March 6, 2025 • 35 mins
Hi This is Brad Weisman - Click Here to Send Me a Text Message
Ready to finally understand the complexities behind your shoulder pain? In this insightful episode, we invite Dr. Nate Tiedeken back to explore everything from common shoulder issues to the fictional narratives we create around pain. Get ready to unravel the intricate web of shoulder health as we discuss not just rotator cuff tears but also touch on the often overlooked connections between neck issues and shoulder pain.
The episode dives into the nuances of arthritis, clarifying the distinctions between primary and secondary conditions, and highlighting why this knowledge is essential for effective treatment strategies. We challenge the misconception that surgery is the only answer, providing listeners with valuable insights on how to manage pain through conservative treatments and lifestyle modifications.
With humor and relatability, we tackle all the questions you’ve had about shoulder health in an engaging format that feels like a conversation with friends. You’ll leave feeling equipped with actionable advice and the understanding that surgery is not always the first option. Tune in now, and don’t forget to subscribe and share to keep the conversation going!
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Welcome to The Brad Weisman Show, where we dive into the world of real estate, real life, and everything in between with your host, Brad Weisman! 🎙️ Join us for candid conversations, laughter, and a fresh take on the real world. Get ready to explore the ups and downs of life with a side of humor. From property to personality, we've got it all covered. Tune in, laugh along, and let's get real! 🏡🌟 #TheBradWeismanShow #RealEstateRealLife
Credits - The music for my podcast was written and performed by Jeff Miller.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
All right, you guys ready?
Yeah, all right, we're ready.
Here we go, from real estate toreal life and everything in
between, the Brad Wiseman Showand now your host, brad Wiseman.
All right, we are back and wehave a repeat guest.
You're going to love this.
Yes, you might see a little bitof what's on the desk there,
(00:21):
and no, we are not going to betalking about dinosaur bones.
It might look like that fromwhat you see here in front of me
, but we brought somebody backwho was here before to talk
about my wrist.
I have carpal tunnel, thinkingwhat's going on and everybody
has to have a Dr Oz.
So, my Dr Oz, I'm going to callyou Dr T.
What do you think, dr T?
I like that Dr T is in thehouse.
(00:42):
Yeah, so, dr T, I like that DrT is in the house.
So, dr Nate Teetigan, how areyou doing?
Speaker 2 (00:44):
buddy, good Been.
Great.
I can't believe I got invitedback after the first time.
Yeah, I thought you and Hugotalked.
There was a lot of words backand forth.
Speaker 1 (00:52):
Hugo said no, I said yes.
Split vote.
Speaker 2 (00:55):
Split vote.
Yeah, split vote, since itgreat to be back.
Yeah, you guys changed some ofyour angles around here.
Speaker 1 (01:06):
I guess we changed some angles around and there's
still a book on the table heretoo, hugo, the book's just
laying there from another show.
I didn't have to say that, andyou know what's funny, my
phone's over there on the tabletoo.
Gotta get used to it.
You gotta get used to the newangles.
My game, everybody's gotta havea new angle.
You know what I mean.
You gotta have a new angle.
Speaker 2 (01:27):
I hope it's my good side it is, it is yeah, from
what we were told um, but no, soyou brought.
Speaker 1 (01:31):
We talked about um shoulders right a little bit
last time, just a little bit, Ithink.
We talked about the rotatorcuff or whatever, something like
that, and um, mostly what wetalked about was the carpal
tunnel thing.
By the way, I'm still doinggreat.
I don't have to wear the braceanymore, which is wonderful and
it worked out great.
And I didn't have to havesurgery.
Everybody, everybody, thinksyou have need to go to surgery
and, and you know, you know youwill tell people that you don't
(01:53):
have to always right.
Speaker 2 (01:54):
My goal I say a surgeon's goal should be to try
to keep you out of the operatingroom.
Yeah Right, Sometimes it's wheneverything else fails.
That's your last result, butthat should be your main goal,
Right.
Speaker 1 (02:03):
Now, you don't want to cut unless you have to.
Yeah, absolutely yeah.
Speaker 2 (02:06):
Surgery is surgery, no matter how big or how small,
so you have to treat that withrespect.
Exactly, that's a big thing, inmy practice at least.
Make sure you've exhausted allother treatments first, gotcha.
Speaker 1 (02:24):
Yeah, that's cool, that's really cool.
So we bad issues and has gonethrough.
The same physical therapistthat I am Also went to your
practice to get the work doneand he's very, very happy.
And he had something which Inever heard of before until my
father-in-law and my brother hadthis done called a reverse
shoulder replacement.
Speaker 2 (02:42):
I guess A reverse shoulder replacement.
Yep, you can get a totalshoulder replacement or a
reverse shoulder replacement.
Speaker 1 (02:48):
Okay, so what?
What is the difference?
Because I know what, I knowwhat the reverse is, and it to
me.
It just freaked me out when Irealized what it was.
Speaker 2 (02:56):
So so you know, people study this for like five
years and you're giving me like10 minutes, yeah, yeah.
Speaker 1 (03:00):
Just just set the table top here.
Okay, I'll give you the cliffGive us the cliff note version.
Speaker 2 (03:06):
So shoulder pain can happen for a number of reasons.
Okay, People will alwaysassociate shoulder pain with I
must've tore my rotator cuff.
Gotcha, that's what it is, butit's not.
You can have inflammation inthe shoulder, bursitis,
tendinitis you don't have tohave a tear.
One of the problems which Ithink we'll talk about today is
arthritis of the shoulder.
Okay, so there's two types ofarthritis in the shoulder
(03:27):
primary arthritis, which is justwear and tear over time right,
Grandma and grandpa getarthritis.
Or their secondary arthritisSomething happens in the
shoulder.
You tear your rotator cuff.
Maybe you don't know about it,or you live with it for a long
time and that can result inarthritis from a secondary
reason, not just because it'swear and tear gotcha.
So the first thing and I don'tknow how deep you want me to get
(03:50):
, no, but the arthritis thing isthat's from just getting older
not, necessarily not necessarilyhave a fracture of your
shoulder, which then results inpost-traumatic arthritis.
Okay, so a trauma okay or youcan have a rotator cuff tear,
and and I'll explain that alittle bit to you guys and that
can result in a very common formof arthritis in the shoulder.
Oh wow, so you can see an x-rayand immediately know that this
(04:11):
person has what we call rotatorcuff tear arthritis.
Oh wow, so the way you treatthem, though, is different,
gotcha, so that's why it'simportant to have the correct
diagnosis before you start atreatment plan, because treating
rotator cuff tear arthritisversus treating regular
arthritis- Now, when you saytreating it, do you mean
operating or talk about physicaltherapy?
Speaker 1 (04:29):
A little bit of both, okay, right, because some of
this stuff, once again, can besolved or not solved can be, can
work better or can get past thepain with doing physical
therapy.
Speaker 2 (04:40):
One of the first options for arthritis is
treating it with eithercortisone injections to lower
inflammation and therapy and,honestly, activity modifications
.
So a lot of people who havearthritis if you try to stop
doing what's causing the pain,like painting your ceiling or
things like overhead work thatcan really actually improve some
of your inflammation because,arthritis is not your problem
(05:01):
right, it's the.
Speaker 1 (05:02):
It's a result of a problem inflammation.
Speaker 2 (05:04):
Arthritis causes gotcha.
So if you can treat theinflammation which is causing
your pain, yeah, well then what?
Speaker 1 (05:10):
exactly is arthritis?
Is it?
Is that a tissue swelling?
Is that what it is?
What is it?
So?
It's part of your body, is it?
Is it how?
Speaker 2 (05:18):
can you give me like an analogy of what it might be,
I guess?
Uh, it would be like I don'tknow here, I don't know here we
go with the now.
Speaker 1 (05:23):
Now he's showing stuff.
So if you're watching, ifyou're listening to the podcast,
you're not going to know.
It's a little tough to getthese angles, so look here is
it's opposite.
Speaker 2 (05:30):
Usually there, there we go.
Okay, so this is the ball ofyour shoulder right.
So we're looking at it.
If it were right here on me,yep holds the ball and the
socket and they wear togethernicely.
Okay, so it's a smooth surface.
Gotcha, all arthritis is is thebreakdown of that cartilage
layer.
Speaker 1 (05:51):
Okay, so when they say you have bone on bone
arthritis, you've worn thecartilage, down Okay, and then
when you have bone on bone, thatstarts to cause pain, because
that's where the nerve fibersare in the bone.
Speaker 2 (06:03):
The cartilage itself won't cause pain.
It's the bone underneath itwhich will sense pain.
Speaker 1 (06:09):
So once you wear that , down.
Speaker 2 (06:10):
That can cause the inflammation and that can cause
the pain.
Gotcha.
Speaker 1 (06:14):
So you got to get.
So the inflammation is what'sreally becomes the issue,
Correct.
And that's why you knowibuprofen or or doing different
things that you can do to toreduce the swelling.
The cortisone shot, like yousaid, that reduces the swelling
in the form of like a steroid.
Speaker 2 (06:26):
I guess, yeah, a steroid.
So it's a very powerfulanti-inflammatory, a steroidal
anti-inflammatory.
Speaker 1 (06:31):
And sometimes that'll do the trick.
Oh yeah, because what does itdo?
It knocks it down.
It gets it down and then itdoesn't come back up again.
Speaker 2 (06:38):
I mean it usually does right because it's
arthritis.
So what you do, the idea behindcortisone is to lower the
inflammation.
The arthritis is still there,oh, got it.
So over time, as you use itagain and the cortisone wears
off, then the arthritis willkick in again.
But I mean, I have patients whoI see, you know, every year and
they get a cortisone shot andthat's all they need for
arthritis well, that's cool thatway.
Speaker 1 (06:57):
Well, if that works, it works right, that's good.
That's the best treatment if itworks, yeah, amazing, very cool
.
So let's go back to this wholeshoulder the shoulder reversal
versus the shoulder replacementon all that.
Sure, let's talk about that,because this is something new,
right?
So, reversal or no, when I saynew 10 years 15 years really.
Speaker 2 (07:17):
Oh yeah, I'm much older.
Okay, but the problem is when Iwas doing surgery back in the
day, back in your day.
Speaker 1 (07:22):
We just didn't do that.
We just didn't do that.
I use Band-Aid actually.
Speaker 2 (07:26):
So when I trained about 10 years ago, we actually
were doing these fairly often.
But their technology has gottenso much better for shoulders I
think in the last 10, 20 yearsthat it's really been a good
option for people now, beforethey used to break down in five,
six years or they'd have a lotof failures.
But you know, through failureyou learn and you have but I
(07:49):
think there's a lot of confusionout there regarding a regular
shoulder versus a reverseshoulder, and so I wanted to try
to clear that up.
I'm going to clear that up forall your, for all your viewers.
So I don't know.
Hugo, here's our angles yourviewers.
Speaker 1 (08:05):
So I don't know.
Hugo, here's our angles.
Yeah, now now.
Nate also was an elementaryteacher at one point, so you can
see his drawings are very good,so very good, I'm not an artist
, but this is about as good asit gets, okay, cool I like it
and if you're listening to thisand not seeing it, he's got a
picture of a shoulder, basicallythe it's a very crude diagram
of yes, yes, now you're gonnayell it could be a hair dryer
too.
I'm not sure, hug not sure itlooks like a hairdryer, Like if
you look at it this way.
Like if you hold the handle ofthe hairdryer there, this is not
(08:27):
bad.
Speaker 2 (08:27):
Okay, go ahead, sorry , so, anyway.
So here is your.
Your head will be up here, okay.
Speaker 1 (08:32):
Okay, we'll draw it like this Okay, oh wow, that's
really nice, that is not?
Speaker 2 (08:36):
to scale.
All right, we'll put it there,gotcha.
So here is the, the rotatorcuff, coming in Now.
Hugo, he's been yelling to meabout the mic, so I'm going to
have to move this a little bithere.
Speaker 1 (08:44):
That's right.
You want me to hold this, I canhold it, maybe two.
Okay, got it, that's perfect.
That's perfect.
We'll knock this out.
That's actually really good.
Speaker 2 (08:50):
So here is your shoulder, here is the socket
part of your shoulder.
Gotcha, the rotator cuff sitsatop the shoulder and it
actually comes in front.
You don't need to worry aboutthat one.
But the big rotator cuff muscleattaches to the ball right.
The function of the rotatorcuff, in addition to moving your
shoulder, is to keep theshoulder centralized in the
(09:12):
socket.
Oh right, so you can imagine onthe outside.
So you know, we're color-coded.
Speaker 1 (09:17):
Yeah, so this is not blood.
This is actually just rednesshere, not yet, not yet.
So here.
Speaker 2 (09:23):
Let's say these are the cartilage layers.
Oh yes, very good.
So there's the cartilageholding it.
Now what happens is this is, ifyou have arthritis, the red
goes away, right.
Speaker 1 (09:34):
Oh, the red goes away .
Speaker 2 (09:37):
And now you're wearing bone on bone.
So if you want to do a shoulderreplacement, you have to treat
the arthritis, gotcha.
The good news is you still havea rotator cuff that's keeping
you centralized in the socket,gotcha.
So it's still moving nicely andsmoothly Right.
So what you can do is so, ifyour rotator cuff is okay.
Speaker 1 (09:52):
This is the way you do it.
Speaker 2 (09:53):
You do a total shoulder, total shoulder, okay.
Shoulder, total shoulder, okay,not the reverse, gotcha, okay.
Yep, so what you do is you goin, you make an incision and you
would actually cut the ball out, gotcha.
Then you would grind the socketdown, gotcha.
So now you've taken away thearthritis here and there then
what you do is you put in a newmetal ball so the new metal goes
(10:13):
down the shaft of the bone yep,I've seen, and it forms this
here and so now you have a newball and then you put a actually
a plastic, technicallycomponent in the socket I've
seen that for the new socket?
amazing.
So that is a total shoulder.
Okay, gotcha.
And the reason you can do atotal shoulder is because the
(10:33):
rotator cuff is still intact.
So here's the why, if yourrotator cuff isn't intact, why
you would work on changing thisup.
So let's say you have a rotatorcuff tear right, it rips off of
the bone.
Now your rotator cuff issitting up here.
Speaker 1 (10:48):
Oh gosh, that doesn't look good.
Speaker 2 (10:49):
What do you think, hugo?
It looks like jaws.
Speaker 1 (10:51):
I think is that a shark bite that happened.
Speaker 2 (10:53):
It looks like a shark bite.
It looks like that's whathappened.
That is gone.
Speaker 1 (10:56):
Yeah, so swimming with the sharks is not a good
idea because it takes yourrotator, cuff.
Speaker 2 (10:59):
Definitely not for this one.
Yeah, okay, definitely not forthis.
Speaker 1 (11:01):
No, this makes so much sense now.
I totally am getting this nowSee, I mean this is good stuff.
Speaker 2 (11:05):
I told you I'm not a real doctor.
Speaker 1 (11:06):
This is good.
It's good drawing.
You can explain it with a firstgrade diagram it.
Speaker 2 (11:14):
Now we know why you do a total shoulder.
Let's say you don't have arotator cuff right.
So what happens?
There's other muscles here thatI'm not showing right.
One of the big shoulder muscles, your deltoid, will pull your
shoulder because you're stillusing your shoulder all day,
right, and it is not keeping itcentralized in the socket
Because your rotator cuff isgone, correct.
So what happens now is thatbegins to pull up.
Speaker 1 (11:41):
Oh not good.
Good, so what happens is youget what we call the dreaded
high riding humorous.
Oh, this doesn't look good howbad does that?
Speaker 2 (11:43):
and it's not in the socket.
Not so at that point it isstill in the socket, it's still
inside.
Speaker 1 (11:45):
But it's on the top edge of it, eccentrically moving
.
So does it pop then?
And stuff do you start to feelpopping?
You don't have to.
Speaker 2 (11:52):
okay, some people can't.
The more you know, the moreadvanced it gets.
But you know, it's just's justpainful, painful, very painful.
So then imagine if you went andput a total shoulder in there.
It wouldn't work, it wouldn'tbecause?
Speaker 1 (12:03):
No, because you still don't have the rotator cuff
holding it in place.
Speaker 2 (12:05):
That's what we used to do oh gosh, so we'd put a
total shoulder in and peoplewould do terrible.
Obviously yeah, Because we werenot understanding the
biomechanics of I get it so somesmarter people than myself came
along.
Speaker 1 (12:17):
This is the part that blows my mind, hugo, this is
good stuff here.
Speaker 2 (12:20):
And said well listen, if we don't have a rotator cuff
, we can still keep everythingcentralized if we flip the ball
and the socket.
Speaker 1 (12:31):
That's the part that blows my mind.
Reverse total shoulder yeah, soyou're basically putting the
ball where the socket was youput the ball.
Speaker 2 (12:36):
Now.
You put the ball there here,right when the socket was.
So you put the ball now.
You put the ball there here,right With a big old screw right
down your scapula Okay,unbelievable.
So now the ball stays here,mm-hmm.
And then the socket part.
You guys make a socket there.
Well, it's made out of metalUnbelievable.
Now you put the plasticcomponent here.
Now, this one's obviously notin place get.
You get better movement thanfrom that or better so what
(12:59):
people will do is is they willusually get better movement with
it, but it is a pain operation.
More than anything, it's a painoperation, your pain should
greatly improve.
Speaker 1 (13:09):
Got it, got it, got it.
So less pain.
Yes, now there are people whodo.
I'm thinking you're doing thisoperation to have more pain.
You're like this is what we doto give people more pain.
This is the goal.
Speaker 2 (13:18):
This is the goal.
The goal is pain.
Speaker 1 (13:20):
No, but that, that to me is brilliant.
Speaker 2 (13:23):
Yeah, and it and it is.
It's a brilliant idea becauseit just it may.
It's such a simple idea, right?
But the best ones are alwaysthe most simple, right?
Yeah, all I need is one simple.
Speaker 1 (13:31):
Could you imagine the guy pitching that though?
At the doctor's meeting.
So last night I was drinkingand I came up with this crazy
idea we're going to switch theball and the socket and they're
sitting there like you'rekidding me and they did it and
it's worked.
Speaker 2 (13:50):
And it's worked great and it works great for people
who even have bad fractures ofthe shoulder.
You can't fix it.
This is a great way to givethem mobility with decreased
pain.
Speaker 1 (14:01):
Amazing, yeah, so I know two people with that my
brother and my father-in-law.
Is that crazy, or what?
Speaker 2 (14:05):
Because rotator cuff tears.
Believe it or not.
If you took an MRI of a hundredpeople outside random people
about 40% would have some formof a rotator cuff there.
They don't know about it'samazing, right.
So it doesn't mean you have tooperate on every rotator cuff
there.
They don't know about it'samazing, right.
So it doesn't mean you have tooperate on every rotator cuff
tear you see?
no, but you operate on thesymptoms and a lot of times over
time those rotator cuff tearscan increase right and people.
I see a lot of people that cometo my office with shoulder pain
(14:27):
and they didn't even know theyhad a rotator cuff tear.
Speaker 1 (14:29):
Well, they already have arthritis in their shoulder
because it's been decades wherethey've accommodated gotcha and
eventually the body made itwork, the body makes it work,
the body makes it work and ittries to right Up to some point
Right, you said there's that.
I remember the last time withthe carpal tunnel, you said it
won't hurt, it won't hurt, itwon't give you problems.
And all of a sudden it startsto give you problems.
It falls off of that one spot,yeah.
Speaker 2 (14:51):
And that's true for almost anything in the body.
I think Other muscles fire, butI see a lot of people they'll
have a fall and they'll flare uparthritis that they never even
knew they had because it was anacute traumatic event.
Speaker 1 (15:02):
Yeah, amazing, when you looked at my back, you you
did a x-ray of my back and welooked at that and you were even
just showing me like, look athere's your, here's your discs
coming down through.
And it was interesting, like Idon't have really any issues
down there, you know, like Idon't have any bulging discs or
anything like that.
Your mind's stretching.
Speaker 2 (15:17):
Your problem is, I think there's too much muscle
mass holding your back up.
Yeah, so you got to work onthat muscle mass.
Speaker 1 (15:22):
Yeah, that that's weird.
I don't think that's theproblem.
I think I have.
I have little muscle mass righthere.
Yeah, that's not muscle.
Yeah, yeah, no, but I'll tellyou, the stretching's working.
Speaker 2 (15:33):
Yeah, it works it works a lot, and that's why I
say a lot of these things.
You don't have to have surgeryfor yeah, you just have to be
able to be patient with it.
We're not very patientsometimes.
No, we're not at all.
We want to get better fast.
Speaker 1 (15:44):
So that was an excellent explanation of that
and I totally get it.
Now let's talk about a littlebit about more of the other
pains you can have Bursitis, isthat having to do with the bursa
sac bursitis?
So it is.
And here we go.
See this is, let's see, this isarts, and crafts, you're not
going to use your t-rex.
Speaker 2 (16:02):
Uh bones, I get nervous with the t-rex bones.
Speaker 1 (16:03):
All right, these are probably your kids bones, aren't
they?
Well, you take these from theirroom my kids, they sometimes
they like the.
Speaker 2 (16:10):
They're like what did you hear about today, dad?
What'd you see today?
I'm like oh man, that's funny solet me show you what bursitis
would be okay.
Okay, now this is back to wherewe were.
Okay, there's the ball andsocket part, got it.
So, bursitis, there are bursasacks You're exactly correct
that sit on top of the rotatorcuff muscle, okay, and they act
as like oil in an engine, right,so move it.
It helps everything glide,cause, right.
(16:31):
The problems is if you're doinga lot of overhead work.
I see in a lot of overhead work, uh, you know, drywallers,
drywallers, seriously,construction painters painters.
Speaker 1 (16:51):
I can totally see painters.
Speaker 2 (16:52):
They'll have very serious pain in the front part
and the outside part of theirshoulder and what happens is
they get bursitis.
This gets acutely inflamed,just like you would get an
Achilles tendonitis, and it canbe one of the hardest ones to
get rid of.
Because what do you do?
All day You're moving theshoulder Right, and so you've
got to be able to get this thingto calm down.
But now you're sure, what doyou do when you have Achilles
(17:12):
tendonitis?
You're in a boot for six weeks.
Speaker 1 (17:13):
You don't run, you don.
You can't do that with yourshoulder.
Speaker 2 (17:15):
You can't be in a sling for seven weeks.
You'll be so stiff.
Yeah, exactly, so then you alsostart to atrophy, then too right
, for sure, yeah for sure, andso you have to find a way in the
shoulder to get things to healbut still be functional while
you're healing, which isdifficult.
Yeah, so people can haveshoulder pain, like I think I
tore my rotator cuff, but noinjury, sign of, just bursitis
(17:35):
in the shoulder, and that iswhere actually usually a
cortisone injection in that areaworks wonders for people.
Interesting Because it willreally lower that acute
inflammation.
Speaker 1 (17:43):
Yeah.
So when that thing's inflamed,is it still doing its job,
though, or no?
If it's?
Speaker 2 (17:47):
inflamed, it's still doing it.
Speaker 1 (17:49):
It's still doing it, but it hurts.
It hurts.
Speaker 2 (17:51):
It hurts.
I mean I just had Achillestendonitis and I mean it was
brutal.
Speaker 1 (17:55):
I've heard that is brutal.
Speaker 2 (17:56):
I heard it is so I mean, you got to take it easy
and the problem is in theshoulder.
It's the most mobile joint,right, it's the most mobile
joint in the body, so there's noway that you're gonna.
Speaker 1 (18:03):
So there's and isn't, isn't.
So when you say most mobile,like it, it does more things.
It can go like if you thinkabout your knee.
Your knee goes back and forth.
Speaker 2 (18:10):
Your knee is a hinge joint yeah, this is like oh, it
goes all over, all over theplace, all over.
Yeah, it's crazy.
So people get really people canget really inflamed with
bursitis, but they'll all.
Everyone thinks it's a rotatorcuff tear.
Right, and remember, I justsaid there's a lot of people out
there with a rotator cuff.
Yeah, the problem is is that ifyou get an mri on that, yes,
and it shows a small rotatorcuff tear, they're gonna they're
(18:31):
gonna say it's that, that'swhat's causing my pain.
Yeah, and, and maybe it is, butthere's a lot of things you got
to go through before you in myopinion.
Yeah, you can fix the tear.
Oh, yeah, rotator cuff surgeryis one of the most common, so
you can fix the tear and thenput it back where it needs to be
.
Speaker 1 (18:47):
Oh yeah, so.
So here you go.
Is that where you drill throughthe bone and like with a little
washer?
Speaker 2 (18:51):
So it's it's almost like a drywall anchor.
Speaker 1 (18:53):
Yeah, okay, I think I yeah.
Speaker 2 (18:58):
So if you have a tear , let's say you have a tear
right here, right in there, thetop part what you would do is
you come in here with us andthis is where you do it
arthroscopically, right, no bigincisions wow small stab
incision so you can move acamera and shuttle your sutures
around.
So then you say, all right, wegot to get this back down to the
, to the x's yep.
So you take a little drywallanchor and you literally put it
back in.
(19:18):
You put it into the bone.
Amazing, there's sutures thatcome out of there.
Okay, take those stitches, passthem through the rotator cuff,
yep, yep, and then that will,once you tie it down, yeah,
it'll advance it back.
Speaker 1 (19:31):
Unbelievable repair that will that attach, then
eventually, oh yeah, it'll,it'll actually attach about six
weeks.
Speaker 2 (19:37):
That's it six weeks for that to heal.
Now, remember, for surgery,you're just showing scar tissue
where to go.
Right, you're showing scartissue because that's how you
stimulate a healing response,right?
Okay, surgery is controlledtrauma.
To show scar tissue where to go?
Oh, I get it now.
So, you want that scar tooverlap the tendon and the bone
so it heals.
Speaker 1 (19:58):
Not where it is up there.
Speaker 2 (19:59):
Correct.
Yes, you want to make sure thatGot it.
Speaker 1 (20:02):
Wow, never heard it like that before either.
That's great, great, uh way tolook at it.
Speaker 2 (20:07):
Yeah, you learn something new every day.
Speaker 1 (20:08):
I'll tell you this is see, this is, this is good
stuff, yeah, so let's go into umtendonitis right.
Speaker 2 (20:14):
So, just like we said , you can have a bursitis.
You can actually have aninflammation around the tendon
itself.
So one of the other options isthe tendon itself can become
inflamed.
Now that's a little bit moredifficult to treat because you
don't want to keep puttingcortisone into a tendon itself,
obviously because that repeatedcortisone injections and I hear
it all the time I don't want todo a cortisone injection because
(20:35):
I heard it eats away all yourtissues.
Oh right, that's not true.
I mean, if you're a baseballplayer and for 162 games you're
getting one before that's,that's bad yeah, but you know,
here and there if you need acortisone injection, there's no
long-term effects, right.
But tendinosis, or tendonitisreally is the same as bursitis,
is just involving the tendon.
Tendon got it and, once again,though, you can get an mri on
(20:55):
that and you'll see that thetendon looks thickened, looked
angry and there's a small tear.
And people say I saw my mrireport, it's a tear, I need fix,
it's here.
Well, no, let's not get thereyet.
Now there are some tears youhave to fix right, like you fall
and that's pulled off.
You want to get to those sooner, but the average run of the
mill shoulder pain that you see,that walks through the door you
hear someone complain about, isnot because they fell outside,
(21:16):
it's.
This has been bothering me fora year.
It it hurts me at nightoverhead motions when I try to
scratch your back.
I can't do it.
Those are very commonly seenfor bursitis, tendinitis and
sometimes small rotator cufftears, but more so the latter.
Yeah, it's amazing.
Speaker 1 (21:32):
Do you have any questions yet, Hugo?
Speaker 2 (21:33):
No, I'm just impressed, did you say depressed
or impressed?
Speaker 1 (21:39):
No, no, I'm just mad.
Pretty amazing, right, yeah,that's pretty amazing.
Speaker 2 (21:43):
The shoulder is a very difficult thing to really
conceptualize, but once you doand you can dumb it down,
there's only so many things thatcan really cause shoulder pain.
Speaker 1 (21:54):
Yeah, it is amazing, totally amazing.
So let's talk about themisdiagnosis is one of the
things that we kind of chatted alittle bit about.
Some people will come in andthey'll say it's neck pain or
shoulder pain, or it's notshoulder pain, it is actually
neck pain.
I mean, what, what do you seewith that?
Speaker 2 (22:11):
So I think one of the things you always have to look
at when you're looking atshoulder pain is you got to look
a little bit higher, okay.
And what I mean by higher isyou got to look around the neck,
because a lot of people willhave mild neck pain it doesn't
bother that much.
But you got to remember all thenerves that come out and go to
your shoulder start up in theneck Right.
So if those nerves come out andlet's say, you have arthritis
in your neck and it's pinchingthat nerve or it's inflaming
(22:33):
that nerve, that can fire aroundthe shoulder.
So there can be some people.
I've seen people come in.
They're like both of myshoulders are killing me, I
don't know what, and I'm likeboth of your shoulders Both of
them yeah, right, right and so.
I don't know what it is, it'sjust been bothering me for such
a long time.
And you look at their neck andthey actually the nerves that
are giving sensation and pain tothe shoulders are inflamed.
Oh wow, and so it presents inthe shoulders.
Speaker 1 (22:55):
Yeah, and people like I don't have that where it
terminates to the nerve or someof them wherever it terminates.
Speaker 2 (23:05):
Right, and I'll have people where you can have both.
Right, you can have both.
Some people come in and theyhave neck pain and shoulder pain
.
Oh geez, those poor peoplethat's where you're exactly.
Speaker 1 (23:10):
Do you say hey, you know what, if I were you, I
would just, uh, it might be timeto.
Speaker 2 (23:14):
Yeah, I don't know, like a horse you know, you take
him out to a field.
Speaker 1 (23:18):
I'm not in that part of medicine, but there was
another guy that was doing thatfor a while, yeah, he, he done.
Speaker 2 (23:24):
I think he's in jail.
He's dead.
Actually, he's dead.
Yeah, he died.
Yeah, I think he killed himselfin prison.
Speaker 1 (23:29):
Yeah, something there goes the family show, all right
.
Speaker 2 (23:33):
This is where you turn it off, if you have kids.
Speaker 1 (23:35):
Yeah, exactly, so it can be misdiagnosed with a neck.
Speaker 2 (23:38):
It can.
Speaker 1 (23:40):
You know what's funny ?
I looked under shoulders todayand then I looked at.
Sometimes people misdiagnose aheart attack for shoulder pain.
Speaker 2 (23:51):
See, this is where I tell people I'm not the real
doctor.
Speaker 1 (23:55):
Dr Traer.
Speaker 2 (23:56):
We'll bring Dr Traer in.
I'm on the phone and I call areal doctor and they go.
Speaker 1 (24:01):
But seriously, that could be.
People sometimes go oh, it's myshoulder, but if it goes into
your jaw and down your left arm,that could be.
People sometimes go, oh, it'smy shoulder, but if it goes into
your jaw and down your left arm, that could be.
Speaker 2 (24:07):
It's funny you mention that because there was
just an article I read wheresomeone had chronic shoulder
pain and then it was actuallypresenting in that fashion.
Get out of here it was more ofa cardiac issue than it was a
shoulder issue.
Speaker 1 (24:19):
Oh jeez, can you imagine that you keep thinking
it's your shoulder and nextthing you know that's not good.
No, that's that's that's everyorthopedist nightmare yeah,
absolutely, and, like they saidthat, there's other things that
usually go with that like thefever like sweating and and the
drawl and down the arm and allthat stuff and usually your.
Speaker 2 (24:34):
Your physical exam right should show you that yes,
exactly if you move the shoulderand it hurts, that's shoulder,
that's shoulder pain.
Move the shoulder and they'relike I'm sweating and I have
palpitations that's's probablynot a.
Speaker 1 (24:44):
I don't think you need to go to medical school.
I'm thinking not the reversal.
Speaker 2 (24:48):
I'm thinking the reversal is not going to work
for you at that point we're notsigning that person up for total
shoulder Put it that way.
Speaker 1 (24:52):
Dr Nate, I have a question.
What?
Speaker 2 (24:53):
profession I was thinking maybe is the baseball
pitcher, but what professionsuffers more, given their work
from?
Speaker 1 (25:01):
shoulder injuries.
Speaker 2 (25:01):
Honestly, there's a ton of stuff out there for
baseball players, especiallypitchers.
I mean, the shoulder is notmeant to rocket a projectile.
95 miles an hour 100 timesevery five days?
Obviously not.
What you see with pitchers is alot more soft tissue injury
than really arthritis.
So they'll have bursitis,they'll have impingement, which
(25:22):
is where the bone can kind ofpush down on the rotator cuff.
All of those things are muchmore common in baseball players
and pitchers.
But you'd be surprised any typeof overhead Like I even see
volleyball players.
Speaker 1 (25:35):
Oh, because you're doing this.
Yeah, right.
Speaker 2 (25:37):
So the serve a lot, a lot of rock climbers, believe
it or not.
Speaker 1 (25:40):
Oh, yeah, because they're hanging from their
shoulders a lot of time.
They're always up here.
Yeah, because they're hangingfrom their shoulders a lot of
time.
They're always up here.
It's this, yeah, it's all that.
Speaker 2 (25:46):
So they end up getting a lot of stuff too, and
rock climbing is a big deal nowaround here.
Yeah, I'm back.
Speaker 1 (25:49):
There's like a couple places over here.
Speaker 2 (25:50):
You'll never see me do that.
No, I don't do heights?
No, no I don't like goingdownstairs.
Nah, nah, nah your hand and youcould just close your eyes
looking for the railing.
Speaker 1 (26:03):
I got nervous, right now, no, but I'll tell you.
Speaker 2 (26:06):
You're right, those guys rock climbing and it's, and
that's all exerting on yourshow.
Speaker 1 (26:10):
I'm always amazed how they can hold on with just
their fingers, like theirfingers, their whole bodies on
their fingers.
Speaker 2 (26:15):
It's not I mean a little off topic, but I saw.
Do you ever see the one guy whodoes it without a uh, oh, not a
rope?
Yeah, I've seen that guy.
It's unbelievable that that's awhole documentary.
Speaker 1 (26:24):
I sweat when I watch him.
My palms are sweating the wholetime.
I remember Like I actually I'mstressed out when I watch him
and he was like I couldn't makeit up this time, so I came back
down.
Speaker 2 (26:33):
I'm like that's probably a good decision.
Speaker 1 (26:35):
Yeah Well, did he go down the fast way or the slow
way?
And they make?
We're not doing that.
Speaker 2 (26:41):
No, it's not happening.
Not happening.
I do the rock climb at the YMCAand I get two up.
I'm like I'm good.
Yeah, this is where I thought Iwas going to start crying.
Speaker 1 (26:50):
Mom.
Where's my mommy?
So is there anything else aboutthe shoulder?
Speaker 2 (26:59):
I mean you got these nice little things here, but I
guess we did most of it on thewhiteboard right.
These are where muscles attachor come off in the shoulder, so
you can see how much is involvedwith.
You know the anatomy.
Speaker 1 (27:12):
Whoa, that's a lot.
Speaker 2 (27:13):
There's a lot of things that can go wrong.
There's a lot of things thatcan go wrong and that's why your
physical exam is most important.
In the shoulder, you got tolook at the neck.
You got to make sureeverything's going up here.
You know there's a lot of othersmaller joints, not just the
ball and socket joint, that canreproduce a lot of pain.
Speaker 1 (27:27):
Unbelievable Crazy.
So not about shoulders, butlet's just talk real quick about
the flu.
That's really rampant right now.
You were talking about on thephone.
We talked about how and we'veall heard this a lot of times as
they basically they, they kindof do a crap shoot and go okay,
this is what we think the flu isgoing to be.
Speaker 2 (27:46):
And there's a bunch of versions in that shot right.
What's also crazy is so youknow, we got over flu maybe two,
three weeks ago in my house.
We had three kids get it rightand then I didn't get it.
Speaker 1 (27:55):
Now, does that mean that you had that my?
Speaker 2 (27:56):
wife says that's because I'm not around the kids
enough.
Oh, that sounds like something.
Oh, you know what we go todinner.
Speaker 1 (28:02):
I'm going to say that .
You know, I heard you didn'tget the flu.
Speaker 2 (28:04):
I wonder if it's because he's not around the kids
that much.
I told her the other day I'mlike you know, I never get their
sicknesses and she goes.
Oh really that sounds likesomething you don't say that's
because when our kids are sick,I'm like get that away from me,
Stay away.
I didn't get it.
Yeah, I don't know what it is.
Speaker 1 (28:23):
That was a while ago.
Speaker 2 (28:23):
Remember the whole thing with COVID too, Some
people got it, some peopledidn't, I never got it.
You don't think you had it.
Speaker 1 (28:28):
I probably did, hey, if you don't test, does that
make it that you didn't get it?
Yeah, you never tested, that'swhy.
Yeah, exactly.
Well, you know, that was all.
Speaker 2 (28:49):
They oh that was negative.
Speaker 1 (28:49):
Yeah, it was negative .
All right, listen.
Is this a fun show or something?
Because I have a.
I have a shoulder pain is onething, but I got a, I got a
question.
Speaker 2 (28:52):
I would like to go ahead, go ahead.
This is a question back on usall, right?
So listen, I go to this oneplace and I get a haircut every
every couple weeks, right, yeah,it's just one of those places
you walk in, you just sure likeit's easy, it's?
So I go in there on a friday, Iget my haircut.
I come home I think we hadsomething next week so my wife's
like, hey, you got to lookpresentable.
Speaker 1 (29:07):
So I go get the haircut.
Speaker 2 (29:08):
I come back and my wife's like ooh, it's not a good
haircut.
Oh, whoa, it wasn't.
Speaker 1 (29:13):
All right.
Okay, it wasn't All right.
Speaker 2 (29:18):
It wasn't blended.
Are you planning on going?
Speaker 1 (29:20):
back there, okay, okay.
Speaker 2 (29:21):
Okay, and here's why, and that's why I'm gonna get
your what, get your opinion onit, you go.
So that was Friday, okay, thispast Friday, your hair looks
fine.
Speaker 1 (29:28):
No, no, no, oh, a couple of Fridays ago, I'm still
.
Speaker 2 (29:29):
I'm still processing it, okay, got it so so four days
later I said, hey, listen, Ican pick up one or two of the
kids, take them with me, thatway you don't have all four
there.
She's like, oh awesome, thanks.
So I drive over, okay.
The guy who cut my hair Okay,is there.
(29:51):
Okay, I walk in.
He acknowledges me.
Hey, hair looks great.
I said thanks, man, and I sitdown.
My wife looks over me and, nate, while you're here, can you get
another haircut?
Oh gosh, no, no, no, no.
Oh man, that's terrible.
So let me set the scene.
No, no, so let me set the scene.
Okay.
So I'm sitting there, okay.
(30:12):
The guy who cut my hair fourdays ago acknowledged that he
saw me, commented on how good myhair was which it wasn't okay,
it was
Speaker 1 (30:21):
not a great cut, but I don't care, yeah, whatever,
yeah, it goes back, and so mywife goes.
Speaker 2 (30:26):
Can you get a new haircut?
Oh, no.
And I looked at her and I'mlike you know, like he, you know
she doesn't know it's him, soshe doesn't know, oh gosh.
Speaker 1 (30:34):
She doesn't know.
Speaker 2 (30:35):
And so she's like, hey, you should get a new
haircut.
I'm like, keep your voice down.
He cut my hair.
She's like it looks like crapfrom before and she said she
said, well, she goes, just youdon't have to go to him.
Speaker 1 (30:51):
but how are you not going?
Speaker 2 (30:53):
to go to him.
Speaker 1 (30:54):
Go to somebody else how I could never do that.
Speaker 2 (30:57):
So I start panicking because I'm like did you start
sweating?
I can't have this conversationwith him right there no, he just
told me, I look good take itout.
Speaker 1 (31:05):
You gotta take that one out start texting her.
Speaker 2 (31:07):
So my question is this okay, what's the?
What do you do?
Your wife is saying hey, brad,this haircut, you got to get a
new one.
The guy who just cut your hairfour days ago right says oh, you
look good, good haircut.
Yeah, recognizes me.
What do you Do?
You get a new haircut With him.
Speaker 1 (31:26):
I don't know how I With him, or no, no, I would say
I'm not getting a haircut.
I would text my wife and sayI'm not getting a haircut.
This is very uncomfortable.
That's what I would do.
There's no way I'm going tosomebody else after he just said
it looked good.
Okay, I respect that.
I will tell him the truth, Iwill say hey man, you know, my
(31:46):
wife said that I personally likeit.
But my wife doesn't.
Speaker 2 (31:51):
She's right there.
Throw the wife under the bus.
That is the best answer.
Throw the wife under the bus.
No, it's the truth though.
Speaker 1 (32:00):
Yeah, my wife would kill me if I did that.
Speaker 2 (32:02):
Kill me, so I panicked what did, you, do, do I
got a haircut by someone elseoh my gosh what did he say?
Did he say anything?
Yeah, he did.
What'd he say?
So I got up and I walked by himand I acted like it wasn't
happening.
Right, you just act like it wasand he looks at me where you
going.
Speaker 1 (32:19):
I was like oh, oh my gosh, this is so uncomfortable
I'm just getting a new haircut.
Speaker 2 (32:24):
uh, and he goes why I just cut your hair four days
ago Like wouldn't let me off thehook.
Speaker 1 (32:30):
Oh man, you should have just taken off running.
Speaker 2 (32:31):
I said you know, I'm just getting it freshened up.
He goes it was four days agoand I'm like, and I panicked and
I just sat down.
I said clipper number three onthe.
You went and sat down.
Oh yeah, he's asking me as I'mgoing to the chair I thought you
(32:52):
meant after it was cut as I'mgoing to the new chair.
Oh, my gosh, dude, so I can'tgo back there.
No, yeah, no, I can never go.
I would never go back.
No, you can't, absolutely not.
No, so you were, I could nevergo back.
Speaker 1 (32:57):
See, I would you know what I would done.
I would have text jess and Iwould have said this is where
it's funny, we're a littledifferent.
Uh, I would text her and Iwould say this is not happening
right now, but she's right nextto you, I would text her.
If you're in a situation likethat, just text her, and you
know what I do.
I go check your phone.
Speaker 2 (33:13):
Check your phone no, you can tell that you have
diarrhea or that you have tofart.
Speaker 1 (33:17):
You go outside real quick and then you text her from
outside that's a good one.
Speaker 2 (33:22):
When I'm in this situation, I'm texting Hugo.
Hugo's definitely got theanswers right he does.
Speaker 1 (33:26):
Oh my God.
All right, We've got to wrapthis up Longest podcast ever?
Speaker 2 (33:29):
I think, yeah, sorry about that.
I wanted to ask you about lifesituations.
I love the stories, love thestories.
Speaker 1 (33:44):
That's a good one.
Speaker 2 (33:45):
We'll talk about that next time.
Speaker 1 (33:47):
All right, that's it.
Dr T was in the house.
That was a good time, all right, so come see us every Thursday
at 7 pm.
You can find us on Facebook,instagram, youtube wherever you
want to find us, we'll be there.
All right, that's about it, seeyou.
All right, you guys ready?
Yeah, all right, we're ready.
Here we go, from real estate toreal life and everything in
between, the Brad Wiseman Showand now your host, brad Wiseman.
All right, we are back and wehave a repeat guest.
You're going to love this.
Yes, you might see a little bitof what's on the desk there,
(00:21):
and no, we are not going to betalking about dinosaur bones.
It might look like that fromwhat you see here in front of me
, but we brought somebody backwho was here before to talk
about my wrist.
I have carpal tunnel, thinkingwhat's going on and everybody
has to have a Dr Oz.
So, my Dr Oz, I'm going to callyou Dr T.
What do you think, dr T?
I like that Dr T is in thehouse.
(00:42):
Yeah, so, dr T, I like that DrT is in the house.
So, dr Nate Teetigan, how areyou doing?
Speaker 2 (00:44):
buddy, good Been.
Great.
I can't believe I got invitedback after the first time.
Yeah, I thought you and Hugotalked.
There was a lot of words backand forth.
Speaker 1 (00:52):
Hugo said no, I said yes.
Split vote.
Speaker 2 (00:55):
Split vote.
Yeah, split vote, since itgreat to be back.
Yeah, you guys changed some ofyour angles around here.
Speaker 1 (01:06):
I guess we changed some angles around and there's
still a book on the table heretoo, hugo, the book's just
laying there from another show.
I didn't have to say that, andyou know what's funny, my
phone's over there on the tabletoo.
Gotta get used to it.
You gotta get used to the newangles.
My game, everybody's gotta havea new angle.
You know what I mean.
You gotta have a new angle.
Speaker 2 (01:27):
I hope it's my good side it is, it is yeah, from
what we were told um, but no, soyou brought.
Speaker 1 (01:31):
We talked about um shoulders right a little bit
last time, just a little bit, Ithink.
We talked about the rotatorcuff or whatever, something like
that, and um, mostly what wetalked about was the carpal
tunnel thing.
By the way, I'm still doinggreat.
I don't have to wear the braceanymore, which is wonderful and
it worked out great.
And I didn't have to havesurgery.
Everybody, everybody, thinksyou have need to go to surgery
and, and you know, you know youwill tell people that you don't
(01:53):
have to always right.
Speaker 2 (01:54):
My goal I say a surgeon's goal should be to try
to keep you out of the operatingroom.
Yeah Right, Sometimes it's wheneverything else fails.
That's your last result, butthat should be your main goal,
Right.
Speaker 1 (02:03):
Now, you don't want to cut unless you have to.
Yeah, absolutely yeah.
Speaker 2 (02:06):
Surgery is surgery, no matter how big or how small,
so you have to treat that withrespect.
Exactly, that's a big thing, inmy practice at least.
Make sure you've exhausted allother treatments first, gotcha.
Speaker 1 (02:24):
Yeah, that's cool, that's really cool.
So we bad issues and has gonethrough.
The same physical therapistthat I am Also went to your
practice to get the work doneand he's very, very happy.
And he had something which Inever heard of before until my
father-in-law and my brother hadthis done called a reverse
shoulder replacement.
Speaker 2 (02:42):
I guess A reverse shoulder replacement.
Yep, you can get a totalshoulder replacement or a
reverse shoulder replacement.
Speaker 1 (02:48):
Okay, so what?
What is the difference?
Because I know what, I knowwhat the reverse is, and it to
me.
It just freaked me out when Irealized what it was.
Speaker 2 (02:56):
So so you know, people study this for like five
years and you're giving me like10 minutes, yeah, yeah.
Speaker 1 (03:00):
Just just set the table top here.
Okay, I'll give you the cliffGive us the cliff note version.
Speaker 2 (03:06):
So shoulder pain can happen for a number of reasons.
Okay, People will alwaysassociate shoulder pain with I
must've tore my rotator cuff.
Gotcha, that's what it is, butit's not.
You can have inflammation inthe shoulder, bursitis,
tendinitis you don't have tohave a tear.
One of the problems which Ithink we'll talk about today is
arthritis of the shoulder.
Okay, so there's two types ofarthritis in the shoulder
(03:27):
primary arthritis, which is justwear and tear over time right,
Grandma and grandpa getarthritis.
Or their secondary arthritisSomething happens in the
shoulder.
You tear your rotator cuff.
Maybe you don't know about it,or you live with it for a long
time and that can result inarthritis from a secondary
reason, not just because it'swear and tear gotcha.
So the first thing and I don'tknow how deep you want me to get
(03:50):
, no, but the arthritis thing isthat's from just getting older
not, necessarily not necessarilyhave a fracture of your
shoulder, which then results inpost-traumatic arthritis.
Okay, so a trauma okay or youcan have a rotator cuff tear,
and and I'll explain that alittle bit to you guys and that
can result in a very common formof arthritis in the shoulder.
Oh wow, so you can see an x-rayand immediately know that this
(04:11):
person has what we call rotatorcuff tear arthritis.
Oh wow, so the way you treatthem, though, is different,
gotcha, so that's why it'simportant to have the correct
diagnosis before you start atreatment plan, because treating
rotator cuff tear arthritisversus treating regular
arthritis- Now, when you saytreating it, do you mean
operating or talk about physicaltherapy?
Speaker 1 (04:29):
A little bit of both, okay, right, because some of
this stuff, once again, can besolved or not solved can be, can
work better or can get past thepain with doing physical
therapy.
Speaker 2 (04:40):
One of the first options for arthritis is
treating it with eithercortisone injections to lower
inflammation and therapy and,honestly, activity modifications
.
So a lot of people who havearthritis if you try to stop
doing what's causing the pain,like painting your ceiling or
things like overhead work thatcan really actually improve some
of your inflammation because,arthritis is not your problem
(05:01):
right, it's the.
Speaker 1 (05:02):
It's a result of a problem inflammation.
Speaker 2 (05:04):
Arthritis causes gotcha.
So if you can treat theinflammation which is causing
your pain, yeah, well then what?
Speaker 1 (05:10):
exactly is arthritis?
Is it?
Is that a tissue swelling?
Is that what it is?
What is it?
So?
It's part of your body, is it?
Is it how?
Speaker 2 (05:18):
can you give me like an analogy of what it might be,
I guess?
Uh, it would be like I don'tknow here, I don't know here we
go with the now.
Speaker 1 (05:23):
Now he's showing stuff.
So if you're watching, ifyou're listening to the podcast,
you're not going to know.
It's a little tough to getthese angles, so look here is
it's opposite.
Speaker 2 (05:30):
Usually there, there we go.
Okay, so this is the ball ofyour shoulder right.
So we're looking at it.
If it were right here on me,yep holds the ball and the
socket and they wear togethernicely.
Okay, so it's a smooth surface.
Gotcha, all arthritis is is thebreakdown of that cartilage
layer.
Speaker 1 (05:51):
Okay, so when they say you have bone on bone
arthritis, you've worn thecartilage, down Okay, and then
when you have bone on bone, thatstarts to cause pain, because
that's where the nerve fibersare in the bone.
Speaker 2 (06:03):
The cartilage itself won't cause pain.
It's the bone underneath itwhich will sense pain.
Speaker 1 (06:09):
So once you wear that , down.
Speaker 2 (06:10):
That can cause the inflammation and that can cause
the pain.
Gotcha.
Speaker 1 (06:14):
So you got to get.
So the inflammation is what'sreally becomes the issue,
Correct.
And that's why you knowibuprofen or or doing different
things that you can do to toreduce the swelling.
The cortisone shot, like yousaid, that reduces the swelling
in the form of like a steroid.
Speaker 2 (06:26):
I guess, yeah, a steroid.
So it's a very powerfulanti-inflammatory, a steroidal
anti-inflammatory.
Speaker 1 (06:31):
And sometimes that'll do the trick.
Oh yeah, because what does itdo?
It knocks it down.
It gets it down and then itdoesn't come back up again.
Speaker 2 (06:38):
I mean it usually does right because it's
arthritis.
So what you do, the idea behindcortisone is to lower the
inflammation.
The arthritis is still there,oh, got it.
So over time, as you use itagain and the cortisone wears
off, then the arthritis willkick in again.
But I mean, I have patients whoI see, you know, every year and
they get a cortisone shot andthat's all they need for
arthritis well, that's cool thatway.
Speaker 1 (06:57):
Well, if that works, it works right, that's good.
That's the best treatment if itworks, yeah, amazing, very cool
.
So let's go back to this wholeshoulder the shoulder reversal
versus the shoulder replacementon all that.
Sure, let's talk about that,because this is something new,
right?
So, reversal or no, when I saynew 10 years 15 years really.
Speaker 2 (07:17):
Oh yeah, I'm much older.
Okay, but the problem is when Iwas doing surgery back in the
day, back in your day.
Speaker 1 (07:22):
We just didn't do that.
We just didn't do that.
I use Band-Aid actually.
Speaker 2 (07:26):
So when I trained about 10 years ago, we actually
were doing these fairly often.
But their technology has gottenso much better for shoulders I
think in the last 10, 20 yearsthat it's really been a good
option for people now, beforethey used to break down in five,
six years or they'd have a lotof failures.
But you know, through failureyou learn and you have but I
(07:49):
think there's a lot of confusionout there regarding a regular
shoulder versus a reverseshoulder, and so I wanted to try
to clear that up.
I'm going to clear that up forall your, for all your viewers.
So I don't know.
Hugo, here's our angles yourviewers.
Speaker 1 (08:05):
So I don't know.
Hugo, here's our angles.
Yeah, now now.
Nate also was an elementaryteacher at one point, so you can
see his drawings are very good,so very good, I'm not an artist
, but this is about as good asit gets, okay, cool I like it
and if you're listening to thisand not seeing it, he's got a
picture of a shoulder, basicallythe it's a very crude diagram
of yes, yes, now you're gonnayell it could be a hair dryer
too.
I'm not sure, hug not sure itlooks like a hairdryer, Like if
you look at it this way.
Like if you hold the handle ofthe hairdryer there, this is not
(08:27):
bad.
Speaker 2 (08:27):
Okay, go ahead, sorry , so, anyway.
So here is your.
Your head will be up here, okay.
Speaker 1 (08:32):
Okay, we'll draw it like this Okay, oh wow, that's
really nice, that is not?
Speaker 2 (08:36):
to scale.
All right, we'll put it there,gotcha.
So here is the, the rotatorcuff, coming in Now.
Hugo, he's been yelling to meabout the mic, so I'm going to
have to move this a little bithere.
Speaker 1 (08:44):
That's right.
You want me to hold this, I canhold it, maybe two.
Okay, got it, that's perfect.
That's perfect.
We'll knock this out.
That's actually really good.
Speaker 2 (08:50):
So here is your shoulder, here is the socket
part of your shoulder.
Gotcha, the rotator cuff sitsatop the shoulder and it
actually comes in front.
You don't need to worry aboutthat one.
But the big rotator cuff muscleattaches to the ball right.
The function of the rotatorcuff, in addition to moving your
shoulder, is to keep theshoulder centralized in the
(09:12):
socket.
Oh right, so you can imagine onthe outside.
So you know, we're color-coded.
Speaker 1 (09:17):
Yeah, so this is not blood.
This is actually just rednesshere, not yet, not yet.
So here.
Speaker 2 (09:23):
Let's say these are the cartilage layers.
Oh yes, very good.
So there's the cartilageholding it.
Now what happens is this is, ifyou have arthritis, the red
goes away, right.
Speaker 1 (09:34):
Oh, the red goes away .
Speaker 2 (09:37):
And now you're wearing bone on bone.
So if you want to do a shoulderreplacement, you have to treat
the arthritis, gotcha.
The good news is you still havea rotator cuff that's keeping
you centralized in the socket,gotcha.
So it's still moving nicely andsmoothly Right.
So what you can do is so, ifyour rotator cuff is okay.
Speaker 1 (09:52):
This is the way you do it.
Speaker 2 (09:53):
You do a total shoulder, total shoulder, okay.
Shoulder, total shoulder, okay,not the reverse, gotcha, okay.
Yep, so what you do is you goin, you make an incision and you
would actually cut the ball out, gotcha.
Then you would grind the socketdown, gotcha.
So now you've taken away thearthritis here and there then
what you do is you put in a newmetal ball so the new metal goes
(10:13):
down the shaft of the bone yep,I've seen, and it forms this
here and so now you have a newball and then you put a actually
a plastic, technicallycomponent in the socket I've
seen that for the new socket?
amazing.
So that is a total shoulder.
Okay, gotcha.
And the reason you can do atotal shoulder is because the
(10:33):
rotator cuff is still intact.
So here's the why, if yourrotator cuff isn't intact, why
you would work on changing thisup.
So let's say you have a rotatorcuff tear right, it rips off of
the bone.
Now your rotator cuff issitting up here.
Speaker 1 (10:48):
Oh gosh, that doesn't look good.
Speaker 2 (10:49):
What do you think, hugo?
It looks like jaws.
Speaker 1 (10:51):
I think is that a shark bite that happened.
Speaker 2 (10:53):
It looks like a shark bite.
It looks like that's whathappened.
That is gone.
Speaker 1 (10:56):
Yeah, so swimming with the sharks is not a good
idea because it takes yourrotator, cuff.
Speaker 2 (10:59):
Definitely not for this one.
Yeah, okay, definitely not forthis.
Speaker 1 (11:01):
No, this makes so much sense now.
I totally am getting this nowSee, I mean this is good stuff.
Speaker 2 (11:05):
I told you I'm not a real doctor.
Speaker 1 (11:06):
This is good.
It's good drawing.
You can explain it with a firstgrade diagram it.
Speaker 2 (11:14):
Now we know why you do a total shoulder.
Let's say you don't have arotator cuff right.
So what happens?
There's other muscles here thatI'm not showing right.
One of the big shoulder muscles, your deltoid, will pull your
shoulder because you're stillusing your shoulder all day,
right, and it is not keeping itcentralized in the socket
Because your rotator cuff isgone, correct.
So what happens now is thatbegins to pull up.
Speaker 1 (11:41):
Oh not good.
Good, so what happens is youget what we call the dreaded
high riding humorous.
Oh, this doesn't look good howbad does that?
Speaker 2 (11:43):
and it's not in the socket.
Not so at that point it isstill in the socket, it's still
inside.
Speaker 1 (11:45):
But it's on the top edge of it, eccentrically moving
.
So does it pop then?
And stuff do you start to feelpopping?
You don't have to.
Speaker 2 (11:52):
okay, some people can't.
The more you know, the moreadvanced it gets.
But you know, it's just's justpainful, painful, very painful.
So then imagine if you went andput a total shoulder in there.
It wouldn't work, it wouldn'tbecause?
Speaker 1 (12:03):
No, because you still don't have the rotator cuff
holding it in place.
Speaker 2 (12:05):
That's what we used to do oh gosh, so we'd put a
total shoulder in and peoplewould do terrible.
Obviously yeah, Because we werenot understanding the
biomechanics of I get it so somesmarter people than myself came
along.
Speaker 1 (12:17):
This is the part that blows my mind, hugo, this is
good stuff here.
Speaker 2 (12:20):
And said well listen, if we don't have a rotator cuff
, we can still keep everythingcentralized if we flip the ball
and the socket.
Speaker 1 (12:31):
That's the part that blows my mind.
Reverse total shoulder yeah, soyou're basically putting the
ball where the socket was youput the ball.
Speaker 2 (12:36):
Now.
You put the ball there here,right when the socket was.
So you put the ball now.
You put the ball there here,right With a big old screw right
down your scapula Okay,unbelievable.
So now the ball stays here,mm-hmm.
And then the socket part.
You guys make a socket there.
Well, it's made out of metalUnbelievable.
Now you put the plasticcomponent here.
Now, this one's obviously notin place get.
You get better movement thanfrom that or better so what
(12:59):
people will do is is they willusually get better movement with
it, but it is a pain operation.
More than anything, it's a painoperation, your pain should
greatly improve.
Speaker 1 (13:09):
Got it, got it, got it.
So less pain.
Yes, now there are people whodo.
I'm thinking you're doing thisoperation to have more pain.
You're like this is what we doto give people more pain.
This is the goal.
Speaker 2 (13:18):
This is the goal.
The goal is pain.
Speaker 1 (13:20):
No, but that, that to me is brilliant.
Speaker 2 (13:23):
Yeah, and it and it is.
It's a brilliant idea becauseit just it may.
It's such a simple idea, right?
But the best ones are alwaysthe most simple, right?
Yeah, all I need is one simple.
Speaker 1 (13:31):
Could you imagine the guy pitching that though?
At the doctor's meeting.
So last night I was drinkingand I came up with this crazy
idea we're going to switch theball and the socket and they're
sitting there like you'rekidding me and they did it and
it's worked.
Speaker 2 (13:50):
And it's worked great and it works great for people
who even have bad fractures ofthe shoulder.
You can't fix it.
This is a great way to givethem mobility with decreased
pain.
Speaker 1 (14:01):
Amazing, yeah, so I know two people with that my
brother and my father-in-law.
Is that crazy, or what?
Speaker 2 (14:05):
Because rotator cuff tears.
Believe it or not.
If you took an MRI of a hundredpeople outside random people
about 40% would have some formof a rotator cuff there.
They don't know about it'samazing, right.
So it doesn't mean you have tooperate on every rotator cuff
there.
They don't know about it'samazing, right.
So it doesn't mean you have tooperate on every rotator cuff
tear you see?
no, but you operate on thesymptoms and a lot of times over
time those rotator cuff tearscan increase right and people.
I see a lot of people that cometo my office with shoulder pain
(14:27):
and they didn't even know theyhad a rotator cuff tear.
Speaker 1 (14:29):
Well, they already have arthritis in their shoulder
because it's been decades wherethey've accommodated gotcha and
eventually the body made itwork, the body makes it work,
the body makes it work and ittries to right Up to some point
Right, you said there's that.
I remember the last time withthe carpal tunnel, you said it
won't hurt, it won't hurt, itwon't give you problems.
And all of a sudden it startsto give you problems.
It falls off of that one spot,yeah.
Speaker 2 (14:51):
And that's true for almost anything in the body.
I think Other muscles fire, butI see a lot of people they'll
have a fall and they'll flare uparthritis that they never even
knew they had because it was anacute traumatic event.
Speaker 1 (15:02):
Yeah, amazing, when you looked at my back, you you
did a x-ray of my back and welooked at that and you were even
just showing me like, look athere's your, here's your discs
coming down through.
And it was interesting, like Idon't have really any issues
down there, you know, like Idon't have any bulging discs or
anything like that.
Your mind's stretching.
Speaker 2 (15:17):
Your problem is, I think there's too much muscle
mass holding your back up.
Yeah, so you got to work onthat muscle mass.
Speaker 1 (15:22):
Yeah, that that's weird.
I don't think that's theproblem.
I think I have.
I have little muscle mass righthere.
Yeah, that's not muscle.
Yeah, yeah, no, but I'll tellyou, the stretching's working.
Speaker 2 (15:33):
Yeah, it works it works a lot, and that's why I
say a lot of these things.
You don't have to have surgeryfor yeah, you just have to be
able to be patient with it.
We're not very patientsometimes.
No, we're not at all.
We want to get better fast.
Speaker 1 (15:44):
So that was an excellent explanation of that
and I totally get it.
Now let's talk about a littlebit about more of the other
pains you can have Bursitis, isthat having to do with the bursa
sac bursitis?
So it is.
And here we go.
See this is, let's see, this isarts, and crafts, you're not
going to use your t-rex.
Speaker 2 (16:02):
Uh bones, I get nervous with the t-rex bones.
Speaker 1 (16:03):
All right, these are probably your kids bones, aren't
they?
Well, you take these from theirroom my kids, they sometimes
they like the.
Speaker 2 (16:10):
They're like what did you hear about today, dad?
What'd you see today?
I'm like oh man, that's funny solet me show you what bursitis
would be okay.
Okay, now this is back to wherewe were.
Okay, there's the ball andsocket part, got it.
So, bursitis, there are bursasacks You're exactly correct
that sit on top of the rotatorcuff muscle, okay, and they act
as like oil in an engine, right,so move it.
It helps everything glide,cause, right.
(16:31):
The problems is if you're doinga lot of overhead work.
I see in a lot of overhead work, uh, you know, drywallers,
drywallers, seriously,construction painters painters.
Speaker 1 (16:51):
I can totally see painters.
Speaker 2 (16:52):
They'll have very serious pain in the front part
and the outside part of theirshoulder and what happens is
they get bursitis.
This gets acutely inflamed,just like you would get an
Achilles tendonitis, and it canbe one of the hardest ones to
get rid of.
Because what do you do?
All day You're moving theshoulder Right, and so you've
got to be able to get this thingto calm down.
But now you're sure, what doyou do when you have Achilles
(17:12):
tendonitis?
You're in a boot for six weeks.
Speaker 1 (17:13):
You don't run, you don.
You can't do that with yourshoulder.
Speaker 2 (17:15):
You can't be in a sling for seven weeks.
You'll be so stiff.
Yeah, exactly, so then you alsostart to atrophy, then too right
, for sure, yeah for sure, andso you have to find a way in the
shoulder to get things to healbut still be functional while
you're healing, which isdifficult.
Yeah, so people can haveshoulder pain, like I think I
tore my rotator cuff, but noinjury, sign of, just bursitis
(17:35):
in the shoulder, and that iswhere actually usually a
cortisone injection in that areaworks wonders for people.
Interesting Because it willreally lower that acute
inflammation.
Speaker 1 (17:43):
Yeah.
So when that thing's inflamed,is it still doing its job,
though, or no?
If it's?
Speaker 2 (17:47):
inflamed, it's still doing it.
Speaker 1 (17:49):
It's still doing it, but it hurts.
It hurts.
Speaker 2 (17:51):
It hurts.
I mean I just had Achillestendonitis and I mean it was
brutal.
Speaker 1 (17:55):
I've heard that is brutal.
Speaker 2 (17:56):
I heard it is so I mean, you got to take it easy
and the problem is in theshoulder.
It's the most mobile joint,right, it's the most mobile
joint in the body, so there's noway that you're gonna.
Speaker 1 (18:03):
So there's and isn't, isn't.
So when you say most mobile,like it, it does more things.
It can go like if you thinkabout your knee.
Your knee goes back and forth.
Speaker 2 (18:10):
Your knee is a hinge joint yeah, this is like oh, it
goes all over, all over theplace, all over.
Yeah, it's crazy.
So people get really people canget really inflamed with
bursitis, but they'll all.
Everyone thinks it's a rotatorcuff tear.
Right, and remember, I justsaid there's a lot of people out
there with a rotator cuff.
Yeah, the problem is is that ifyou get an mri on that, yes,
and it shows a small rotatorcuff tear, they're gonna they're
(18:31):
gonna say it's that, that'swhat's causing my pain.
Yeah, and, and maybe it is, butthere's a lot of things you got
to go through before you in myopinion.
Yeah, you can fix the tear.
Oh, yeah, rotator cuff surgeryis one of the most common, so
you can fix the tear and thenput it back where it needs to be
.
Speaker 1 (18:47):
Oh yeah, so.
So here you go.
Is that where you drill throughthe bone and like with a little
washer?
Speaker 2 (18:51):
So it's it's almost like a drywall anchor.
Speaker 1 (18:53):
Yeah, okay, I think I yeah.
Speaker 2 (18:58):
So if you have a tear , let's say you have a tear
right here, right in there, thetop part what you would do is
you come in here with us andthis is where you do it
arthroscopically, right, no bigincisions wow small stab
incision so you can move acamera and shuttle your sutures
around.
So then you say, all right, wegot to get this back down to the
, to the x's yep.
So you take a little drywallanchor and you literally put it
back in.
(19:18):
You put it into the bone.
Amazing, there's sutures thatcome out of there.
Okay, take those stitches, passthem through the rotator cuff,
yep, yep, and then that will,once you tie it down, yeah,
it'll advance it back.
Speaker 1 (19:31):
Unbelievable repair that will that attach, then
eventually, oh yeah, it'll,it'll actually attach about six
weeks.
Speaker 2 (19:37):
That's it six weeks for that to heal.
Now, remember, for surgery,you're just showing scar tissue
where to go.
Right, you're showing scartissue because that's how you
stimulate a healing response,right?
Okay, surgery is controlledtrauma.
To show scar tissue where to go?
Oh, I get it now.
So, you want that scar tooverlap the tendon and the bone
so it heals.
Speaker 1 (19:58):
Not where it is up there.
Speaker 2 (19:59):
Correct.
Yes, you want to make sure thatGot it.
Speaker 1 (20:02):
Wow, never heard it like that before either.
That's great, great, uh way tolook at it.
Speaker 2 (20:07):
Yeah, you learn something new every day.
Speaker 1 (20:08):
I'll tell you this is see, this is, this is good
stuff, yeah, so let's go into umtendonitis right.
Speaker 2 (20:14):
So, just like we said , you can have a bursitis.
You can actually have aninflammation around the tendon
itself.
So one of the other options isthe tendon itself can become
inflamed.
Now that's a little bit moredifficult to treat because you
don't want to keep puttingcortisone into a tendon itself,
obviously because that repeatedcortisone injections and I hear
it all the time I don't want todo a cortisone injection because
(20:35):
I heard it eats away all yourtissues.
Oh right, that's not true.
I mean, if you're a baseballplayer and for 162 games you're
getting one before that's,that's bad yeah, but you know,
here and there if you need acortisone injection, there's no
long-term effects, right.
But tendinosis, or tendonitisreally is the same as bursitis,
is just involving the tendon.
Tendon got it and, once again,though, you can get an mri on
(20:55):
that and you'll see that thetendon looks thickened, looked
angry and there's a small tear.
And people say I saw my mrireport, it's a tear, I need fix,
it's here.
Well, no, let's not get thereyet.
Now there are some tears youhave to fix right, like you fall
and that's pulled off.
You want to get to those sooner, but the average run of the
mill shoulder pain that you see,that walks through the door you
hear someone complain about, isnot because they fell outside,
(21:16):
it's.
This has been bothering me fora year.
It it hurts me at nightoverhead motions when I try to
scratch your back.
I can't do it.
Those are very commonly seenfor bursitis, tendinitis and
sometimes small rotator cufftears, but more so the latter.
Yeah, it's amazing.
Speaker 1 (21:32):
Do you have any questions yet, Hugo?
Speaker 2 (21:33):
No, I'm just impressed, did you say depressed
or impressed?
Speaker 1 (21:39):
No, no, I'm just mad.
Pretty amazing, right, yeah,that's pretty amazing.
Speaker 2 (21:43):
The shoulder is a very difficult thing to really
conceptualize, but once you doand you can dumb it down,
there's only so many things thatcan really cause shoulder pain.
Speaker 1 (21:54):
Yeah, it is amazing, totally amazing.
So let's talk about themisdiagnosis is one of the
things that we kind of chatted alittle bit about.
Some people will come in andthey'll say it's neck pain or
shoulder pain, or it's notshoulder pain, it is actually
neck pain.
I mean, what, what do you seewith that?
Speaker 2 (22:11):
So I think one of the things you always have to look
at when you're looking atshoulder pain is you got to look
a little bit higher, okay.
And what I mean by higher isyou got to look around the neck,
because a lot of people willhave mild neck pain it doesn't
bother that much.
But you got to remember all thenerves that come out and go to
your shoulder start up in theneck Right.
So if those nerves come out andlet's say, you have arthritis
in your neck and it's pinchingthat nerve or it's inflaming
(22:33):
that nerve, that can fire aroundthe shoulder.
So there can be some people.
I've seen people come in.
They're like both of myshoulders are killing me, I
don't know what, and I'm likeboth of your shoulders Both of
them yeah, right, right and so.
I don't know what it is, it'sjust been bothering me for such
a long time.
And you look at their neck andthey actually the nerves that
are giving sensation and pain tothe shoulders are inflamed.
Oh wow, and so it presents inthe shoulders.
Speaker 1 (22:55):
Yeah, and people like I don't have that where it
terminates to the nerve or someof them wherever it terminates.
Speaker 2 (23:05):
Right, and I'll have people where you can have both.
Right, you can have both.
Some people come in and theyhave neck pain and shoulder pain
.
Oh geez, those poor peoplethat's where you're exactly.
Speaker 1 (23:10):
Do you say hey, you know what, if I were you, I
would just, uh, it might be timeto.
Speaker 2 (23:14):
Yeah, I don't know, like a horse you know, you take
him out to a field.
Speaker 1 (23:18):
I'm not in that part of medicine, but there was
another guy that was doing thatfor a while, yeah, he, he done.
Speaker 2 (23:24):
I think he's in jail.
He's dead.
Actually, he's dead.
Yeah, he died.
Yeah, I think he killed himselfin prison.
Speaker 1 (23:29):
Yeah, something there goes the family show, all right
.
Speaker 2 (23:33):
This is where you turn it off, if you have kids.
Speaker 1 (23:35):
Yeah, exactly, so it can be misdiagnosed with a neck.
Speaker 2 (23:38):
It can.
Speaker 1 (23:40):
You know what's funny ?
I looked under shoulders todayand then I looked at.
Sometimes people misdiagnose aheart attack for shoulder pain.
Speaker 2 (23:51):
See, this is where I tell people I'm not the real
doctor.
Speaker 1 (23:55):
Dr Traer.
Speaker 2 (23:56):
We'll bring Dr Traer in.
I'm on the phone and I call areal doctor and they go.
Speaker 1 (24:01):
But seriously, that could be.
People sometimes go oh, it's myshoulder, but if it goes into
your jaw and down your left arm,that could be.
People sometimes go, oh, it'smy shoulder, but if it goes into
your jaw and down your left arm, that could be.
Speaker 2 (24:07):
It's funny you mention that because there was
just an article I read wheresomeone had chronic shoulder
pain and then it was actuallypresenting in that fashion.
Get out of here it was more ofa cardiac issue than it was a
shoulder issue.
Speaker 1 (24:19):
Oh jeez, can you imagine that you keep thinking
it's your shoulder and nextthing you know that's not good.
No, that's that's that's everyorthopedist nightmare yeah,
absolutely, and, like they saidthat, there's other things that
usually go with that like thefever like sweating and and the
drawl and down the arm and allthat stuff and usually your.
Speaker 2 (24:34):
Your physical exam right should show you that yes,
exactly if you move the shoulderand it hurts, that's shoulder,
that's shoulder pain.
Move the shoulder and they'relike I'm sweating and I have
palpitations that's's probablynot a.
Speaker 1 (24:44):
I don't think you need to go to medical school.
I'm thinking not the reversal.
Speaker 2 (24:48):
I'm thinking the reversal is not going to work
for you at that point we're notsigning that person up for total
shoulder Put it that way.
Speaker 1 (24:52):
Dr Nate, I have a question.
What?
Speaker 2 (24:53):
profession I was thinking maybe is the baseball
pitcher, but what professionsuffers more, given their work
from?
Speaker 1 (25:01):
shoulder injuries.
Speaker 2 (25:01):
Honestly, there's a ton of stuff out there for
baseball players, especiallypitchers.
I mean, the shoulder is notmeant to rocket a projectile.
95 miles an hour 100 timesevery five days?
Obviously not.
What you see with pitchers is alot more soft tissue injury
than really arthritis.
So they'll have bursitis,they'll have impingement, which
(25:22):
is where the bone can kind ofpush down on the rotator cuff.
All of those things are muchmore common in baseball players
and pitchers.
But you'd be surprised any typeof overhead Like I even see
volleyball players.
Speaker 1 (25:35):
Oh, because you're doing this.
Yeah, right.
Speaker 2 (25:37):
So the serve a lot, a lot of rock climbers, believe
it or not.
Speaker 1 (25:40):
Oh, yeah, because they're hanging from their
shoulders a lot of time.
They're always up here.
Yeah, because they're hangingfrom their shoulders a lot of
time.
They're always up here.
It's this, yeah, it's all that.
Speaker 2 (25:46):
So they end up getting a lot of stuff too, and
rock climbing is a big deal nowaround here.
Yeah, I'm back.
Speaker 1 (25:49):
There's like a couple places over here.
Speaker 2 (25:50):
You'll never see me do that.
No, I don't do heights?
No, no I don't like goingdownstairs.
Nah, nah, nah your hand and youcould just close your eyes
looking for the railing.
Speaker 1 (26:03):
I got nervous, right now, no, but I'll tell you.
Speaker 2 (26:06):
You're right, those guys rock climbing and it's, and
that's all exerting on yourshow.
Speaker 1 (26:10):
I'm always amazed how they can hold on with just
their fingers, like theirfingers, their whole bodies on
their fingers.
Speaker 2 (26:15):
It's not I mean a little off topic, but I saw.
Do you ever see the one guy whodoes it without a uh, oh, not a
rope?
Yeah, I've seen that guy.
It's unbelievable that that's awhole documentary.
Speaker 1 (26:24):
I sweat when I watch him.
My palms are sweating the wholetime.
I remember Like I actually I'mstressed out when I watch him
and he was like I couldn't makeit up this time, so I came back
down.
Speaker 2 (26:33):
I'm like that's probably a good decision.
Speaker 1 (26:35):
Yeah Well, did he go down the fast way or the slow
way?
And they make?
We're not doing that.
Speaker 2 (26:41):
No, it's not happening.
Not happening.
I do the rock climb at the YMCAand I get two up.
I'm like I'm good.
Yeah, this is where I thought Iwas going to start crying.
Speaker 1 (26:50):
Mom.
Where's my mommy?
So is there anything else aboutthe shoulder?
Speaker 2 (26:59):
I mean you got these nice little things here, but I
guess we did most of it on thewhiteboard right.
These are where muscles attachor come off in the shoulder, so
you can see how much is involvedwith.
You know the anatomy.
Speaker 1 (27:12):
Whoa, that's a lot.
Speaker 2 (27:13):
There's a lot of things that can go wrong.
There's a lot of things thatcan go wrong and that's why your
physical exam is most important.
In the shoulder, you got tolook at the neck.
You got to make sureeverything's going up here.
You know there's a lot of othersmaller joints, not just the
ball and socket joint, that canreproduce a lot of pain.
Speaker 1 (27:27):
Unbelievable Crazy.
So not about shoulders, butlet's just talk real quick about
the flu.
That's really rampant right now.
You were talking about on thephone.
We talked about how and we'veall heard this a lot of times as
they basically they, they kindof do a crap shoot and go okay,
this is what we think the flu isgoing to be.
Speaker 2 (27:46):
And there's a bunch of versions in that shot right.
What's also crazy is so youknow, we got over flu maybe two,
three weeks ago in my house.
We had three kids get it rightand then I didn't get it.
Speaker 1 (27:55):
Now, does that mean that you had that my?
Speaker 2 (27:56):
wife says that's because I'm not around the kids
enough.
Oh, that sounds like something.
Oh, you know what we go todinner.
Speaker 1 (28:02):
I'm going to say that .
You know, I heard you didn'tget the flu.
Speaker 2 (28:04):
I wonder if it's because he's not around the kids
that much.
I told her the other day I'mlike you know, I never get their
sicknesses and she goes.
Oh really that sounds likesomething you don't say that's
because when our kids are sick,I'm like get that away from me,
Stay away.
I didn't get it.
Yeah, I don't know what it is.
Speaker 1 (28:23):
That was a while ago.
Speaker 2 (28:23):
Remember the whole thing with COVID too, Some
people got it, some peopledidn't, I never got it.
You don't think you had it.
Speaker 1 (28:28):
I probably did, hey, if you don't test, does that
make it that you didn't get it?
Yeah, you never tested, that'swhy.
Yeah, exactly.
Well, you know, that was all.
Speaker 2 (28:49):
They oh that was negative.
Speaker 1 (28:49):
Yeah, it was negative .
All right, listen.
Is this a fun show or something?
Because I have a.
I have a shoulder pain is onething, but I got a, I got a
question.
Speaker 2 (28:52):
I would like to go ahead, go ahead.
This is a question back on usall, right?
So listen, I go to this oneplace and I get a haircut every
every couple weeks, right, yeah,it's just one of those places
you walk in, you just sure likeit's easy, it's?
So I go in there on a friday, Iget my haircut.
I come home I think we hadsomething next week so my wife's
like, hey, you got to lookpresentable.
Speaker 1 (29:07):
So I go get the haircut.
Speaker 2 (29:08):
I come back and my wife's like ooh, it's not a good
haircut.
Oh, whoa, it wasn't.
Speaker 1 (29:13):
All right.
Okay, it wasn't All right.
Speaker 2 (29:18):
It wasn't blended.
Are you planning on going?
Speaker 1 (29:20):
back there, okay, okay.
Speaker 2 (29:21):
Okay, and here's why, and that's why I'm gonna get
your what, get your opinion onit, you go.
So that was Friday, okay, thispast Friday, your hair looks
fine.
Speaker 1 (29:28):
No, no, no, oh, a couple of Fridays ago, I'm still
.
Speaker 2 (29:29):
I'm still processing it, okay, got it so so four days
later I said, hey, listen, Ican pick up one or two of the
kids, take them with me, thatway you don't have all four
there.
She's like, oh awesome, thanks.
So I drive over, okay.
The guy who cut my hair Okay,is there.
(29:51):
Okay, I walk in.
He acknowledges me.
Hey, hair looks great.
I said thanks, man, and I sitdown.
My wife looks over me and, nate, while you're here, can you get
another haircut?
Oh gosh, no, no, no, no.
Oh man, that's terrible.
So let me set the scene.
No, no, so let me set the scene.
Okay.
So I'm sitting there, okay.
(30:12):
The guy who cut my hair fourdays ago acknowledged that he
saw me, commented on how good myhair was which it wasn't okay,
it was
Speaker 1 (30:21):
not a great cut, but I don't care, yeah, whatever,
yeah, it goes back, and so mywife goes.
Speaker 2 (30:26):
Can you get a new haircut?
Oh, no.
And I looked at her and I'mlike you know, like he, you know
she doesn't know it's him, soshe doesn't know, oh gosh.
Speaker 1 (30:34):
She doesn't know.
Speaker 2 (30:35):
And so she's like, hey, you should get a new
haircut.
I'm like, keep your voice down.
He cut my hair.
She's like it looks like crapfrom before and she said she
said, well, she goes, just youdon't have to go to him.
Speaker 1 (30:51):
but how are you not going?
Speaker 2 (30:53):
to go to him.
Speaker 1 (30:54):
Go to somebody else how I could never do that.
Speaker 2 (30:57):
So I start panicking because I'm like did you start
sweating?
I can't have this conversationwith him right there no, he just
told me, I look good take itout.
Speaker 1 (31:05):
You gotta take that one out start texting her.
Speaker 2 (31:07):
So my question is this okay, what's the?
What do you do?
Your wife is saying hey, brad,this haircut, you got to get a
new one.
The guy who just cut your hairfour days ago right says oh, you
look good, good haircut.
Yeah, recognizes me.
What do you Do?
You get a new haircut With him.
Speaker 1 (31:26):
I don't know how I With him, or no, no, I would say
I'm not getting a haircut.
I would text my wife and sayI'm not getting a haircut.
This is very uncomfortable.
That's what I would do.
There's no way I'm going tosomebody else after he just said
it looked good.
Okay, I respect that.
I will tell him the truth, Iwill say hey man, you know, my
(31:46):
wife said that I personally likeit.
But my wife doesn't.
Speaker 2 (31:51):
She's right there.
Throw the wife under the bus.
That is the best answer.
Throw the wife under the bus.
No, it's the truth though.
Speaker 1 (32:00):
Yeah, my wife would kill me if I did that.
Speaker 2 (32:02):
Kill me, so I panicked what did, you, do, do I
got a haircut by someone elseoh my gosh what did he say?
Did he say anything?
Yeah, he did.
What'd he say?
So I got up and I walked by himand I acted like it wasn't
happening.
Right, you just act like it wasand he looks at me where you
going.
Speaker 1 (32:19):
I was like oh, oh my gosh, this is so uncomfortable
I'm just getting a new haircut.
Speaker 2 (32:24):
uh, and he goes why I just cut your hair four days
ago Like wouldn't let me off thehook.
Speaker 1 (32:30):
Oh man, you should have just taken off running.
Speaker 2 (32:31):
I said you know, I'm just getting it freshened up.
He goes it was four days agoand I'm like, and I panicked and
I just sat down.
I said clipper number three onthe.
You went and sat down.
Oh yeah, he's asking me as I'mgoing to the chair I thought you
(32:52):
meant after it was cut as I'mgoing to the new chair.
Oh, my gosh, dude, so I can'tgo back there.
No, yeah, no, I can never go.
I would never go back.
No, you can't, absolutely not.
No, so you were, I could nevergo back.
Speaker 1 (32:57):
See, I would you know what I would done.
I would have text jess and Iwould have said this is where
it's funny, we're a littledifferent.
Uh, I would text her and Iwould say this is not happening
right now, but she's right nextto you, I would text her.
If you're in a situation likethat, just text her, and you
know what I do.
I go check your phone.
Speaker 2 (33:13):
Check your phone no, you can tell that you have
diarrhea or that you have tofart.
Speaker 1 (33:17):
You go outside real quick and then you text her from
outside that's a good one.
Speaker 2 (33:22):
When I'm in this situation, I'm texting Hugo.
Hugo's definitely got theanswers right he does.
Speaker 1 (33:26):
Oh my God.
All right, We've got to wrapthis up Longest podcast ever?
Speaker 2 (33:29):
I think, yeah, sorry about that.
I wanted to ask you about lifesituations.
I love the stories, love thestories.
Speaker 1 (33:44):
That's a good one.
Speaker 2 (33:45):
We'll talk about that next time.
Speaker 1 (33:47):
All right, that's it.
Dr T was in the house.
That was a good time, all right, so come see us every Thursday
at 7 pm.
You can find us on Facebook,instagram, youtube wherever you
want to find us, we'll be there.
All right, that's about it, seeyou.
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