever heard that onebefore?
Speaker 4 (09:00):
Yes. Motion is the lotion. So
Speaker 3 (09:02):
Why does it last so long? Well, you set up to a
year. People with tennis elbowor golfer's elbow can be in
pain. You don't wanna take likeibuprofen for a whole year,
right? Yeah,
Speaker 4 (09:12):
You don't. You don't. So I would say like if
you're taking it more than onan occasional basis or if
you're taking it around theclock, you know, three times a
day, that's probably time formore focused treatment. So
that's when I would see amedical professional. See if
you're a candidate for aninjection, that'll give you
more localizedanti-inflammatory and medical
treatment to that area. Andwhether it's the
(09:34):
anti-inflammatories that workor something else that can be
really helpful. And then thosetreatments are more focal
instead of being systemic or inyour whole body. And that can
make them safer.
Speaker 3 (09:43):
Good tips about keeping your elbows , uh,
healthy or what to do about 'emwhen you do have an injury to
your elbows. That was Dr.
Jackie Geiser. When we comeback from a short break, I'm
gonna shift to your shouldersand we're gonna talk about
injuries to the rotator cuffand surrounding structures in
your shoulder. That will bewith Dr. Nancy Luger . We'll be
right back.
Speaker 2 (10:05):
You are listening to the Healthy Matters podcast
with Dr. David Hilden. Got aquestion or comment for the
doc, email us at Healthymatters@hcme.org or give us a
call at six one two eight seventhree talk. That's 6 1 2 8 7 3
8 2 5 5. And now let's get backto more healthy conversation.
Speaker 3 (10:27):
And we're back and we're going to shift gears to
the shoulder. Dr. Nancy Luger,another orthopedic surgeon
colleague of mine in HennepinHealthcare, does a lot of work
with sports injuries andshoulders . So Nancy, first of
all, what are the commonshoulder injuries? And
specifically, I guess on whatI'm talking about is your
rotator cuff .
Speaker 4 (10:44):
So there are many injuries about the shoulder,
but most people talk about therotator cuff. And the rotator
cuff is actually four tendonsthat are making up the rotator
cuff. So collectively we callit the rotator cuff, but there
are four tendons and there aredifferent actions in the
shoulder. And the shoulder isthe most mobile joint in the
body. So rotator cuffresponsible for the movement of
(11:06):
that shoulder. And
Speaker 3 (11:06):
It's really, I've often found it a remarkable
joint. And I'm not just sayingthat 'cause I'm talking to a
shoulder surgeon, but you know,a lot of the, a lot of the
joints kind of go in onedirection, but this allows a
baseball player to throw a , a, a ball a hundred miles an
hour and allows us to do ourshoulders and all these
different directions. It'sactually quite a remarkable
structure, but it also meansstuff can go wrong. So how do
(11:29):
people injure their rotatorcuff commonly?
Speaker 4 (11:32):
So I'd say there's a couple ways. One, you can just
have an acute trauma. You could, um, be riding on your bike
real fast, hit a pothole, fallwith your outstretched arm and
have an acute event of yourrotator cuff tearing a rotator
cuff. I'd say most commonly wesee as people age, their tendon
qualities kind of change overtime. The composition of the
(11:52):
tendon changes over time andthe more you recreate and do
golf, tennis, upper extremitysports like swimming,
volleyball, et cetera , you caninjure or cause inflammation or
damage to the rotator cuff.
That way
Speaker 3 (12:06):
Maybe you should just stop doing all those
things and become a couchpotato
Speaker 4 (12:10):
That has consequences of its own. Dr.
Den
Speaker 3 (12:12):
. I love
that you gave that a little bit
of thought before you answeredthat . Okay, so I've
had some injury or I'm apitcher for the twins or
whatever it is. Uh, whatclassic symptoms might I have?
Uh, in a rotator cuff injury?
In
Speaker 4 (12:25):
A rotator cuff tear, it's often pain that radiates
down kind of the outside of thearm, the upper arm , um, pain
at night, very difficult times. Sleeping, sleeping on that
side. Uh, pain with overhead,motion lifting overhead, so
putting things in cupboards orum, if you work overhead like
an electrician or somethinglike that. Um, those are the
(12:46):
most common things peoplecomplain about.
Speaker 3 (12:47):
Just like one of our producers has a a tennis elbow.
You are describing my dailylife right now. So do you have
any appointments coming up? I'mgonna come see you. I have
exactly what you've justdescribed. Pain overhead , um,
especially at night. And how doI know? And I'm serious. I have
all that right now. How do Iknow, how do I know if it's
serious?
Speaker 4 (13:08):
Um, I'd say, you know, the common things that
you do for , uh, pain in yourany joint is you rest it. You
can , um, avoid things thatreally bother it or fancy term
activity modification. You guys
Speaker 3 (13:21):
Are buzz kills , you know, you just,
you have to stop doing all thestuff,
Speaker 4 (13:26):
Take some anti-inflammatories, ice it, et
cetera. But if it's unrelentingand doesn't resolve after your
, uh, week or so of , um,trying to modify it, then we're
always happy to see you in ourclinic.
Speaker 3 (13:37):
When do you need to get images and , and you know ,
or in non-medical terms, X-raysand the like. So
Speaker 4 (13:43):
Usually when someone comes into our office we can
see some things on x-rays. Sowe do a screening X-ray, it's
bad enough to come see us inthe office. So I'd say x-rays
are usually a , a good initialassessment and then it's our
physical exam or have you lostmotion? Have you lost strength
and did you have a realsignificant accident or
something like that. That makesme concerned that you actually
(14:04):
tore all the way through thetendon and now have a, a large
rotator cuff tendon tear versusjust irritation of the tendon.
And then I would order an m r i.
Speaker 3 (14:12):
Okay. So you've talked about tears and
irritation , um, and there'sfour of 'em you said, I think
you said there's fourstructures in there . Uh, can
you tell if they're partiallytorn or they're ripped or
they're completelydisconnected? Um , can you ,
can the patient tell that? Iknow you can tell that with
some of some
Speaker 4 (14:30):
Procedures. Um , I think, you know, they can be
equally as painful if there's afull tear or just irritation.
So from a patient perspective,probably can't tell as much on
physical exam if there isgenuine weakness , um, that
would make me highly suspiciousthat someone has a full tendon
tear and that that tendon is nolonger working
Speaker 3 (14:48):
And they might not know they have that no , it
would, would just hurt.
Speaker 4 (14:51):
No . Correct.
Speaker 3 (14:52):
So there's options for treatments, I take it
there's non-surgical ones andprobably surgical ones start
with a non-surgical. What, whatwould you do to somebody once
you've diagnosed this
Speaker 4 (15:01):
Generally? Um, I think the vast majority of
people get better with someform of physical therapy. And I
think as Dr. Geisler said, Ithink of them as your coach. So
some people need more coachingthan others. So as far as how
many visits you're gonna need,it's gonna be dependent on how
much instruction you need. Butthey can teach you how to do ,
um, motion appropriately, makesure you maintain your range of
(15:22):
motion and then show you how tolike gradually strengthen all
the muscles that are involvedin the rotator cuff and the
surrounding structures that cansupport the shoulder joint as
well.
Speaker 3 (15:33):
Can you hurt it or make it worse by doing that?
Speaker 4 (15:36):
Generally you don't make it worse. People tend to
stop if it's very painful andthat's where your therapist can
help you and get back to youand say, listen, this patient
isn't doing very well, can youreassess? And that's when you
would maybe lean towardsimaging if they're not
improving with therapy.
Speaker 3 (15:51):
So when do you have to do surgery? Or I shouldn't
maybe put it that way. When issurgery a good idea?
Speaker 4 (15:56):
So again, when we think of um , rotator cuff
tears, I'd say if there's atear all the way through the
tendon and you head a acutetrauma, we often recommend
surgery. That is a acute changein your rotator cuff tendon. If
you have a kind of more ofdegenerative tear over time,
you've gone through the fullcourse of physical therapy,
(16:17):
you've tried to ice it, rest it, et cetera , and you're still
not getting to the point whereyou're back to the activities
that you enjoy, that's when Iwould maybe have a discussion
about the benefits of asurgery.
Speaker 3 (16:26):
Okay. Now Dr.
Geisler talked about a fairlylong recovery course for some
of the elbow tendinopathies.
How long of a situation are wetalking about with most rotator
cuff problems?
Speaker 4 (16:38):
I'd say it's pretty similar. I'd say most
orthopedic injuries in generalare 12 months. Um, I, I think
everyone gets a little scaredwhen they hear that, but when
you think of how long you'vebeen suffering and then you
modify your activities kind ofrest it , you get weak over
time. So it just takes a lot toget your motion back. Then you
have to get your strength backand you don't get strong
(17:00):
overnight. It takes many weeksto get strong and then you
haven't been in your sport oractivities and then you have to
go through your preconditioningof your sport back to your full
competition.
Speaker 3 (17:12):
Yeah, it is a long time, but that seems to be a
consistent theme. You'd almostrather just like break a bone
in half half and have you putsome hardware in there and it'd
fix it.
Speaker 4 (17:19):
Still long recovery with that Dr.
Speaker 3 (17:21):
Hilman . I know, I know , but you can ,
you both orthopedic surgeonsadmit it. You like to put in
hardware, don't you ?
Speaker 4 (17:28):
Yes.
Speaker 3 (17:28):
Yeah, they both said yes immediately.
. Okay. Um , Dr. Luger,you do , uh, um, other sports
injuries as well and I hear alot, I hear about soccer
players and in my age group Ihear a lot about pickleball
players and they're all comingup with a c l injuries. What's
that?
Speaker 4 (17:46):
An A C L injury is an injury to the ligament in
the center of the knee. Thereis a couple ligaments in the
center of the knee. Most peoplehave heard of the A C L, which
is the anterior cruciateligament. There's also a P C L
or posterior cruciate ligament.
But the most common injury insoccer players, basketball
players, cutting, pivoting,twisting sports is the a c l.
Speaker 3 (18:07):
You know, I'm an , I'm an internal medicine guy,
I'm like terrified of anatomyand scalpels and all that. But
I do remember when and when wehad to do , uh, an anatomy lab
and the a c L is a thick shortshort but thick little
ligament. How the heck can thatthing pop or or break? I don't
even get it. There
Speaker 4 (18:25):
Are many ways you can do it, direct trauma,
contact injury, but also it's acommon non-contact injury where
you just twist funny andyou're, you're going in one
direction, you twist, pivot,and your momentum's carrying
you in one direction and you'retrying to go another direction
in it
Speaker 3 (18:40):
And that one hurts and your knee maybe isn't
stable. Um, what do you doabout it?
Speaker 4 (18:44):
What I think that most people should know is the
classic presentation for an A CL is they twisted her to pop,
they couldn't put any weight onit and their knee swelled up.
You definitely wanna go see a ,a physician at that point to
have an evaluation after yousee the physician, more than
likely will get an M R I toconfirm what that a c L looks
like and then see if there'sany other structural injuries
(19:06):
to the knee.
Speaker 3 (19:07):
Are you able to then surgically repair most of them?
Speaker 4 (19:10):
So there's different treatments now , uh,
historically there was a c lrepair. Um, there is some
traction on repairing acls, butthey're very specific new
literature on that. So that iskind of old school
Speaker 3 (19:25):
Repairing them?
Speaker 4 (19:26):
Correct. The gold standard is and still is
reconstruction, remaking thatligament taking tissue from
your body usually and puttingin place where your ligament
has been torn. Okay,
Speaker 3 (19:38):
Where, where do you take it from in the body to
reconstruct it?
Speaker 4 (19:42):
You can take it from multiple places. You can take
part of the quad tendon on thesame knee, you can take part of
the patellar tendon and you cantake hamstringing tendons
Speaker 3 (19:51):
And you can do without these
Speaker 4 (19:53):
And you can do without these.
Speaker 3 (19:54):
I always wonder who's the first first person
that ever said, let's take alittle bit out of a different
tendon and like reconstruct andthen you just sew it in place
Speaker 4 (20:02):
And you sew it in place. There are some devices
to use to hold it little
Speaker 3 (20:06):
Well, you guys do cool stuff . Little fancy .
Speaker 4 (20:07):
It's a little fancy .
Speaker 3 (20:09):
You know , you don't just like take a staple gun
and you do it that way.
So those are a c l injuries andum , we've talked about your
elbows and your shoulders. I'mgonna ask each of you in turn
to tell me what else you areseeing in your practices.
You're both or orthopedicsurgeons at a big downtown
hospital in Minneapolis andit's summertime. Jackie, what
(20:31):
else are you seeing ? So
Speaker 4 (20:32):
In the summer, anytime people in Minnesota are
out active pickle balling,bicycling, whatever it is,
they're vulnerable to both thesports injuries and the other
injuries that you get from justlike being active. So, you
know, we do see a lot offractures, wrist fractures,
ankle fractures, those arepretty common. Um, tendonitis
is pretty common. Carpaltunnel, everybody always seems
(20:53):
to have that trigger. Fingersare also other things that are
really common. There's atendonitis called day cor veins
tendonitis.
Speaker 3 (21:01):
Can I ask you to say more about trigger finger?
Because in my primary careclinic I see loads of people
with this and it could be anyone of these fingers where
their fingers all kind of stuck
Speaker 4 (21:10):
Bent. Yeah, it's very common and no one has ever
heard of it until it happens tothem. And then it's like common
for us to see. But a newexperience for the patient,
it's where there is a littlebit of a mismatch between your
tendon and the , and the pulleysystem that it runs through,
through the tunnel that it runsthrough and either the tendon
gets a little big or thattunnel gets a little thickened
(21:32):
and then the tendon wants tosort of not slide through that
tunnel very easily. Kind oflike a knot on your shoelace
sliding through the eyelet.
It'll go through, but it kindof pops back and forth as it
does that.
Speaker 3 (21:42):
That's a great way to put it. Can I ask you, Dr .
Geister, how'd you get intohand surgery? Because you are
specifically a surgeon of theupper body, the arms and the
hands. Mm-hmm. ,what drew you to that?
Speaker 4 (21:53):
I just think it's super interesting. The anatomy
is super complex. The breadthof what we do. There's so many
conditions that affect thehand, and the hand is a little
bit like the face, like it'svery socially interactive and I
just really love the interplayof the complex and the way we
use our hands. And I just thinkit's a great specialty.
Speaker 3 (22:13):
A pro tip to listeners, if you have a hand
injury, you want to see asurgeon who specializes in
hands. And I often recommendDr. Jackie Geiser for just that
purpose. Dr. Luga , you do alot of sports injuries. How'd
you get into that?
Speaker 4 (22:26):
I love sports. I love talking about sports. I
like watching sports, I likeparticipating in sports and
there's lots of cool tools andinstruments in surgery for
sports. Okay.
Speaker 3 (22:36):
You said cool tools.
Uh, do you get 'em at HomeDepot or what are the coolest
tools?,
Speaker 4 (22:41):
We do not get 'em at you .
Speaker 3 (22:42):
Do . I bet you do.
You go down to Home Depot and
Speaker 4 (22:45):
We , we , I love Home Depot . I know we
do not get 'em at Home Depot.
However, I will say thatputting in traction pins, you
do use the A drill Yeah . FromHome Depot.
Speaker 3 (22:55):
Yeah . So you guys break out the power tools in
the , in the, in the surgerysuite and you're putting in all
this cool metal and stuff likethat. Yes. Yep . Unbelievable.
So let's talk about what peoplecan do to avoid all these
injuries. Dr. Luger, you start.
So
Speaker 4 (23:07):
I'd say it's very important that you have a
proper warmup , uh, so that youget warm before you go to your
, uh, extreme competitioncompetition . Secondly, I think
that it's important torecognize when you have some
fatigue and that you takeappropriate breaks so that you
don't injure yourself becauseyour form suffers or you can no
longer do your amazingcompetition. Um, and then also
(23:29):
a proper cool down . Make sureyou that you stretch and
maintain your nutrition andhydration and proper equipment.
Make sure you're wearing properfootwear, et cetera , depending
on what you're doing.
Speaker 3 (23:43):
So after hearing all this, Dr. Jackie Geisler, maybe
you can help me out with thisone. Is exercise still a good
idea?
Speaker 4 (23:48):
Oh, it's fabulous.
Yeah. I mean the , the benefitsof exercise are never
contested, but I do think, Ispend a lot of time talking to
patients about settingexpectations for what kind of
sporting is appropriate intheir life. And so I think one
of the things to just sort ofpay attention to is make sure
that you have appropriateexpectations. If you're gonna
pick up a new sport, sayrunning, you don't wanna sign
(24:09):
yourself up for a marathon insix weeks. You wanna start with
something like a couch to fiveK program where you can really
get your body in, in themovements, in the exercise,
build up that strength, buildup that endurance, try to
listen to your body, respond toany new injuries or sore spots,
and modify your techniques.
Speaker 3 (24:25):
That's a great tip.
I love the couch to five K. Itprobably doesn't happen over
one weekend.
Speaker 4 (24:29):
No, sure doesn't. It takes a lot of effort.
Speaker 3 (24:31):
We have been talking about summertime injuries ,
sports injuries of the elbowsand the hands and the knees and
the shoulders with Dr. JackieGeisler and Dr. Nancy Luger .
They are colleagues of minehere at Hennepin Healthcare in
downtown Minneapolis and a keypart of our orthopedic surgery
department. I do often tellpeople, if you need an
orthopedic surgeon, you come toHennepin Healthcare. If you
(24:54):
happen to be in the upperMidwest, that's where you wanna
go. Not only these two, buttheir whole team is simply the
best in orthopedic surgeryanywhere. So Jackie , Nancy,
thanks for being on the showwith me today. Thank
Speaker 4 (25:05):
You Dave. Happy to be here. It's a pleasure.
Speaker 3 (25:06):
Thank you both for lots of great information.
Listeners. I hope you've pickedup a thing or two and I hope
you'll join us for the nextepisode. And in the meantime,
be healthy and be well.
Speaker 2 (25:17):
Thanks for listening to the Healthy Matters podcast
with Dr. David Hilden . To findout more about the Healthy
Matters podcast or browse thearchive, visit healthy
matters.org. You got a questionor a comment for the show?
Email us at Healthymatters@hcme.org or call 6 1 2
8 7 3 talk. There's also a linkin the show notes. And finally,
(25:40):
if you enjoy the show, pleaseleave us a review and share the
show with others. The HealthyMatters Podcast is made
possible by Hennepin Healthcarein Minneapolis, Minnesota, and
engineered and produced by JohnLucas At Highball Executive
Producers are Jonathan, CTO andChristine Hill . Please
remember, we can only givegeneral medical advice during
this program, and every case isunique. We urge you to consult
(26:01):
with your physician if you havea more serious or pressing
health concern. Until nexttime, be healthy and be well.
Speaker 2 (00:04):
Welcome to the Healthy Matters podcast with
Dr. David Hilden , primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health healthcare and
what matters to you. And nowhere's our host, Dr. David
Hilden .
Speaker 3 (00:21):
Hey everybody, it's Dr. David Hilden, your host of
the Healthy Matters podcast.
Welcome to episode 18. Here inMinnesota, most of us are
soaking up every last littlebit of our most precious
summer. And for many of us,this is the most active time of
the year. And while that'salmost always a good thing, it
does open us up to thepossibility of injury. But what
(00:41):
exactly is, say golfer's elbow,what's tennis elbow and why do
so many people end up withshoulder injuries? Well, today
we're gonna get to the bottomof some of these more common
injuries that interrupt oursummer fun. Hopefully come up
with some options for ways toprevent them altogether.
Joining me today are orthopedicsurgeons, Dr. Jackie Geisler,
(01:02):
who specializes in hands, andDr. Nancy Luger, who
specializes in sports injuries.
So one we hear about all thetime, Dr. Geisler is tennis
elbow, what is it?
Speaker 4 (01:12):
Yes. Tennis elbow goes by two names. It goes by
tennis elbow and it goes bylateral epicondylitis. So it's
a common disorder on theoutside of your elbow. It's
pretty painful. It's atendonitis or a tendinopathy,
sometimes considered adegenerative condition, often
seen for overuse and sometimesathletics as well. A misnomer,
(01:33):
you do not need to be a tennisplayer to suffer from tennis
elbow. So
Speaker 3 (01:37):
Why is it called that?
Speaker 4 (01:38):
Uh , 'cause it's common in tennis players with
the overhead serves, they'redoing that repetitive, actually
wrist motion as well as theelbow motion that will really
aggravate that the tennis elbowis a problem with actually the
wrist extensors where theyoriginate in the elbow. And so
anything with that wristextension can really aggravate
that condition.
Speaker 3 (01:56):
Is it common? I mean, even in non chemist
players ,
Speaker 4 (01:59):
It's so common. I , it's probably the number one
condition I get stopped in thehallway for my colleagues to
ask me about. Everybody has it.
It doesn't matter if you'redoing stuff for hobbies on the
weekends, if you're an athlete,if it's part of your job. We
see it a lot in manuallaborers. We see it in people
doing their everydayactivities, cleaning their
house, things like that.
Speaker 3 (02:17):
And so, I know a guy works in the hospital with us.
He swears he doesn't playtennis. His outside of his
elbow has been hurting him forweeks, maybe even a month or
two, and he doesn't know how hegot it. So in addition to
tennis and those things thatyou've mentioned, you can get
it just from your normal lifeor from sports, totally normal.
But what , what are youfeeling? What does it feel
like?
Speaker 4 (02:34):
People complain that it feels like hot or even
burning there. It's extremely ,um, not only point tender, but
almost burning when they movetheir wrist or do their elbow
activities. And it's, it'sright adjacent to that point of
the elbow on the outside there.
Speaker 3 (02:49):
So other than not doing the things that led to it
mm-hmm.
for it?
Speaker 4 (02:55):
Yeah, there's lots of things you can do from it.
So , uh, I will say you're ontosomething if it, if it hurts,
don't do it is totally atreatment. We even put a name
on it, it's called activitymodification. It sounds super
fancy, but the idea is , is youwanna pull back from your
activities a little bit so thatyou can allow that area to rest
and to heal. And then thetreatment is, is, has so many
(03:17):
options in part because theyall work a little, but none of
them will reliably cure yoursymptoms necessarily on their
own. I
Speaker 3 (03:24):
Love that activity modification, Jackie . That
pretty much just means when ithurts when you do this, stop
doing that. Yeah. You got it.
So quit doing what you'redoing. What makes it hurts?
When do they need to see you?
You're a surgeon. Yeah.
Speaker 4 (03:35):
So I would say if it continues to get worse, instead
of continuing to get better,despite the obvious home re
remedies. So, you know, thefirst thing to do is to pull
back on your activities.
Usually people say like, when Ido these three things, it's
really painful. So scale backon that, do some rest.
Ibuprofen, Tylenol over thecounter , both help with pain
and inflammation. Um, so thosecan be really helpful. You can
(03:56):
even go on, this soundsridiculous, but like, you can
buy over the counter likearmbands, you can like Google
tennis elbow and they'll showyou an armband that you can
buy. You wanna be careful notto apply those two tightly to
solve one problem and make anew problem. But if those
things are really not servingto make you better, that's a
great time to schedule anappointment with with a
provider.
Speaker 3 (04:14):
How long does it last? And , and , and let's say
you don't do anything. I I'mjust, okay. I stopped playing
tennis, I stopped doing work ata jackhammer or whatever it was
that caught brought it on.
Mm-hmm .
bother you?
Speaker 4 (04:26):
Uh, in good news, 80% of people have their
symptoms resolved by a year.
But
Speaker 3 (04:31):
That's the good news. That's
Speaker 4 (04:33):
A long, I know I was blasted
Speaker 3 (04:34):
Time.
Speaker 4 (04:35):
I was being a little facetious. Yeah, it's, it's a
difficult, difficult condition.
Most people don't have theirconditions last that soon. I
think if you get on it rightaway and try to intervene and
interrupt that cycle, you canshorten the course of it. But
some people just have a reallydifficult time with it. It
doesn't mean that it's notgoing to get better. It's just
really difficult in theinterim. Is
Speaker 3 (04:55):
There a surgery that's helpful?
Speaker 4 (04:57):
There is, but the good news is most people don't
need the surgery. So justbecause you see a surgeon,
don't be surprised if they havea whole menu of options that
they offer to you beforesurgery. Surgery's really a
last resort.
Speaker 3 (05:10):
So maybe I'm not gonna make it as a Wimbledon
champion , uh, with my tenniselbow, but I want to golf. I'm
gonna win the US open golftournament. What is golfer's
elbow?
Speaker 4 (05:20):
Yeah, good question.
So that's basically a verysimilar condition on the inside
of the elbow. So on the side ofyour elbow next to your body.
And it's the same kind of idea,but using different muscles
that aggravate the condition.
And so that side , um, can feellike very similar, can be
aggravated by similar butslightly different activities.
Treatments are very similar.
(05:42):
The one thing that's a littlebit different is there's a
nerve, your funny bone nerve issitting right next to there ,
also known as your ulnar nerve.
And that can be associated withthe condition sometimes and
that can cause numbness andtingling in your fingers. And
so some people have those twoconditions together.
Speaker 3 (05:56):
Okay , so I can't let that one go. People do talk
about the funny bone. Mm-hmm.
Speaker 4 (06:02):
About that . Oh yeah. So the funny bone, when
you bang your elbow, you getthat electrical shock
Speaker 3 (06:06):
Hurts like a big dog hurt .
Speaker 4 (06:08):
Yeah. We call it the funny bone. The bone it
actually runs next to is calledthe humerus, which in my head
the humorous is funny. And so Ithink that's probably how it
got its name, but there'sreally nothing that that
laughable about it. It reallyis sore.
Speaker 3 (06:22):
Oh, it just like d when you get that dinger on the
inside of your elbow, it's theworst
Speaker 4 (06:26):
And it is the nerve that causes that problem that
is really painful. So the,
Speaker 3 (06:30):
The golfer's elbow, the tennis elbow or the medial
and lateral epicondilitis,they're treated roughly the
same, right?
Speaker 4 (06:38):
Yeah, very similar treatments. So for example, we
talked a little bit about somethings you can do at home. So
you can scale back on some ofthe activities that you enjoy.
You can or that aggravate yoursymptom. You can take
ibuprofen, take tenol, both tworeally great medications that
you can get without aprescription over the counter .
You can get what's called acounterforce band and that can
help with uh, redistributingthe stress that's on the area
(07:02):
that hurts, which can be reallyhelpful. A lot of people do
benefit from an occupational orphysical therapy course. It's
conflicting whether thatactually changes things. But
what I find most helpful aboutthat is they can serve as a bit
of a coach to help you identifythe activities that are
aggravating your condition andhelp you understand where to
scale back. They can continuehelping you be active while
(07:24):
also avoiding the things thatare giving you trouble. And
then there's more invasivetreatment options as well. So
injections can be very helpfuland there's a variety of
injections that can be useful.
So steroids are pretty common.
They seem to help in the shortterm , maybe not as much in the
long term . There's some otheroptions like you can inject
some blood or you can use somep r p, platelet rich plasma has
(07:46):
a little bit of evidence for itstill sometimes in the
experimental phase. But thoseare all things that can be
helpful. And then of course ifthose things fail and your
symptoms are really limiting,it could be that you need to
see a surgeon and we could helpyou with that
Speaker 3 (08:00):
Heat or ice, what should you use? Good
Speaker 4 (08:03):
Question. So that's a pretty dynamic area right
now. So I would say in general,ice is good when there's a
component of inflammation andwith the, the conditions that
we're talking about, there's anunderstanding that they might
actually be more degenerativethan they are actually
inflammatory. And so I would,this is the way I recommend it.
I say try the ice and if ithelps you feel better than
(08:25):
that's what you're gonna use tohelp the pain. It may not
overall help your conditionnecessarily get better faster
or shorten your coursereliably, but it's gonna help
you feel better and toleratethose symptoms better. I like
heat in the morning when you'rea little bit stiff, warm it up
a little bit just like aprofessional athlete, they're
gonna warm up in the beginningand then they're gonna cool
down at the end. But you wannabe careful that you don't, you
(08:48):
know, immobilize or hold thingsstill too long. 'cause that'll
solve one problem and make anew problem. And we know that
movement is important forhealing.
Speaker 3 (08:56):
Motion is the lotion, somebody is the lotion
. Have you ever heard that onebefore?
Speaker 4 (09:00):
Yes. Motion is the lotion. So
Speaker 3 (09:02):
Why does it last so long? Well, you set up to a
year. People with tennis elbowor golfer's elbow can be in
pain. You don't wanna take likeibuprofen for a whole year,
right? Yeah,
Speaker 4 (09:12):
You don't. You don't. So I would say like if
you're taking it more than onan occasional basis or if
you're taking it around theclock, you know, three times a
day, that's probably time formore focused treatment. So
that's when I would see amedical professional. See if
you're a candidate for aninjection, that'll give you
more localizedanti-inflammatory and medical
treatment to that area. Andwhether it's the
(09:34):
anti-inflammatories that workor something else that can be
really helpful. And then thosetreatments are more focal
instead of being systemic or inyour whole body. And that can
make them safer.
Speaker 3 (09:43):
Good tips about keeping your elbows , uh,
healthy or what to do about 'emwhen you do have an injury to
your elbows. That was Dr.
Jackie Geiser. When we comeback from a short break, I'm
gonna shift to your shouldersand we're gonna talk about
injuries to the rotator cuffand surrounding structures in
your shoulder. That will bewith Dr. Nancy Luger . We'll be
right back.
Speaker 2 (10:05):
You are listening to the Healthy Matters podcast
with Dr. David Hilden. Got aquestion or comment for the
doc, email us at Healthymatters@hcme.org or give us a
call at six one two eight seventhree talk. That's 6 1 2 8 7 3
8 2 5 5. And now let's get backto more healthy conversation.
Speaker 3 (10:27):
And we're back and we're going to shift gears to
the shoulder. Dr. Nancy Luger,another orthopedic surgeon
colleague of mine in HennepinHealthcare, does a lot of work
with sports injuries andshoulders . So Nancy, first of
all, what are the commonshoulder injuries? And
specifically, I guess on whatI'm talking about is your
rotator cuff .
Speaker 4 (10:44):
So there are many injuries about the shoulder,
but most people talk about therotator cuff. And the rotator
cuff is actually four tendonsthat are making up the rotator
cuff. So collectively we callit the rotator cuff, but there
are four tendons and there aredifferent actions in the
shoulder. And the shoulder isthe most mobile joint in the
body. So rotator cuffresponsible for the movement of
(11:06):
that shoulder. And
Speaker 3 (11:06):
It's really, I've often found it a remarkable
joint. And I'm not just sayingthat 'cause I'm talking to a
shoulder surgeon, but you know,a lot of the, a lot of the
joints kind of go in onedirection, but this allows a
baseball player to throw a , a, a ball a hundred miles an
hour and allows us to do ourshoulders and all these
different directions. It'sactually quite a remarkable
structure, but it also meansstuff can go wrong. So how do
(11:29):
people injure their rotatorcuff commonly?
Speaker 4 (11:32):
So I'd say there's a couple ways. One, you can just
have an acute trauma. You could, um, be riding on your bike
real fast, hit a pothole, fallwith your outstretched arm and
have an acute event of yourrotator cuff tearing a rotator
cuff. I'd say most commonly wesee as people age, their tendon
qualities kind of change overtime. The composition of the
(11:52):
tendon changes over time andthe more you recreate and do
golf, tennis, upper extremitysports like swimming,
volleyball, et cetera , you caninjure or cause inflammation or
damage to the rotator cuff.
That way
Speaker 3 (12:06):
Maybe you should just stop doing all those
things and become a couchpotato
Speaker 4 (12:10):
That has consequences of its own. Dr.
Den
Speaker 3 (12:12):
of thought before you answeredthat
had some injury or I'm apitcher for the twins or
whatever it is. Uh, whatclassic symptoms might I have?
Uh, in a rotator cuff injury?
In
Speaker 4 (12:25):
A rotator cuff tear, it's often pain that radiates
down kind of the outside of thearm, the upper arm , um, pain
at night, very difficult times. Sleeping, sleeping on that
side. Uh, pain with overhead,motion lifting overhead, so
putting things in cupboards orum, if you work overhead like
an electrician or somethinglike that. Um, those are the
(12:46):
most common things peoplecomplain about.
Speaker 3 (12:47):
Just like one of our producers has a a tennis elbow.
You are describing my dailylife right now. So do you have
any appointments coming up? I'mgonna come see you. I have
exactly what you've justdescribed. Pain overhead , um,
especially at night. And how doI know? And I'm serious. I have
all that right now. How do Iknow, how do I know if it's
serious?
Speaker 4 (13:08):
Um, I'd say, you know, the common things that
you do for , uh, pain in yourany joint is you rest it. You
can , um, avoid things thatreally bother it or fancy term
activity modification. You guys
Speaker 3 (13:21):
Are buzz kills
you have to stop doing all thestuff,
Speaker 4 (13:26):
Take some anti-inflammatories, ice it, et
cetera. But if it's unrelentingand doesn't resolve after your
, uh, week or so of , um,trying to modify it, then we're
always happy to see you in ourclinic.
Speaker 3 (13:37):
When do you need to get images and , and you know ,
or in non-medical terms, X-raysand the like. So
Speaker 4 (13:43):
Usually when someone comes into our office we can
see some things on x-rays. Sowe do a screening X-ray, it's
bad enough to come see us inthe office. So I'd say x-rays
are usually a , a good initialassessment and then it's our
physical exam or have you lostmotion? Have you lost strength
and did you have a realsignificant accident or
something like that. That makesme concerned that you actually
(14:04):
tore all the way through thetendon and now have a, a large
rotator cuff tendon tear versusjust irritation of the tendon.
And then I would order an m r i.
Speaker 3 (14:12):
Okay. So you've talked about tears and
irritation , um, and there'sfour of 'em you said, I think
you said there's fourstructures in there . Uh, can
you tell if they're partiallytorn or they're ripped or
they're completelydisconnected? Um , can you ,
can the patient tell that? Iknow you can tell that with
some of some
Speaker 4 (14:30):
Procedures. Um , I think, you know, they can be
equally as painful if there's afull tear or just irritation.
So from a patient perspective,probably can't tell as much on
physical exam if there isgenuine weakness , um, that
would make me highly suspiciousthat someone has a full tendon
tear and that that tendon is nolonger working
Speaker 3 (14:48):
And they might not know they have that no , it
would, would just hurt.
Speaker 4 (14:51):
No . Correct.
Speaker 3 (14:52):
So there's options for treatments, I take it
there's non-surgical ones andprobably surgical ones start
with a non-surgical. What, whatwould you do to somebody once
you've diagnosed this
Speaker 4 (15:01):
Generally? Um, I think the vast majority of
people get better with someform of physical therapy. And I
think as Dr. Geisler said, Ithink of them as your coach. So
some people need more coachingthan others. So as far as how
many visits you're gonna need,it's gonna be dependent on how
much instruction you need. Butthey can teach you how to do ,
um, motion appropriately, makesure you maintain your range of
(15:22):
motion and then show you how tolike gradually strengthen all
the muscles that are involvedin the rotator cuff and the
surrounding structures that cansupport the shoulder joint as
well.
Speaker 3 (15:33):
Can you hurt it or make it worse by doing that?
Speaker 4 (15:36):
Generally you don't make it worse. People tend to
stop if it's very painful andthat's where your therapist can
help you and get back to youand say, listen, this patient
isn't doing very well, can youreassess? And that's when you
would maybe lean towardsimaging if they're not
improving with therapy.
Speaker 3 (15:51):
So when do you have to do surgery? Or I shouldn't
maybe put it that way. When issurgery a good idea?
Speaker 4 (15:56):
So again, when we think of um , rotator cuff
tears, I'd say if there's atear all the way through the
tendon and you head a acutetrauma, we often recommend
surgery. That is a acute changein your rotator cuff tendon. If
you have a kind of more ofdegenerative tear over time,
you've gone through the fullcourse of physical therapy,
(16:17):
you've tried to ice it, rest it, et cetera , and you're still
not getting to the point whereyou're back to the activities
that you enjoy, that's when Iwould maybe have a discussion
about the benefits of asurgery.
Speaker 3 (16:26):
Okay. Now Dr.
Geisler talked about a fairlylong recovery course for some
of the elbow tendinopathies.
How long of a situation are wetalking about with most rotator
cuff problems?
Speaker 4 (16:38):
I'd say it's pretty similar. I'd say most
orthopedic injuries in generalare 12 months. Um, I, I think
everyone gets a little scaredwhen they hear that, but when
you think of how long you'vebeen suffering and then you
modify your activities kind ofrest it , you get weak over
time. So it just takes a lot toget your motion back. Then you
have to get your strength backand you don't get strong
(17:00):
overnight. It takes many weeksto get strong and then you
haven't been in your sport oractivities and then you have to
go through your preconditioningof your sport back to your full
competition.
Speaker 3 (17:12):
Yeah, it is a long time, but that seems to be a
consistent theme. You'd almostrather just like break a bone
in half half and have you putsome hardware in there and it'd
fix it.
Speaker 4 (17:19):
Still long recovery with that Dr.
Speaker 3 (17:21):
Hilman . I know, I know
you both orthopedic surgeonsadmit it. You like to put in
hardware, don't you ?
Speaker 4 (17:28):
Yes.
Speaker 3 (17:28):
Yeah, they both said yes immediately.
injuries as well and I hear alot, I hear about soccer
players and in my age group Ihear a lot about pickleball
players and they're all comingup with a c l injuries. What's
that?
Speaker 4 (17:46):
An A C L injury is an injury to the ligament in
the center of the knee. Thereis a couple ligaments in the
center of the knee. Most peoplehave heard of the A C L, which
is the anterior cruciateligament. There's also a P C L
or posterior cruciate ligament.
But the most common injury insoccer players, basketball
players, cutting, pivoting,twisting sports is the a c l.
Speaker 3 (18:07):
You know, I'm an , I'm an internal medicine guy,
I'm like terrified of anatomyand scalpels and all that. But
I do remember when and when wehad to do , uh, an anatomy lab
and the a c L is a thick shortshort but thick little
ligament. How the heck can thatthing pop or or break? I don't
even get it. There
Speaker 4 (18:25):
Are many ways you can do it, direct trauma,
contact injury, but also it's acommon non-contact injury where
you just twist funny andyou're, you're going in one
direction, you twist, pivot,and your momentum's carrying
you in one direction and you'retrying to go another direction
in it
Speaker 3 (18:40):
And that one hurts and your knee maybe isn't
stable. Um, what do you doabout it?
Speaker 4 (18:44):
What I think that most people should know is the
classic presentation for an A CL is they twisted her to pop,
they couldn't put any weight onit and their knee swelled up.
You definitely wanna go see a ,a physician at that point to
have an evaluation after yousee the physician, more than
likely will get an M R I toconfirm what that a c L looks
like and then see if there'sany other structural injuries
(19:06):
to the knee.
Speaker 3 (19:07):
Are you able to then surgically repair most of them?
Speaker 4 (19:10):
So there's different treatments now , uh,
historically there was a c lrepair. Um, there is some
traction on repairing acls, butthey're very specific new
literature on that. So that iskind of old school
Speaker 3 (19:25):
Repairing them?
Speaker 4 (19:26):
Correct. The gold standard is and still is
reconstruction, remaking thatligament taking tissue from
your body usually and puttingin place where your ligament
has been torn. Okay,
Speaker 3 (19:38):
Where, where do you take it from in the body to
reconstruct it?
Speaker 4 (19:42):
You can take it from multiple places. You can take
part of the quad tendon on thesame knee, you can take part of
the patellar tendon and you cantake hamstringing tendons
Speaker 3 (19:51):
And you can do without these
Speaker 4 (19:53):
And you can do without these.
Speaker 3 (19:54):
I always wonder who's the first first person
that ever said, let's take alittle bit out of a different
tendon and like reconstruct andthen you just sew it in place
Speaker 4 (20:02):
And you sew it in place. There are some devices
to use to hold it little
Speaker 3 (20:06):
Well, you guys do cool stuff . Little fancy .
Speaker 4 (20:07):
It's a little fancy
Speaker 3 (20:09):
You know , you don't just like take a staple gun
So those are a c l injuries andum , we've talked about your
elbows and your shoulders. I'mgonna ask each of you in turn
to tell me what else you areseeing in your practices.
You're both or orthopedicsurgeons at a big downtown
hospital in Minneapolis andit's summertime. Jackie, what
(20:31):
else are you seeing ? So
Speaker 4 (20:32):
In the summer, anytime people in Minnesota are
out active pickle balling,bicycling, whatever it is,
they're vulnerable to both thesports injuries and the other
injuries that you get from justlike being active. So, you
know, we do see a lot offractures, wrist fractures,
ankle fractures, those arepretty common. Um, tendonitis
is pretty common. Carpaltunnel, everybody always seems
(20:53):
to have that trigger. Fingersare also other things that are
really common. There's atendonitis called day cor veins
tendonitis.
Speaker 3 (21:01):
Can I ask you to say more about trigger finger?
Because in my primary careclinic I see loads of people
with this and it could be anyone of these fingers where
their fingers all kind of stuck
Speaker 4 (21:10):
Bent. Yeah, it's very common and no one has ever
heard of it until it happens tothem. And then it's like common
for us to see. But a newexperience for the patient,
it's where there is a littlebit of a mismatch between your
tendon and the , and the pulleysystem that it runs through,
through the tunnel that it runsthrough and either the tendon
gets a little big or thattunnel gets a little thickened
(21:32):
and then the tendon wants tosort of not slide through that
tunnel very easily. Kind oflike a knot on your shoelace
sliding through the eyelet.
It'll go through, but it kindof pops back and forth as it
does that.
Speaker 3 (21:42):
That's a great way to put it. Can I ask you, Dr .
Geister, how'd you get intohand surgery? Because you are
specifically a surgeon of theupper body, the arms and the
hands. Mm-hmm.
Speaker 4 (21:53):
I just think it's super interesting. The anatomy
is super complex. The breadthof what we do. There's so many
conditions that affect thehand, and the hand is a little
bit like the face, like it'svery socially interactive and I
just really love the interplayof the complex and the way we
use our hands. And I just thinkit's a great specialty.
Speaker 3 (22:13):
A pro tip to listeners, if you have a hand
injury, you want to see asurgeon who specializes in
hands. And I often recommendDr. Jackie Geiser for just that
purpose. Dr. Luga , you do alot of sports injuries. How'd
you get into that?
Speaker 4 (22:26):
I love sports. I love talking about sports. I
like watching sports, I likeparticipating in sports and
there's lots of cool tools andinstruments in surgery for
sports. Okay.
Speaker 3 (22:36):
You said cool tools.
Uh, do you get 'em at HomeDepot or what are the coolest
tools?
Speaker 4 (22:41):
We do not get 'em at you .
Speaker 3 (22:42):
Do . I bet you do.
You go down to Home Depot and
Speaker 4 (22:45):
We , we , I love Home Depot
do not get 'em at Home Depot.
However, I will say thatputting in traction pins, you
do use the A drill Yeah . FromHome Depot.
Speaker 3 (22:55):
Yeah . So you guys break out the power tools in
the , in the, in the surgerysuite and you're putting in all
this cool metal and stuff likethat. Yes. Yep . Unbelievable.
So let's talk about what peoplecan do to avoid all these
injuries. Dr. Luger, you start.
So
Speaker 4 (23:07):
I'd say it's very important that you have a
proper warmup , uh, so that youget warm before you go to your
, uh, extreme competitioncompetition . Secondly, I think
that it's important torecognize when you have some
fatigue and that you takeappropriate breaks so that you
don't injure yourself becauseyour form suffers or you can no
longer do your amazingcompetition. Um, and then also
(23:29):
a proper cool down . Make sureyou that you stretch and
maintain your nutrition andhydration and proper equipment.
Make sure you're wearing properfootwear, et cetera , depending
on what you're doing.
Speaker 3 (23:43):
So after hearing all this, Dr. Jackie Geisler, maybe
you can help me out with thisone. Is exercise still a good
idea?
Speaker 4 (23:48):
Oh, it's fabulous.
Yeah. I mean the , the benefitsof exercise are never
contested, but I do think, Ispend a lot of time talking to
patients about settingexpectations for what kind of
sporting is appropriate intheir life. And so I think one
of the things to just sort ofpay attention to is make sure
that you have appropriateexpectations. If you're gonna
pick up a new sport, sayrunning, you don't wanna sign
(24:09):
yourself up for a marathon insix weeks. You wanna start with
something like a couch to fiveK program where you can really
get your body in, in themovements, in the exercise,
build up that strength, buildup that endurance, try to
listen to your body, respond toany new injuries or sore spots,
and modify your techniques.
Speaker 3 (24:25):
That's a great tip.
I love the couch to five K. Itprobably doesn't happen over
one weekend.
Speaker 4 (24:29):
No, sure doesn't. It takes a lot of effort.
Speaker 3 (24:31):
We have been talking about summertime injuries ,
sports injuries of the elbowsand the hands and the knees and
the shoulders with Dr. JackieGeisler and Dr. Nancy Luger .
They are colleagues of minehere at Hennepin Healthcare in
downtown Minneapolis and a keypart of our orthopedic surgery
department. I do often tellpeople, if you need an
orthopedic surgeon, you come toHennepin Healthcare. If you
(24:54):
happen to be in the upperMidwest, that's where you wanna
go. Not only these two, buttheir whole team is simply the
best in orthopedic surgeryanywhere. So Jackie , Nancy,
thanks for being on the showwith me today. Thank
Speaker 4 (25:05):
You Dave. Happy to be here. It's a pleasure.
Speaker 3 (25:06):
Thank you both for lots of great information.
Listeners. I hope you've pickedup a thing or two and I hope
you'll join us for the nextepisode. And in the meantime,
be healthy and be well.
Speaker 2 (25:17):
Thanks for listening to the Healthy Matters podcast
with Dr. David Hilden . To findout more about the Healthy
Matters podcast or browse thearchive, visit healthy
matters.org. You got a questionor a comment for the show?
Email us at Healthymatters@hcme.org or call 6 1 2
8 7 3 talk. There's also a linkin the show notes. And finally,
(25:40):
if you enjoy the show, pleaseleave us a review and share the
show with others. The HealthyMatters Podcast is made
possible by Hennepin Healthcarein Minneapolis, Minnesota, and
engineered and produced by JohnLucas At Highball Executive
Producers are Jonathan, CTO andChristine Hill . Please
remember, we can only givegeneral medical advice during
this program, and every case isunique. We urge you to consult
(26:01):
with your physician if you havea more serious or pressing
health concern. Until nexttime, be healthy and be well.
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