Jaime Lewis (Host): Maybe it's happened to you, you're getting holiday decorations down from the attic or playing tennis, and suddenly there's acute pain in your shoulder, elbow or wrists. Though many of us experience this kind of discomfort in our day to day lives, we often have no idea where it originates or why it's happening.

Well, Dr. Andrew Boltuch is an orthopedic surgeon specializing in primary and complex surgeries of the upper extremity. And he's here to share about the common injuries he sees, how they happen, how they're treated, and most of all, how they can be avoided.

This is BayCare HealthChat from BayCare Health System. I'm Jamie Lewis. Hello, Dr. Boltuch. Great to have you on the podcast.

Andrew D. Boltuch, DO: Hey, Jamie, glad to be here.

Host: In your experience, what are the various areas in the shoulder that can generate pain?

Andrew D. Boltuch, DO: So, the reason why I like that question is because it's actually a complex question to answer, in that there are multiple regions of the shoulder that can generate pain. And usually when I see a patient in my office, it's up to me to decide where that pain is coming from. Generally, however, there are some particular areas in the shoulder that I generally look for as a reason for pain, such as, and starting at the top, the AC joint. It's a tiny little joint at the top of the shoulder, between the clavicle and acromion, and that can actually be a pinpoint area of pain. Moving a little bit further down below the AC joint, we have what you've probably heard of before, which is the bursal region, which is the subacromial bursa. And that is a little bit of tissue that lives between our rotator cuff and the bones above, and it can generally cause pain and impingement. Moving further into the shoulder, there are such things like arthritis, which can cause pain, or a frozen shoulder, which can also cause pain. It's up to a physical exam to try to determine where some of that can be coming from. And lastly, and not to forget, is the biceps in the front of the shoulder, which is another area of the shoulder that can be painful.

Host: Okay. So, what are the more common things that you see in your office?

Andrew D. Boltuch, DO: I would say the most common thing that I see is shoulder impingement, meaning that when you raise your arm, you feel a lot of pain on the outside of the shoulder. And when I raise the arm, it kind of recreates that pain. I'd say that's probably the number one thing that I see.

Another thing that I commonly see is bicep tendonitis, or pain pinpointed right in the front of the shoulder. I can literally take my finger, put it right on the bicep tendon, and generate a lot of pain. I also see a lot of shoulder arthritis, which that is generally seen on an X-ray, but generally there's a history of crepitation or crackling in the shoulder with motion.

And one of the things I do also commonly see, and it's not to be forgotten, is a frozen shoulder. And what a frozen shoulder is, is a very painful process that can happen where due to some small injury or sometimes we don't know what started it, but the capsule of the shoulder becomes red, it becomes inflamed, and we begin to lose shoulder motion over time.

Host: Let's say someone wants to treat their pain at home before coming in to see you. What sort of approach do you recommend there?

Andrew D. Boltuch, DO: You know, I tell everyone the two-week treatment is a right way to go, meaning that if any pain arises, you give it about two weeks and see if it gets better. What can you do during that two weeks? Certainly resting. Another word for that is activity modification or avoiding anything that's making the pain worse. Secondly, anti-inflammatories can be helpful, and I do generally recommend them to be taken consistently for a period of two weeks so long as your stomach can handle it, your kidneys can handle it, and you're not on blood thinners. And lastly, stretching. In the beginning, after an acute injury, I never like strengthening, but I do believe stretching can be helpful and can take some of the pain away. And now, if that pain persists, then we maybe consider coming in to see a doctor.

Host: Okay. So then on the other side of things, when should a person skip at-home treatment and go straight to seeing a doctor?

Andrew D. Boltuch, DO: All right. So, there are a couple instances where I believe the two-week rule doesn't always apply. Number one, if you're in a sporting event or you just have a slip and fall injury and your shoulder dislocates, that is a big problem. And that can cause damage to either the rotator cuff or the nerves in the shoulder or the shoulder joint itself, and that needs to be seen acutely by a physician. And next, a common clinical scenario that I see is, if you were to take a slip and fall and then all of a sudden for some reason you can't move your shoulder as well as you once could, meaning you can't raise it above your head anymore, that's a problem, and that could be a rotator cuff tear, and that is something that should be seen more quickly than the two-week mark.

Host: What are the kinds of injuries or conditions that require surgery?

Andrew D. Boltuch, DO: So, some of the indications for surgery in the shoulder can be either soft tissue or bony. So from a soft tissue standpoint, there is a labrum, which encircles the shoulder joint. This can also be injured in shoulder dislocations. And if someone is having recurrent shoulder dislocations or even sometimes after one shoulder dislocation, repairing the labrum is recommended.

Furthermore, from a soft tissue standpoint, the rotator cuff in the shoulder, it can tear during falls. And tears come in many different sizes and many different shapes. But, generally speaking, a partial tear of the rotator cuff, I generally treat initially without surgery. However, a full thickness tear of the rotator cuff will not heal on its own. It will retract, it will get worse. And that is something I generally always recommend surgery for.

Host: Okay. Now, let's talk about prevention. In general, what are some of the ways to keep the shoulder healthy and avoid injury?

Andrew D. Boltuch, DO: So, some of the common things that I see that consistently lead to shoulder pain and injury is improperly lifting heavy weights at the gym. And generally, that means lifting heavy weights repetitively overhead, I see very often can create a situation in which the shoulder wears down more quickly than it should. Also, I have seen certain jerking lifts that are commonly done in things like CrossFit. With weight that's heavy and repetitively, you have to make sure your lifting mechanics are perfect.

And so, I'd say kind of a general concept that I share with my patients that have shoulder pain is I do have them avoid repetitive weighted lifts overhead, because you can get a wonderful shoulder workout bringing weights just simply from your side up to shoulder height. And then, I will suggest turning your thumbs up to the sky because when you have your thumbs in this position, your rotator cuff actually clears the acromion a bit better than if your thumbs are down in the ground. And you can try this yourself and find that if you put your thumbs down to the ground and try to raise it, it's actually a whole lot harder to do than if you bring your thumbs up in the air.

Host: Well, I was just weightlifting this morning and putting repetitive stress on my shoulders and I am chagrined. And so, thank you for sharing that. I don't want to get injured, and I don't want to wind up in your clinic. So anyway, thank you, Dr. Boltuch. Thank you so much for talking with me today and giving that great information.

Andrew D. Boltuch, DO: No problem whatsoever. Thanks for having me, Jamie.

Host: That wraps up this episode of BayCare HealthChat from BayCare Health System. I'm Jamie Lewis.

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