Dr. Dan Quinn talks about a variety of injuries.

I'm doctor -- laser and you're listening to hope the moment sour on him succeeding WRKO. My guest today is doctor Daniel crane of new wells to a computer associates good afternoon in my -- Thanks for joining us the pleasure thanks for inviting me. So didn't. With respect -- shoulder and bring the shoulder because animals who have been associates. UN many of your colleagues each of their own little niche in the -- it's the shoulder correct that's correct so. I don't that I got a lot of patience coming into my office. And this report back. I was thinking leaves this weekend. Or I was. I'll play sports in the backyard. And I know it's -- -- -- -- work. I'd -- to backtrack. And first let's find the rotator -- for everybody listening because I have a feeling that some people mile difference definition that would truly is. Sure the rotator cuff is really. A series of muscles. In attendance that exist around the shoulder. There are the sort of deep within the shoulder so it's nothing that's really so many can put your finger on. They they basically attached. To shoulder blade and then. The most seen it crosses over the joint attaches to the to the ball surface of the the shoulder. It's muscle. It's tendon in his phone that's sort of the that the links of the chain and would it essentially does is it that helps a shoulder move. With respect to injuries -- the -- America we don't have it here we have a stream. When a patient being able to tell the difference between the two and one other ailments. You know cup as well sure well. It with respect to. The difference between that hair in a strain I think sometimes it's it's a bit difficult. It's if somebody were fall down in feel sharp acute pain in their shoulder. Immediately have difficulty moving it well you know that that. Oftentimes represents -- and it could be it hair. A strained. -- that that's going to hurt two bit probably. A different scale -- different level it's probably not gonna hurt as much in it's probably something that's going to. Not be associated with as much difficulty moving the arm. The the other restaurants right in -- the other aspect of detention terrorist strain. If they're they're both cares. By definition how restrained has more to do with. So we microscopic within the muscle as opposed to something. That you can see within the tendon. What are some of the news that would cause terror Bristol would cause a minor -- -- -- -- Well certainly I think it has to do with the degree of trauma and the degree of energy the term of somebody fell down. It's the flight of stairs. They didn't break something that there's certainly enough force there to care something. On the other hand if you're throwing a football around in the backyard nearly thrown in a while. That on the other hand is a little bit less force of those some repetitive trauma at the shoulders not quite used to it. You may have some sort of more microscopic level of to have damage. With respect to a non athlete. Who thinks -- athletes and they're out there on the weekends trying to keep up with -- teenage son or daughter. In the backyard. What are thinks they should do before throwing the football before playing catch the baseball. So they can prevent going into new Mozilla computer associates. Sure I think we certainly see our fair share of people who. Go from a cold start and start fire in the football. I think that that's that's asking for trouble a lot of ways. You know if you haven't done something like that. In the recent past probably make sense of make sure that you warm up. It seems straightforward but certainly the warmer the shoulder is the more blood flow that you've sort of encouraged to have within it initially by taking some short tosses or you know. Moving the arm around bit. Certainly elevated temperature of the tissue makes a little bit more supple. Makes a little bit more flexible little less likely to do some damage. With respect to the warm up. Iranians. They're neat cool down period. After throwing the football around after tossing a baseball. And this one feels of the shoulder. Doesn't feel quite right. What would you recommend to that person so losing a bet in their own. Sure absolutely F if you notice something's not quite right it's probably. Best to get some eyes and your shoulder. There's nothing terribly complicated about managing some of these things that because most of them will never. Develop and -- it needs to commend the office so if you can put some ice on the tissue. This can reduce the risk of developing inflammation and swelling. Certainly ought to consider. Two if you add -- Or another anti inflammatory your choice. Because a lot of times what happens is you get some microscopic. Cellular damage. And following that is the process of inflammation which causes swelling causes. Pain and that something that you can prep circumvent or interruption by taking some anti inflammatory as. -- respect the anti inflammatory it's utterly shows when He had on two of your colleagues doctors and it polity. As a -- specialist doctor consumer. As a -- and -- specialists who spoke about it inflammatory -- and I wanted to remind. Our audience again. That these lessons should be taken out of full stomach. They're not without risk and there's a difference between a prescription strength of 600 milligrams of admiral. Verses. Three of the 200 milligram. Making it a total 600 milligrams of over the counter. So there's a difference between those two if you go ahead issues a couple of -- -- -- on the ball around. There -- many content occasion taking well. -- -- -- -- -- But it didn't you this I'm no longer term use. And you we have done more emphasis than you realize you know -- senior position. Or health care provider BCA asked them if did you yourself were appropriate for the inflammatory medication regiment. Yes they need to get your prescription which again is different than the Jonas and I'm doctor Ellen please are you listen to the health and wellness are -- in succeed that we are you know. And doctor Daniel Quinn -- are speaking about soldiers is. It would just it will about the non athlete. Whose story in the long run on the weekend -- -- -- that city athlete. What are some of the injuries that you see this time of year. Well this time of year football comes back into. Season. And certainly that is a sport. -- ports are called contact sports but to I would certainly consider football. But just context -- but obviously collision sport which. Elevates the risk of thigh injury and so in terms of athletic injuries so OC fair number of shoulder injuries with respect football. You know tackling somebody getting hit their -- things can happen to the shoulder. A lot of times people can break something -- clavicle is pretty common fracture. -- around the shoulder. You can sprain something people heard of shoulder separations. That's essentially a sprain of one of the smaller joints -- on the shoulder that happens pretty regularly if people get tackled directly under the shoulder. And up probably one of the more. Difficult problems to -- managed with respect to injuries that you see up football fields of dislocation. What's happened now with a certain. Degree frequency went. People play football. So with a dislocated shoulder someone is obviously going to mean a lot of pain that I into the emergency room. Will be the first glimpse of what happened emergency room during an evaluation share well if there occasions when the shoulder pops itself back in. But. In in the instances where it doesn't. Contents there. Emerged through positions and need to get an X -- to confirm that it's not fractured. Because sometimes it's difficult to tell the difference -- fracture and dislocation but once -- X ray. Confirms that. The ball soccer actually dislocated. What's going to happen is you gonna have to have to put children back in place. That can happen. With some gentle traction if there's not too much. Pain already because the pain generate some muscle spasm which is tough to overcome occasionally. More likely you can get a bit of medication. In order to relax your muscles and make it easier to put it back in. -- with respect to the overuse injury. This time of the year people are going to be out in the backyard Leo imagine doing a ball around doing some breaking. Could go into little more detail with you overuse injury as far as treatments after the initial ice. Anti inflammatory -- and drive. Chair Alan come. What you've tried that a lot of people are wondering to themselves well when is when is it time to. Start getting help well. You know I think that it's probably. A good idea if you give the shoulder. A couple of days to quiet down if if UK two point where it's either getting worse the medication is controlling the pain. Or it's not getting better after of a period of time and it depends on how -- -- -- but if eventually get to point where you feel like I need some help. Then there's a few options that I have when patients commit to the office. If -- -- try the anti inflammatory depends on how long we've been using it how potent anti inflammatory as. A lot of times. I will use physical therapist if I think that up perhaps what's going on is there's a problem because. Of weakness perhaps some of the pain has has generated some weakness in the shoulder and it's got into a bad cycle where it's weakened sore and you can't get out of that cycle lot of times. If you can improve to about mechanics through therapy that's very helpful. For patients who. Are. He's having trouble sleeping for example and that's not uncommon problem for inflamed shoulders. A lot of patience would come in the B managing it for a couple weeks even and then finally when it stops the search waking them up at night. -- they have trouble going to sleep because of the pain of coming to -- one of the things that can do for them under those circumstances is in the cortisone injection. Presumably. Now what's generating some of this discomfort is inflammation in his either the tendon has inflamed and you'd call it tendinitis. Or the -- is -- and you call -- first sight it's now. And in all honesty don't really -- so we need to distinguish between percent to ten and as people always ask me but what do I have doctors say well these are two things that are. Right next to each other they're touching each other if one sort generally the other source so. Focus on trying to reduce inflammation of both and corners and is really that's quite a nice option for that. When you mentioned a weakening at -- other than that indicating. Severe pain that's going to warrant further evaluation and treatment can -- became a red flag of a little more serious condition going on. And I usually the case. Pressure. You know when it gets a point that it's that severe. I think you start to think well maybe. One of two things either you've you've damage something. You damage attending human damage to ligaments with the activities you've been doing. Or you've you've had some damage in the shoulder which has been miles and then there's sort of a maybe some some age related change with in the tenth -- you've you've uncovered it. You've been functioning well be stressed the tissue too much it has a little bit of damage already in it. And it's just gotten into a situation where now it's inflamed and it's not going away because there's an underlying problem with the tissue. That's because a therapy. Another question that we -- the most primary care medicine. Is when we prescribe it all the times all right physical therapy evaluation and treatment and we'll write down rotator cuff tendinitis. Patients will often wonder at that point how dominant you devote this therapy. And what's that the rich and you know what am I going twice weekly potentially. Meg all for weeks of England for months or is the case sometimes -- -- few times and Pete Sessions similar to the proper exercises and stretching. And does use his partner. With conquering the shoulder implementing for the entry into future. Sure absolutely I think because they're they're couple different theories they have with respect to the physical therapists and I think He touched on a few with them. The first is. You know certainly is that. The intensity of the treatment in the number of visits you need to make depend on a couple of factors number one how source the patient the patient has some. Mild to moderate soreness and it's and it can be generally controlled and we think that maybe they're -- bit weak and seats -- strengthening. They exercise regularly. They're reliable patience and what they need is some instruction so they'll go. Twice three times four times. They'll have the therapist watch them make sure that that whatever exercises there working on their technique is good and they can be discharged. The patience to. Have more damage in their shoulder. And aren't perhaps having a little bit harder time than this including some of the patients after surgery the go. You know twice a week you know go -- you know 810 or twelve visits. I think it's really it's quite revealing for me. To see patients how they respond to the physical therapy if I'm not sure what's going on I think that maybe there's a little bit of damage in the shoulder but it's not something now in this silly I think. We can't overcome a sentiment physical therapy for a month I'll say you know listen go afraid visits let's see where you are. I don't see any red flags doesn't appear to be any significant weakness but let's say and down no go eight visits we'll know that they were treated properly. And good supervision and if they're better -- if they're not well you know maybe there's little bit more that we need to look at. I'm -- only is there and journalists into the -- Obama's Aaron it was X eighty WRKO. My guest is doctor Daniel Quinn a -- multi -- associates. To reach doctor Quinn or any of his associates that we've already on. A previous shows or any associates that will be meeting in the future. Please call 617855862. Against 617. If I find. It's experience you. Operators are standing by ready to take your call you your question and doctor equipment when it was associates book -- -- shortly. I -- you. -- before you find that my producer -- cooks is leaning on the table in a very awkward position and you gonna hurt your shoulder. So I went. And -- is standing up. Right looks much better I've been core zone in my car so I can bring in an opinion in which got -- posthumous. So what these guys that cortisone. Injection. And it's. Further steps. If you could let us know what you get to a point where insert -- going to be needed. Sure I think a lot of people when they come to the office of an orthopedic surgeon they think. You're gonna need an operation. At heavy know that probably about maybe 5% of patients who come through my doors get surgery. So we go through a lot of steps before we get there we've talked a little bit about some of the things He can do at home some of the things we can do in the office including therapy. Including. Cortisone injections. Ultimately if I am concerned enough that there's. Something going on with the so much older than responding to therapy does enough trauma and pain. I'm bored to tears -- damaged initial don't usually get an MRI of the shoulder. I think that's a particularly revealing test a lot of people come in. Picking him in order right away not necessarily the case depending on what I find in your exam but play if I have concerns that. You might have some damage that might end up requiring surgery in -- is -- -- -- -- choice. At a very how -- people come into your office. For -- financial guarantees aimed at those kind of people. Many of these people who it's an apartment or office aren't even making it there ways there. So we -- stickers are a number out of 1000 patients with shoulder pain coming at you think that gets the point who need them. We need an MRI. I would probably venture to guess that we can get. Ninety to 95% of patients. Where they need to be without going. That far in the evaluation process. That typically. The the memorize something that -- due to confirm what I think is the case it's it's not so much of a fishing expedition to. You know find out what what's what's wrong essential because when -- examine new. If that pushing your shoulder here there and you say ouch and I know that it's for example. A sprain of the joint. I don't necessarily need any more information to treat you so. It's it's sort of as a last resort and in many ways. And honestly it's it's a it's almost like a surgical decision making tool so. Maybe 5% of patients so. So this is very helpful to know for. All of us the medical profession but also follow our patients that would hurt his shoulder. If it's not to the point where you gonna be considered for surgery. You know -- can memorize and most of the time the diagnosis will be just by the examination itself. Accusing you got to the point we need physical therapy. As fact quick mention occasionally we meet at the point where a cortisone injection is needed. And it's only very rare who gets the point where someone is so serious. So severe that -- -- not improving that the arrival lenient. But this isn't something that patients. In the back of their mind thinking. Line to get into new rules of ethnic associates and schedule at the adequate I'm telling medium all right that was something that -- -- decide. And we were speaking about and only in the most severe. Situation shirt definitely it's natural -- for patients to wonder what's going on their shoulder and to be concerned that you know. I'm gonna need an operation -- this gonna be some problems going forward and I think that's perfectly natural I think. Also. I have with its experience. Com you. You can tell for the most part we need to be worried about it I would describe some of my job is that of a smoke detector I need to be able to detect who. Who needs help. Who's gonna get better and who I don't know and the patients. Who are gonna need help. I will keep close sign on and follow them and we'll do what's right and if you need an MRI and need an operation then we'll make sense to do those things under those conditions. I'm doctor only user and you're listening to the -- them -- a siren and succeeding WR GO. My guess that is doctor Daniel queens Staten due mostly orthopedic associates that -- great website. Dan just to -- me mindedly that's www. And -- W Wellesley -- orthopedic associates let's NW only dot com that's correct. And the phone number of miles orthopedic associates. That you could start calling them on Monday morning. For appointments before consultations. Is 6179640024. -- 617. 9640024. -- I know I'm very appreciative of it wasn't permit your medicine while the patients always and then the excellent care that they receive. Think you with respect to. Professional athletes in college athletes of the four major sports. Football basketball baseball and hockey. And no disrespect to soccer tennis we could throw those in the rules of the six major sports are not leaving anyone else. What would -- what you say says that most people. To your office as a group. -- -- A question. I think -- golf and there as well what we're probably they they they come with. Different types of injuries certainly the hockey in the football you've got a fair amount of collision trauma you have fractures. And dislocations yes separations. When you talking about them. Baseball. Or overhead sports talking about chronic repetitive trauma it deeply pitchers in their shoulders and they can. Sensitive. Tearing something. And a single episode they can free things over time and just so you know I wouldn't say that there's so much. You know once -- over another but there's certainly different characteristics to the injuries that they bring in. Speaking -- shoulders and I'm so that you mention this because I was gonna. Ask you this question. Maybe monopoly era when He ran out of time. But there's some talk that -- children. Should not attempt certain pitchers in baseball. For example a curve ball or else it's pitch. Because this sort of stuff fully developed and could damage their shoulders and I don't particularly interest in this because my Daniel who six's old. Throws heat. And bring an antenna gain from me next Tony bosses for the Red Sox -- you wherever. Was -- Gillespie situational -- her back in the balconies. So. Cultural business and went. -- So aptly. Be allowed -- structural inspections. -- I think that's that's a great question and that's been a topic that's been debated hotly for many years. I would say that only within the past year. Has have been some fairly good research has come out about type of pitch in weather that. Is responsible for injuries to young throwing athletes shoulders and arms and it turns out that. I think the prevailing wisdom was that He got his -- the curve ball until the shoulders in the elbows are. More fully scale and skillfully mature. And actually it doesn't seem to do in case. But seems to be the case is. The volume of the the the the volume of pitching in the load it's placed on the arm seems to be the predominant. Issue with respect to who's gonna get injured if you're gonna throw a lot of innings and you gonna throw a lot of innings by the time you're twenty. -- year gonna run into problems probably at some point in time your your your risk. Missions it probably but you're you're the highest risk if someone is a Little League pitcher and Oregon -- pitcher and there may be can play high school they can throw in their risk of throwing curve balls and change ups and sliders. Doesn't elevate their risk of shoulder injury as much as those athletes who pitched. More in pitch later into their careers. So be it makes sense that the best players are gonna be the ones exposed must respect as are going to be the ones that teams rely on the pitch more so. That's really where I think the caution needs to be applied his. You've got your best pitcher. If you don't want to overload the shoulder. An actual answer is my next question. Whether certain pitches. Which costs more parents are on the shoulder was really -- the number of pitches and I think we are easy part audience are. Were you watching. -- league World Series but they'll actually have rules. And -- you can only if you exceed its -- isn't actually rest period. Of how -- you can go out there before them again if you're limited to -- think. 1120 pitches. When He. I don't think we'll go back out the following it immediately known how many days -- Game with respect to the baseball pitcher. Are there other positions in baseball or other sports and you can element that is also field. -- well -- specifically with respect to baseball the throwing. Limits also played catchers and I think that that dovetails nicely into the research that was a recently published about the number of throws because certainly. Every pitch the pitcher makes. Virtually every pitched -- how many balls get hit get thrown back to the pitcher as if you're talking about the total number of balls thrown the pitcher and catcher of the two. Positions where you need to worry most about that particular player's arm into whether you're exposing it to the risk of injury or not. And I think it's the smart -- smart ruled to have limits on pitch and balls thrown. Sabrina the good news is that because your on the dance team there is no limit how many hours you can dance like what would you watch less TV. I'm doctor -- wizard and you're listening to the health and wellness are unable to succeed. WR -- Leo my guest today is doctor Daniel -- of Newton Wellesley orthopedic associates. Again to -- to quit. -- weak stock to polity. To be stuck to Schumer. Who we've had on a previous shows aren't as other associates and I believe this thirteen in the group -- thirteen of us to start with Phoenix general outstanding. Please call 617. 85586. Ready to. Again that's 61785586. To you can call right now read your message for doctor Quinn and his sooners were wrapping up. The message we passed on and he'll get back to you shortly. Get it what the question as were wrapping up today. For a patient comes in with what it was pretty bad shoulder -- actually it could have been a fall. It could have been not to solicit your overuse of the non athlete. And tell you that it's not just my shoulder. But -- funny you know my fingers in just don't feel. -- couldn't keep. Well that's not an uncommon situation. I see a lot of patience command with not only just the shoulder pain with the with the pain or numbness -- extending down their arm could be any or all of those. Combined I typically. -- shoulder problem something that's that's. Isolated to the shoulder is going to hurt at the shoulder. Maybe on the side of the shoulder and preps extend down to about the elbow that's generally where shoulder problems and if you're talking about -- and extends all the way down into the fingers. As -- as associated with numbness tingling that's when we start to think maybe this is a little bit higher than the shoulder -- is coming from a pinched nerve in the neck. And these are things that who we generally are pretty. Good about distinguishing in the office and it just requires and an examination. Taking the history tell me where it is. Now -- is sometimes a bit of weakness sometimes if it's extending down into the hands and we think it's the shoulder. And the shoulder exam is completely normal. But -- be you know you've been known in the fingers and -- I'm gonna start thinking of my becoming from -- For just a common soldier. Injury. Nagging eight. But in the -- -- live in what's your whole house so when we beat what they call England for an appointment. Well that's good question I think it depends on the severity of the pain if it's something that. Dose of Advil. -- surmise is going to control then certainly I think it's safe to have to watch that and to deal with that. During normal business hours so to speak. That if this is something that's it becoming progressively painful. Captured. Unable to control the pain. With Tylenol or Advil. A year practices that. To helping some weakness or swelling these are the kind of things that you know these are red flags these these are things that day when your doctor to look at. I'm doctor -- Glazer and you've been listening to the -- -- -- I am succeeding. We were killed and one of the things -- guests such genial quick. A few miles to meet associates in the end thinking this was greeted me personally. Feel this myself I'm gonna play this little patient population. I'm gonna play my own way. And I think this was very helpful for all of our listeners. To restart queen to -- any of his associates. Without any questions from the show. Please call 617. 8558692. Again that's excellence and 8558692. Starting tomorrow if you wanted to get in for an appointment at new Mozilla competed associates. Their phone number is 617. 9640024. Again at 617. 9640024. Democrats website WWW. Dot and W away from you must do you associates. Dot com again that's www. And WO -- Dot com. Again you've been listened to all the analysts are -- -- -- WR you know I would sure -- the week I wish you happy week. I look forward to joining us again next week on Sunday. At the same time from 5 PM until 6 PM stay well and thank you for listening.