Evo Terra (Host): Joint pain. It happens to the best of us, says 55 year old me, at least. But you don't have to live with it. And best of all, there are non-surgical options for you. Welcome to the Live Greater podcast series. Information for a healthier you from the University of Maryland Medical System. I'm Evo Terra, and today I'm speaking with Dr. Sheila Taylor, who specializes in Sports Medicine, and Dr. Myron Szczukowski, Orthopedic Surgeon specializing in hips, knees, and shoulders. They're both specialists at the Orthopedic Center, a partner of UM Shore Regional Health. Doctors, thank you very much for joining me today.

Sheila Taylor, DO: Hi, nice to be here. Thanks for having us.

Myron Szczukowski, Jr, MD: Thank you.

Host: So to start us off, let's talk about some of the major causes of joint related pain. And, uh, Dr. Szczukowski, why don't you take that first?

Myron Szczukowski, Jr, MD: Well, there's lot of causes for joint related pain, and one of the most common is going to be an injury. It can either be a chronic injury. It's been there for a long time. It could be something new, a twist, a turn, a strain, a fall. So trauma is a very common thing for joint related pain. Another thing that we see quite often, of course, is arthritis.

As our population ages, we see more and more of arthritis, and this is a very significant cause of pain. Other things such as infections, such as maybe Lyme's disease, and also post-operative pain, we often see as well.

Host: Dr. Taylor, could you talk to us a little bit about how these problems are diagnosed and also how they're treated, just in general.

Sheila Taylor, DO: Yeah, absolutely. So the most important thing in diagnosis and treatment of any of these musculoskeletal issues would be first starting with your physician. And that could be as simple as your primary care physician to kind of get set on the right path and in which specialists you should start or you could see one of your local orthopedic specialists.

And we start by doing a thorough evaluation, talking with you, getting a history of your issue, then doing a complex physical exam to determine what we think is the source of your pain. We may or may not get imaging depending on what the situation is. And then we will develop a complex treatment plan with you to help treat your issue and get you moving on the path to recovery. And that may or may not include physical therapy, home exercises, medications, or procedural interventions and surgery if absolutely necessary.

Host: Well, you mentioned surgery. Let's talk about surgery for a moment, says the guy that's looking at his shoulder wondering when it's finally going to have to require someone to go in. Are there some patients who are just simply not good candidates for surgery?

Myron Szczukowski, Jr, MD: Yes, there are, and they're, um, mainly related to medical problems. So if there's patients that have issues with kidneys, diabetes, heart issues, that can't undergo a safe operative procedure, then I would say those kind of people would be excluded. Also, age age-related issues can come into there that it's just not reasonable to do an operative procedure on that patient. And also, unfortunately, we have some restrictions on weight, because we know that there are increased complications with people that are overweight.

Host: All good things. I will definitely be playing the age card when it comes to that, but let's go back to Dr. Taylor for a moment and talk about, what are some of these non-treatment options that are out there for people and how do they work?

Sheila Taylor, DO: Yeah. So there are multiple non-surgical treatment options for joint related pain and musculoskeletal pain. And typically it's as simple as, you know, we can start with relative rest, right? So you take a rest from whatever activity is causing your discomfort. We can help you modify your activity. So if you're an athlete or a laborer, how can we change what you're doing to decrease stress on the joint or the muscle? We can provide you or help guide you in a home exercise program to help strengthen the muscles around the joint. We can get you set on a path to a physical therapist that will help strengthen, help improve stability, help improve balance and help to get your issue solved. And then we also offer multiple non-surgical interventions or procedures to help improve your pain.

Some of those include injections. Cortisone injections are very common, for wear and tear osteoarthritis in joints. There are also gel type injections for arthritis and those help to lubricate the joint and improve the joint environment. There are newer injections, which are blood based injections. And they help to harness your body's own natural ability to heal itself and reduce inflammation more naturally. So just through a simple blood draw in the office, and a spin in a specialized machine, we are left with your plasma, which then we inject back into the joint.

And that helps to reduce inflammation, and helps to improve the joint environment and thereby help to alleviate pain. And then for chronic tendon pain or tendinopathy, we have unique treatments that use sound waves that help to stimulate healing, help to break up scar tissue, help to break up nerve tissue and decrease pain and improve and heal the tendon. We do a lot of these procedures under ultrasound guidance and that helps us to visualize the joint and helps us to accurately place our needles in the appropriate location to get the best chance for success and also reduce the rate of injury. And then we also do some specialized treatments to help chronic and severe pain related to wear and tear arthritis that really taps into targeting the sensory nerves. Dr. Szczukowski, do you want to talk a little bit about that?

Myron Szczukowski, Jr, MD: One of the newer things that we've been doing in the office is uh, something called cryo anesthesia, cryo ablation, and this is basically freezing the nerve, the sensory nerves, and we'll just say the knee, to put the nerve to sleep this is a relatively non-invasive procedure.

We don't inject anything into the soft tissues or the joint. We localize the nerve with the ultrasound and then we put a probe in there and freeze the nerve. This basically puts the nerve to sleep. And it will last maybe three or four months. The nerve will regrow, so we're not injuring the nerve per se long term, but it is a temporary procedure, to decrease pain for people, patients, who cannot undergo an operation. It's been very effective. It doesn't get rid of all the pain, but it will probably knock it down about 50%.

Host: That's fascinating. Dr. Taylor, great information. Can you talk for a moment about some of the ways that we can help keep our joints healthy so we A, don't have pain and B, don't require any of these services possibly? What should we do?

Sheila Taylor, DO: So if you don't have joint pain at this time or have only mild joint pain that isn't significantly limiting you or requires further treatment, one of the most important and powerful and impactful things that you can do, is stay physically active. What we know is that a body in motion likes to stay in motion, that helps to increase blood flow to the joints, keeps the joints supple. It helps to improve your balance, helps to prevent falls. And we know that physical activity in any capacity, even if it's not going to the gym for 30 minutes or running on a treadmill, but increasing your walking throughout the day, doing the elliptical, swimming, just getting outside and staying physically active in any capacity is going to help to prevent long term stress on the joints and has multiple benefits across the board.

 We also know that maintaining your weight, if you are of healthy weight is really important. And if you are overweight, losing weight significantly decreases the stress on the joints. So any efforts to reduce your weight, even if it's a pound or two, has you know, fourfold effects on the knee and even sixfold effects on the foot and ankle. So, small changes have huge benefits and just stay active and keep moving.

Host: So, if I hear you right, I can't fire my personal trainer and I really to fire that guy. He's really mean to me. Any takeaways for the listeners that we haven't yet covered?

Myron Szczukowski, Jr, MD: Talking about the freezing nerve procedure, the cryoneurolysis, it's non-operative, immediate results, and it's FDA approved.

Host: That's impressive. That's impressive. Dr. Taylor?

Sheila Taylor, DO: If you're having joint pain, please seek out a consultation with your primary care doc or one of your local musculoskeletal specialists. You want to make sure that you're on the path to treating your pain effectively and getting you back to, you know, what you love to do or what you need to do for your job or for your life.

Host: That's a great suggestion. Doctors, thank you very much for joining me today on the program.

Sheila Taylor, DO: Thanks so much.

Myron Szczukowski, Jr, MD: Thank you so much, it's great to be here.

Host: And once again, that was Dr. Sheila Taylor and Dr. Myron Szczukowski, orthopedic specialists at the Orthopedic Center, a partner of UM Shore Regional Health. You can find more podcast episodes just like this one at umms.org/podcast and on YouTube. I have been your host, Evo Terra. Thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System.

We look forward to you joining us again, and please share this on your social media channels.