Transcription:
MASTRS of Motion Tackle Shoulders

Amanda Wilde (Host): Shoulder pain is quite common, but the good news is it can be addressed with a number of techniques. And joining me today to talk about that are Dr. Sami Ahmed and Dr. Russ Patti, both with Orthopedic Associates of Central, Maryland.

Welcome to A Bone to Fix Podcast, Masters of Motion edition. Where we focus on the physical therapy side of orthopedics. Today, Masters of Motion tackle shoulders. I'm Amanda Wilde. Dr. Ahmed, Dr. Patty, welcome to the podcast Dr. Patti, the shoulder is the body's most flexible joint. Can you sort out, or give us a basic guide of the anatomy of shoulders?

Dr Russ Patti: Sure. the shoulder is made up of a few different bones and quite a few different muscles. the most popular joint of the shoulder is called the Glenohumeral joint. It's where you're humorous your arm, bone meets the end of your scapula, your shoulder blade. That's probably the biggest component of the shoulder joint itself. You also have the AC joint. Your Acromioclaicular joint, where you're clavicle, where your collar bone comes out and meets the end of the scapula as well. So that's kind of the basic overview of bones. I think the most common muscles or muscle group rather that people know about with the shoulders is the rotator cuff. And that's typically one of the bigger injuries or problem Childs, if you will, when it comes to the shoulder.

Amanda Wilde (Host): Well, it seems to me that arms and shoulders are involved in almost every movement we make. Is it true Dr. Ahmed? That arms and shoulders are sort of involved in every movement making, how are they working for us day?

Dr Sami Ahmed: that's a really true statement. I mean, our arms do so much for us throughout the day when it comes down to things associated with lifting, pulling, pushing, pointing. I mean, we, as a whole don't realize how many times a day that we actually use our upper extremities in our shoulders. Specifically, our girdle that Dr. Patti was referring to is such a vital component. To us being able to function daily. And one of the things that we see here at the Orthopedic Associates of Central Maryland is a huge change. In many of our patients. they sometimes get injured, they sometimes get hurt.

They sometimes overuse things and that change that subtle change to one or maybe two muscles or nerves can lead to huge cascading effects and tons of injuries down the line.

Amanda Wilde (Host): Well, Dr. Patti, because shoulder is the most flexible joint in the body it seems like that would make it vulnerable to things other joints are not vulnerable to. So it was most of what you see skeletal, muscular, nerve, soft tissue?

Dr Russ Patti: So the shoulder is a very dynamic joint. If you think about a joint such as the knee where it just kind of hinges in one or two general directions, the shoulder moves almost in a complete circle, complete 360 degrees. So it leaves it very vulnerable to different injuries, whether it's a weight bearing injury, where you fall and you can injure yourself that way, or if it's just reaching overhead in your normal day to day life.

I think one thing with physical therapy is that you kind of start to learn that it all ties together. If you have a joint injury, it never goes without a muscular injury. If you have a muscular injury, it never goes without a joint injury. so they oftentimes cross over and they affect each other very much so. And that's how we develop our treatment is we do a lot of strengthening and a lot of range of motion, but also joint mobilizations. And we couple it all all together.

Amanda Wilde (Host): So you address all of those things, the nerves, the skeleton, the muscles, and the soft tissues?

Dr Russ Patti: Absolutely. The nerves do more than just give us sensation. It's how we get our motor signals to our muscles to let us know, Hey, this is the firing pattern that we need in order to raise our arm overhead. And what we need to do as physical therapists is break that down and we need to find out where the deficiencies, kind of assess how we can reeducate the body, how to move. And that all ties in into more of. Neuromuscular skeletal approach.

Dr Sami Ahmed: Russ, I think you just hit one of the most important parts of what we do. if you look at any one of our eight locations, whether it's our Columbia office or Catonsville, where we have the chance to do potentially some more sports specific things, our number one thing is we're changing how people move. Right? A lot of times people find themselves moving with a quote unquote bad pattern is what we call it in PT, right?

Like you take someone who's a baseball player and common thing for baseball players of their shoulders is what we call GERD or glenohumeral internal rotation deficits. Right. They have tons of mobility in one direction of their shoulder and not the other because they tend to overthrow a lot and they're hinging on their shoulder joint, which can lead to progressive injuries and changing their results and their performances and whatnot.

Your physical therapists, your biomechanical specialists who have the opportunity to work with some of our colleagues in the PA and the MD world, to address these mobility issues, to get our patients back to 100% or in our terms, at least out of pain. And hopefully if, we're improving pain, we're improving performance and the ability for them to do, what we call activities of daily living.

Picking up things, lifting things, if you can't lift up your, two or three year old son or grandson or granddaughter or daughter, that pain could be no different than that of a baseball pitcher in his sixth or seventh inning.

Dr Russ Patti: Absolutely.

Amanda Wilde (Host): Dr. Ahmed to expand on that just a little, the shoulder injuries you see in your practice, are they mostly from injuries or surgery or arthritis or some other problem?

Dr Sami Ahmed: I think that with us at the Orthopedic Associates of Central Maryland, we are now a part of this larger division called the Center for Advanced Orthopedics. And so we, are blessed to work in this circular organization, that we have a little bit of everything. We have tons of patients who are coming in off the streets and Maryland is a state that's got direct access.

So they're coming right to us and saying, Hey, I don't know what I did, but I hurt my shoulder. And they can see a PT who can address whatever their concerns are at that moment. But in some cases, we may start address things with physical therapy and within the first visitor two we'll realize, no, there's a couple red flags here. Things don't seem to be working the way we want them to.

And I quite often will, refer to my physician colleagues who are working with me here at the orthopedic associates and say, Hey Dr. Polsky, Dr. Silverstein, Dr. Sidney, I've got something going on with this shoulder. I've got a patient here that I'm gonna refer to you, would you mind having that communication with me?

And the beautiful part is that we're such a tight knit group that they will go in, potentially see the patient determine if an image of a specific sort is needed, An MRI, an x-ray, a CT. And on that day on many occasions, they will be communicating and kind of having that conversation back with us to allow us to get as much pertinent information possible to that patient. So that way we can get them faster, bigger, and stronger. I mean, we go by our motto, we truly believe that what we are trying to do is build better bodies, so that way people can live better lives.

Amanda Wilde (Host): So Dr. Patti, what are some of the physical therapy treatment alternatives to what I would consider traditional treatment, which might be surgery.

Dr Russ Patti: So, it really kind of depends too once you come in the door, for physical therapy. A lot of doctors will say, go to therapy for a few weeks, give that a try. And that's the expectation you're left with. But as Sammy and I were talking about earlier, we break down the movements and different interventions are good for different deficits. So somebody might come in and if it's primarily a muscular problem. We might do a lot more mild FAIA release, or we might do what we call trigger point dry needling.

A lot of our clinicians with the Orthopedic Associates are certified in that, and that's, something that's emerging within the physical therapy world or has already emerged, but is becoming more and more popular. That's a pretty effective technique that we can use to help reeducate the muscle and, get the muscles to function in a proper way. The other thing that we do is, if it's a joint related problem and you're trying to strengthen all day, but the joint is purely limited, then you can do all the strengthening in the world, but until you clear the full range of motion of the joint, you're not really able to achieve your goal.

So it really kind of depends on what the issue is. But a lot of what we do is joint mobilization, soft tissue work, reeducating muscles, how to work properly through strengthening, and then a bunch of other interventions as well.

Amanda Wilde (Host): Dr. Ahmed, you said you changed the way people move to address some of these issues, are techniques we can do to take care of our shoulders that maybe people don't know about commonly to prevent injury and accidents?

Dr Sami Ahmed: I think the first thing that I would recommend in all honesty is that, I feel like we go to our dentist twice a year. I still truly do not understand why we don't see a physical therapist twice a year. I think that when it comes down to a lot of the movements that we're doing, we're talking about strengthening or mobilization of a certain joint or trying to get our bodies to move the right way. Well to be completely Frank, if you saw a specialist once a year or twice a year and talked about some of the things that you're noticing, we could potentially give you those hints or those gimmicks.

And states like ours and state of Maryland, directs access allows a patient to come in really, whenever they choose for an assessment. Now, depending on how severely they're hurt, depending on what happens they could potentially come in and notice, Hey, I've been starting to notice something's weird with my shoulder. And we can come in as physical therapist, do a full on assessment and make that determinant that at this exact moment, I don't think you need formal care from our perspective.

But here's a good set of activities, exercises, things to avoid posture related to potentially get you moving in the right direction. At the same time, what I tell all my patients to do is I am a true believer in exercise and activity and mobility. So if you're going to the gym, if you're trying to be as active as possible, we know that in today's world, a lot of people are working from home. People have kids to take care of. It's getting more and more tricky to get activity in, but just starting with some basic activit, is usually the number one thing we want to start with.

But oftentimes enough, I tell patients all the time, if you're starting to notice something or something, doesn't feel. Don't wait until it's a seven or eight outta 10 to come in for an evaluation. Because at that point, it may too late. It could be that you've severed a joint or a nerve or a bone to the point where we need to have surgical intervention. Now as PTs, I know that our counterparts will probably laugh at this, but we always try to avoid surgery at all costs because we think we can fix everything.

But we do also come to the point where we recognize that as strong as we can get something, sometimes a surgical intervention is truly needed. And so that's what we're lucky about that we have, these great physicians that we're able to partner with, to kind of have that conversation back and forth for our patients

Amanda Wilde (Host): So pay attention to aches and pains and do something about them before they get crazy, keep active and mobile, and also maybe consider regular checkups once or twice a year with a physical therapist.

Dr Sami Ahmed: 100%. I believe, I love my teeth I gladly go to the dentist twice a year. but my teeth only make up so much my body, right. My body is so big. I mean, you'd think I'd want to get, check at least once a year to make sure that everything's working okay.

Amanda Wilde (Host): Yeah, exactly. It's just a matter of getting that done, getting that as part of your routine. Dr Ahmed, Dr. Patti, thank you so much for sharing your insights and your expertise in shoulder recovery. It's reassuring to know you address such a wide variety of issues with such a wide variety of techniques.

Dr Sami Ahmed: Thank you very much for having us.

Dr Russ Patti: It was great to talk about it.

Amanda Wilde (Host): Find out more online@www.md bone docs.com with eight physical therapy locations for your convenience in Catonsville, Clarksville, Columbia Eldersburg, Elcot city, Fulton, Jess, and Westminster.

And you can subscribe to this podcast for more insight into the physical therapy side of orthopedics. That's all for today. I'm Amanda Wilde and that was A Bone That's Fixed.