Bill Klaproth (Host):  Are you suffering from a shoulder condition that's affecting your daily life? Do you have pain when reaching up in a kitchen cabinet, or washing your hair or even sleeping on your side?  With us is Dr. William Greer, an orthopedic surgeon with a Sports Medicine subspecialty at Tidelands Health. Dr. Greer is also the team physician for the Myrtle Beach Pelicans baseball team, which is a farm team for the Chicago Cubs. Dr. Greer, thank you so much for being on with us. Let's jump right into this. So, what is the most common problem you see when it comes to shoulder pain and injury?

Dr. William Greer (Guest):  I think there are a variety of causes of shoulder pain but, primarily, the most common complaint that I hear from patients is loss of motion and pain. Oftentimes, this occurs with weakness, with or without, injury.

Bill:  How do we get there? Is it mainly injuries from sports, work-related injuries, or does old age just take its course and just wreak havoc on our shoulders?

Dr. Greer:  You know what? I think you hit the nail on the head. There are different causes. For instance, in younger individuals, they are more apt to have had an injury or maybe an overuse type phenomenon. For instance, a youngster playing baseball that may have thrown too many pitches would present with shoulder pain or a football player that were to dislocate his shoulder, certainly would come to my office with shoulder pain; whereas, I might see a construction worker that does a lot of dry walling and sheetrock that would have shoulder pain over a longer time frame and certainly, there are active elderly folks that may have an arthritic condition that presents with a nagging pain that gets worse with time. So, those are different ways that shoulder pain may present but the common link between all of them is pain.

Bill:  What is that pain? What is the most common pain? Is it just general in the shoulder or do you see a specific area where pain usually manifests?

Dr. Greer:  Well, most of the time, pain that is caused by a shoulder condition would involve the shoulder, of course, but with that, oftentimes, folks with a shoulder condition would have some radiating pain to their arm. It's not uncommon at all for patients that see me and say, "Well, you know, doc, it's not really my shoulder. It's the mid-portion of my arm or the humerus region," but most often that pain is generated closer to the neck or shoulder. You know, the shoulder joint is a typical cause.

Bill:  So, when is it time to come see the doctor?

Dr. Greer:  Well, I think that for most musculoskeletal injuries, it's typically time to see the doctor whenever you have instituted the simple things at home. The rest, the ice, the elevation and if you have pain that persists after a day or two, or, certainly if you're pain is getting worse, it's time to get evaluated. Any pain that is worsening over a week, clearly you need to see a physician or an orthopedic surgeon with a specialty in shoulder conditions would be somebody that could help.

Bill:  So, there are a lot of moving parts in shoulders. We all know that. How do you diagnose? Is it certain areas? And, what's your most typical diagnosis? What are the most common problems you see?

Dr. Greer:  The most common problem that I see here is rotator cuff issues and the rotator cuff is a group of muscles that's the primary initiator of shoulder motion. Certainly, there could be an injury which would cause a rotator cuff tear or, more commonly, we see more inflammation or bursitis around the rotator cuff.  Folks would present with worsening pain and decreased motion and its pain that typically bothers people at night.

Bill:  So, sleeping on the side and reaching for something, that's when you kind of get that radiating pain? If it's not a tear of the rotator cuff, is it something that, if you don't use it, it can heal on its own over time?

Dr. Greer:  Certainly. Mild cases can resolve with just what we call “activity modification” or just babying that side. Mild cases could resolve like that. Certainly, more advanced cases may not and may require additional treatment--medications, therapy, those sorts of things.

Bill:  So, speaking of treatment, tell us how you go about treating someone that may have a bad rotator cuff. There are probably varying levels of injury. How do you go about determining that and how do you treat it?

Dr. Greer:  Sure. The first thing we would do is perform a good physical examination in the office. That's something that, in my opinion, is the most important thing. We would examine the patient, hear what the complaints are. Oftentimes, the patient, if you can listen, will tell you exactly what's wrong with them before you even get any tests. Most of the tests that we get confirm what we think. We would get x-rays in the office. X-rays are useful to determine whether there's any joint destruction or arthritic change to the shoulder. Certainly, if I were concerned about a rotator cuff problem, which is soft tissue, oftentimes, an MRI is obtained which helps guide whether or not there's a large tear or a smaller tear and would help me make recommendations as to the varying treatments. Clearly, if someone were to have a large rotator cuff tear and were having worsening pain and had failed a course of conservative care--which would be medications or even injections and therapies--surgery is an option. However, we reserve surgery for cases that just don't improve with non-surgical treatment.

Bill:  So, when you go in and perform surgery on a shoulder, what is the recovery period and what's the efficacy of that? Can people expect to regain full use of their shoulder with minimal pain or no pain? What's the general prognosis with somebody that's having shoulder surgery?

Dr. Greer:  So, I think it varies for the particular condition. For instance, a young person who dislocates their shoulder where the shoulder comes out of socket and requires a surgery has an excellent recovery rate with very minimal recurrence and typically has a normal shoulder.  For somebody that's had 20 years of shoulder pain has maybe neglected themselves and basically has a paralyzed arm, we could certainly improve their condition. Their shoulder may not be normal in the sense of having full motion but we can minimize the pain and improve the function. By and large, most of the surgery that I do is done arthroscopically. Arthroscopic surgery is minimally invasive surgery through usually 3-4 quarter inch incisions where a camera is inserted into the shoulder joint. I'm able to address a lot of problems in the shoulder as well as even outside of the shoulder, repair rotator cuff tears, fix instability issues with the shoulder with this technique. Their recovery varies but, typically, most shoulders recover from 4-6 months afterwards and it varies depending on what's done and how much therapy is needed.

Bill:  Dr. Greer, you touched on something there. It sounds like you shouldn't wait if you have shoulder problem. You mentioned somebody that waited for 20 years and just lived with it. There's probably not much you can do at that point, so if you are experiencing shoulder pain, it’s best to see the doctor early than wait and try to live through it, is that correct?

Dr. Greer:  I think, generally speaking, that's a great recommendation. Clearly, it's not wrong to wait a day or two to see if your symptoms resolve, but I, unfortunately, do see patients that have a neglected shoulder for a variety of different reasons over a number of years which makes treatment options very selective and difficult and the recovery is often more problematic, so addressing the condition sooner than later is always beneficial.

Bill:  For weekend warriors who want to go out there and play sports and throw the softball and baseball and throw the football, are there stretching exercises that you recommend that somebody should do to loosen the shoulder up first and do those help?

Dr. Greer:  Yes, I think it's pretty clear that if we had a group of individuals that very rarely are engaged in any overhead activities or throwing, we would want them to start off with maybe a light toss instead of trying to throw as hard as you could. For instance, throwing somebody out from center field to home plate on a first throw would be probably detrimental to that individual. So, there are a bank of stretching exercises as well as warm-up routines that would likely help and try to minimize any injury in those sorts of individuals.

Bill:  Okay. So, warm up and stretching is important. Dr. Greer, very informative stuff here today. What haven't I asked you? What else do we need to know about shoulder pain and shoulder health?

Dr. Greer:  I think the large majority of shoulder conditions can be treated non-operatively, first and foremost. I think getting an accurate diagnosis helps guide this process and I think that we can expect to have a normal functioning shoulder throughout the latter years of life if common sense as well as good medical care is provided the individuals.

Bill:  That's really important and for all of us who will be grandparents someday, you want to be able to lift that kid up. If you've got bad shoulders, that's certainly not conducive for that.  Dr. Greer, thank you so much. Can you tell us:  why should someone choose Tidelands Health for any of their shoulder issues?

Dr. Greer:  Well, here at Tidelands Health, we have a comprehensive panel of experts from physicians and physician assistants to physical therapists, as well as the latest technological aspects in the operating room to treat the whole spectrum of shoulder problems whether it be simply an office visit and therapy or a more involved surgery. We have the ability to deal with it.

Bill:   Dr. Greer, thank you so much. Very, very informative. For more information about Tidelands Health physicians, services, and facilities, visit tidelandshealth.org. That's tidelandshealth.org. This is Better Health Radio. I'm Bill Klaproth, thanks for listening.