Suprascapular Nerve Injury

  • In this episode: An injury to the suprascapular nerve results in weakness of the supraspinatus and the infraspinatus (muscles of the rotator cuff). This will typically present as slight pain of the shoulder with weakness and is often initially diagnosed as impingement or possible rotator cuff tear.

  • Chip Review @ (13:45): Spudkins Honey Barbecue (Thank you Lisa)

  • Trivia question of the week @ (07:53): Why is a hockey puck named a puck?

  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional episode specific information throughout the week.

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Brief overview of the episode:

            Suprascapular nerve injuries (SNI) are rare. Accounting for only about .5% of all shoulder injuries. This number however, can be misleading because a diagnosis is almost always made by eliminating other possible causes, particularly impingement and rotator cuff tear.

            The common signs of SNI are vague discomfort/pain in the shoulder with weakness of shoulder external rotation and abduction. In later stages atrophy can happen to the supraspinatus and infraspinatus. Sometimes pain in the neck and numbness can also occur.

           The mechanism of injury is due to traction as the result of slowing your arm down in a cross body manner, as is common with volleyball players or throwers. Sometimes this injury is referred to a “dead arm”.

            Treatment is almost always focused on scapular and para-scapular muscle strengthening as well as postural and mechanical correction.

 

Other episodes you might enjoy:  

Cervicogenic Headache: Episode 10

Shoulder Dislocation: Episode 63

Biceps Tendonitis: Episode 24

 

 

Proximal Biceps Injuries

  • In this episode: Proximal Biceps Injuries can range from tendonitis to full tears and everything in between. Most cases are a result of reduced stability in the corresponding shoulder joint. When the joint is stabilized the pain tends to go away.

  • Chip Review @ (07:54): Uncle Ray’s – Maples Bacon (The official chip of Minor League Baseball) Thank you Matt Schneider

  • Trivia question of the week @ (07:08): What is Cookie Monsters real name?

  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional episode specific information throughout the week.

  • Thanks for listening!!

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Brief overview of the episode:

             The biceps, more specifically the biceps brachii, is named because it has 2 heads (bi=2 cep= head), the long head and short head. The long head is more lateral, runs through the bicipital groove and attaches to the glenoid. The short head sits more medial and connects to the corocoid.
            More often the long head is hurt. The long head is more responsible for stability as well as elbow flexion and forearm supination while the short head is more responsible for power, shoulder flexion, elbow flexion and forearm supination.
            Pain in the front of the shoulder is the most common symptoms of all biceps injuries. In most cases the biceps become irritated because there is instability in the shoulder joint. This can occur though injury, weakness or poor scapular or postural control.
            Biceps injuries along rarely need surgery and in almost all cases respond well to physical therapy treatment.

 

 

Other episodes you might enjoy:   

Shoulder Dislocation: Episode 63

Shoulder Impingement: Episode 55

Shoulder Labrum: Episode 47

Clavicle Fracture: Episode 79

  • In this episode: Clavicle fracture both following ORIF surgical fixation and non-surgical.

  • Chip Review @ (11:15): Mr. Chips – Chilli (This chip is from the country of Jordan compliments of Khem, Thank you so much!)

  • Trivia question of the week @ (09:20): Who is the only non-human to testify in front of congress?

  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional episode specific information throughout the week.

  • Thanks for listening!!

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Brief overview of the episode:

            Clavicle fractures, also known as collarbone fractures, make up about 3% of all fractures. They are most common with men between ages 13-20 years old. The most common causes of a clavicle fracture are falls, bicycle accidents and sports.
            70% of collarbone fractures occur in the mid shaft. About 20% of these will result in surgery to stabilize. The most common stabilization technique (~95%) is called an ORIF (open reduction internal fixation).
            In most cases physical therapy will begin between 2 weeks and 4 weeks post injury. If surgical fixation has occurred this can happen sooner. Physical therapy will focus on increasing ROM, strength and return to activity/sport.

Other Episodes you might enjoy:

Biceps Tendonitis: Episode 24

Biceps Tendonitis: Episode 24

Biceps Tendonitis: Episode 24

Shoulder Pain: Episode 4

 

Total Shoulder Replacement: Episode 71

  • In this episode: We discuss total shoulder arthroplasty (TSA) both traditional and reverse.

  • Chip Review: Wilde Brand – Chicken Chips, Chicken & Waffles – (07:58)

  • Trivia question of the week: Which US state raises the most Turkeys? – (06:33)

  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional episode specific information throughout the week.

  • Thanks for listening!!

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Brief overview of the episode:

            Total shoulder replacement (TSR) more formally known as total shoulder arthroplasty (TSA). This is a common procedure these days but it was rare until about 20 years ago. Back then you would see about 2 a year. Now we see 2 a week.
            There is a traditional approach. This is where the ball and socket stay on their anatomical side, the ball at the end of the humerus and the socket on the shoulder blade. With a reverse total shoulder arthroplasty (rTSA) these positions are switched. The ball is now on the shoulder blade and the socket is on the humerus.
            The reverse is more commonly used when there is instability in the shoulder, usually due to a rotator cuff tears. Perform a rTSA allows the patient much improved joint congruency versus the typical anatomical position. The down side of a rTSA is that typically your range of motion will be slightly less. Maybe as much as 20 degress. If for some reason you would need a revision surgery on either a reverse total shoulder you would only be able to have a rTSA again. There is unfortunately a change in bone structure that won’t allow a traditional to be performed at that point.
            The opposite is true with a traditional total shoulder replacement. If a revision is needed you can perform another traditional or a reverse. There is also more range of motion possible. However, the first few months of recovery are typical slower due to increased pain and weakness.
            Both surgeries do incredible well long term. This is really a great surgery. We have found that most people find the rehabilitation portion to go more smoothly than they would have expected with less pain and better functional outcomes.

 

Other episodes you might enjoy:

Biceps Tendonitis: Episode 24

Knee Replacement: Episode 58

Osteoarthritis & Rheumatoid Arthritis: Episode 57

 

 

Thoracic Outlet Syndrome: Episode 70

  • In this episode: Thoracic Outlet Syndrome (TOS) is compression of nerves or blood vessels near the neck and shoulder resulting in pain, numbness, weakness and sometimes cold and blue hands or fingers.

  • Chip Review: Bohemaia – Paprika (Thank You Susan Jerman) – (13:23)

  • Trivia question of the week: What bone are babies born without? (10:43)

  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional episode specific information throughout the week.

  • Thanks for listening!!

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Brief overview of the episode:

            Thoracic Outlet Syndrome (TOS) is compression of the blood vessels or nerves resulting in pain, numbness, weakness and sometimes cold and blue hands or fingers. Compression is of the brachial plexus (a nerve bundle around the neck/armpit area, think sciatic nerve but of the arms) or the subclabian artery or subclavian vein.
            Signs and symptoms include numbness in hands and arms, pain in neck/shoulder/arms, hands, weak grip, possible muscle wasting in the hands (usually at the thumb). There can also be swelling in arms and hands, discoloration and or cold hands, weak pulse and sometimes throbbing near the collarbone.
            Causes of Thoracic Outlet Syndrome are trauma, repetivie motions, backpack or similar providing an external pressure, posture or anatomical changes and pregnancy. TOS is most commonly seen in females, about 70% of cases, and with individuals aged between 20-50 years of age.
            Typically with physical therapy symptoms can be lessened or reduced entirely. However, on occasion surgery is performed.

Other episodes you might enjoy:

Radicular Pain: Episode 22

Biceps Tendonitis: Episode 24

Intro to Rebound Therapy and Wellness Clinic: Episode 1

Cervicogenic Headache: Episode 10

Upper and Lower Extremity Posture: Episode 8

 

Acromio-Clavicular Joint Separation: Episode 64

  • In this episode: AC separation the difference between Grades I, II, III. What your recovery time and potential interventions could be.

  • Chip Review: Which Wich – House Chips (Thank you Dale Coplan) (10:15)

  • Trivia question of the week: How many times does the moon revolve around the earth in 1 year. (08:08)

  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional episode specific information throughout the week.

  • Thanks for listening!!

To Subscribe, Review and Download select your preferred hyperlink below

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Brief except from the episode:

Acromio-Clavicular Joint Separation, better known as AC joint separation. This is commonly confused with shoulder dislocation, or subluxation.
With the Acromio-clavicular separation, the joint is no longer lined up. The clavicle has popped up and it will result in what is called a step-off deformity. This can be mild (grade I), to sever (grade III).
Grade I Acromio-Clavicular Joint Separation is diagnosed as partial acromio-clavicluar (AC) ligament sprains. Grade II will be a partial to full rupture of the AC ligament and Grade III is a full rupture of the AC ligament as well as the corico-clavicluar (CC) ligament
Typially this injury occurs in the younger population and most often during sports or from a fall. In Colorado we see them most often from a full during mountain biking, skiing or with contact sports like football and hockey.
A grade I acromio-clavicular joint separation will become comfortable in about 7-10 days and most people can return to sport in 6 weeks. A grade III injury will typically result in surgery and return to sport can take as long as 1 year. Depending on the severity of the Grade II injury return to sport can take between 2-6 months.
Just about every acromio-clavicular joint separation we see in the clinic will benefit from taping, either Kinesio tape or McConnel tape. This applies downward pressure on the joint, improves comfort and stability and allows the individual to move their arm more easily.
Increasing range of motion is the most important aspect of recovery from an acromio-clavicular joint separation.

 

Other episodes you might enjoy:

Biceps Tendonitis: Episode 24

Biceps Tendonitis: Episode 24

Imaging: Episode 45

Shoulder Pain: Episode 4

 

Shoulder Dislocation: Episode 63

  • In this episode: Shoulder dislocation is painful so please do not use force to try to relocate.

  • Chip Review: Tsakiris Chips – Salt (Thank you Dave Bata) (12:53)

  • Trivia question of the week: What is the only number, when spelt out that has the same number of letters as its value? (11:27)

  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional episode specific information throughout the week.

  • Thanks for listening!!

To Subscribe, Review and Download select your preferred hyperlink below

Apple Podcasts:

Google Play:

Youtube: 

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Brief except from the episode:

Shoulder dislocation, it hurts. The most common cause is trauma, from a fall. The result is where the humerus (the upper arm bone), is no longer contacting the glenoid. Based on the joint configuration it is fairly easy to see why this happens. It is actually surprising this does not happen more often.
The shoulder joint is set up like a golf ball resting on a saucer that is tipped on it’s side. The saucer however, is the size of a golf tee. This is why there is a lot of mobility in the shoulder. It is also the reason why there can be a lot of instability.
Physical therapy can be a good way to help strengthen and stabilize the shoulder joint. Most people who come to physical therapy for a shoulder dislocation do so as a result of recurrent dislocation and are hoping to avoid surgery. Surgery is typically done to repair the labrum or to tighten up the joint capsule.
A lot of people recall the movie Lethal Weapon with Mel Gibson. We see him jam his shoulder into the wall to relocate it. This is 1 million percent the wrong way to try to relocate a shoulder. When a shoulder is dislocated the muscle around the shoulder go into spasm. The spasms prevent relocation. The goal is to try to get the individual with the dislocation to relax. If you can get the upper trapezius, the deltoid and the latissimus dorsi to stop spasming the shoulder will at times relocate on its own. DO NOT FORCE the shoulder to relocate.
Relocating a shoulder is difficult; take the individual to the hospital as soon as possible. Often time’s sedation is the only way to get an individual to relax and get the shoulder to relocate.

 

Other episodes you might enjoy:

Biceps Tendonitis: Episode 24

Imaging: Episode 45

Adhesive Capsulitis/Frozen Shoulder Syndrome: Episode 26

 

Impingement Syndrome: Episode 55

  • In this episode: A really fancy name for shoulder pain. Basically this diagnosis means you have inflammation in your shoulder and as a result it hurts. There is a little more to it than that so check out the full episode.

  • Chip Review: Lorenz – Plantain Chip Tasting featuring Kiwa Golden Plantain Chips, thank you Michelle Price as well as a snack pack from Shegraa with Lime, Sea Salt and Sweet & Salted, thanks Pip & Jamie – (12:19)

  • Trivia question of the week: Brazil boarders all but two countries of South America. Which are they? – (11:12)

  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional episode specific information throughout the week.

  • Thanks for listening!!

 

To Subscribe, Review and Download select your preferred hyperlink below

Apple Podcasts:

Google Play:

Youtube: 

Stitcher: 

Podbean: 

Brief except from the episode:
Shoulder impingement is pretty common. This is pain in the shoulder which is worse with reaching overhead or out to the side and behind the back. Tucking in your shirt or into the back seat of the car are also bothersome.
Usually this is caused by work, overhead work, sports like swimming and throwing but also with tennis players and golfers. The source of pain is swelling in the subacromial space. Which is the area below the acromion, which is the top tip of your shoulder blade.
The space between the acromion and the head of the humorous is known as the subacromial space. That area there contains a lot of tendons, ligaments and a bursa. If this area is irritated it can stay irritated because the structures will squeeze and pinch each other. Also changes to bony structure in this area can take up space. The swelling associated with this with pinch or impinge and that gives you the typical pain.
A good self-test is called a painful arch. If you take your arm; starting at your side and bring it straight up over your head, ysually the first 90degrees are comfortable the range from 90-120 is painful and than the pain goes away at the top again.
Keep listening for more.
Other episode you might enjoy:

Imaging: Episode 45

Adhesive Capsulitis/Frozen Shoulder Syndrome: Episode 26

Biceps Tendonitis: Episode 24

Rotator Cuff Injury: Episode 18

Shoulder Pain: Episode 4

 

 

Shoulder Labrum: Episode 47

Lets start with what the labrum is and does. It is a cartilaginous soft tissue that helps to deepen the relationship between the humorous and the glenoid. The bones that make up the shoulder joint. The bones have a relationship similar to a golf ball and tee, except they are at an 80-degree angle to each other. To keep the bones from falling away from each other the labrum, ligaments and muscles work together to hold them in place. When we see shoulder labrum issues we are usually talking about a SLAP tear. This is an acronym that stands for Superior Labrum Anterior Posterior. This potion of the labrum is where the long head of the biceps brachii attaches. The biceps will tug on the labrum and in bad cases pull the labrum off the bony glenoid. This can result in pain, clicking, loss of ROM and changes to function. Or there can be very little issue. The most common causes of labrum injury are traumatic, usually dislocation or participation in throwing and other overhead sports. Imaging, typically with contrast can be helpful in seeing a tear however, physical examination is very good at determining if a probably tear exists. The most common special tests: Apprehension with Relocation, Load and shift, Sulcus sign, Crank test, and O’brien test. Symptom pattern is often pain referral by the axillary nerve into the deltoid and teres minor as well as pain in the long head of the biceps tendon. With audible clicking and feeling of instability.
Other episodes you might be interested in:

Shoulder Pain: Episode 4

Upper and Lower Extremity Posture: Episode 8

Rotator Cuff Injury: Episode 18

Imaging: Episode 45

Joint Replacement: Episode 33

  • In this episode we discuss joint replacement broadly. We cover the 3 primary joints that get replaced, Shoulder, Hip & Knee. Then touch on some of the lesser-known joints.

  • Chip Review: Paqui – Haunted Ghost Pepper compliments of Becky & Dustin

  • Trivia question of the week: Which city was the first to reach 1 million inhabitants?

  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional episode specific information throughout the week.

  • Thanks for listening!!

Today we are discussing joint replacement. The large version, all versions. All joint replacements. Covering them as a whole. And reviewing the Paqui Haunted Ghost Pepper chips compliments of Becky and Dustin. Thank you Becky and Dustin for trying to kill us. The bag says “Freakin’ Hot” on it so… Actually right now they are melting through the tissue we put them on. I’m not kidding. They are really red.

 

Hey we had fun in Chicago. We did. For those of you who listened to last week’s episode, we realize that the quality was not all that good. But boy was it fun. Now we are back in our friendly confines.

 

Joint replacement, there are 3 main types. Shoulder, hip and knee. Those are all the same type just at three different joints. Yeah, yeah, yeah, those are the main ones. Correct. There are some, elbow, ankle relatively new, toe, finger, thumb have been around for a long time. They don’t really fit the… They are not common. The stuff we are going to be talking about.

 

I’ve seen a couple ankles, they are different. Tend not to do very well. They are still in the experimental phase I think. Plus it’s an alternative to fusing the ankle. So I guess it all depends on how you define function. Do I want my ankle fused or do I want to see if the ankle replacement will give me some relief.

 

Shoulder, probably the most uncomfortable of the group. Huh? When you have the shoulder replacement. I think the knee is more uncomfortable. People with knee joint replacements complain all the time of pain. I think the knee is hardest. I think having your shoulder replaced, up by your head, trying to sleep, all that throbbing early on, it gets better sooner. Most of these people can’t lie down, they sleep in a chair, they sleep in a reclined position. Which is advisable at first. They are all uncomfortable.

 

Hip is the easiest. By far and this is not based on our experience this is based on our clients experience. Over the course of the last 30 years hip replacement is by far the easiest. People recovery really well, really quick. Regardless of the approaches.

 

For additional episode recommendations check out:

Knee Pain: Episode 2

Shoulder Pain: Episode 4

Hip Pain: Episode 15

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