rotator

What are the best rehab options for patients with an irreparable rotator cuff tear? Can we predict which patients will do well and how long rehab will take?

Find out in this podcast with Jo Gibson (Clinical Physiotherapy Specialist), discussing rehab options, a patient case study and the latest evidence for massive rotator cuff tear (MRCT) rehab. Discover:

• When patients are unable to have surgery, what rehab options are available to rehab MRCT?
• What is classified as a MRCT?
• What common issues do patients with MRCT face?
• What proprioceptive deficits exist in MRCT patients functionally and on fMRI?
• Is the “Anterior deltoid program” really the best rehab program for MRCT patients?
• What MRCT rehab exercises & programs are supported by the latest research?
• Which MRCT patients are likely to respond to rehab?
• Is scapular dyskinesis important to target in MRCT rehab?
• When patients are unable to lie supine, and are therefore unable to complete the anterior deltoid program, what options are available for rehab?
• How do rotator cuff imaging results help guide treatment?
• Which rotator cuff tendons need to be intact for successful rehab?
• Specific exercise ideas and progressions that can be used in rehab.
• How long is recovery likely to take?
• What key messages are important to convey to patients?
• What is the evidence for injections in MRCT, including prolotherapy, PRP?
• How can rehab programs target subscapularis strength?
• Is humeral head depression an important component in rehab?

Get free access to video series on assessment & diagnosis of acute shoulder pain and stiff shoulders at clinicaledge.co/shoulder

For improved clinical skills, knowledge and treatment results with all other areas of the body, get a free trial Clinical Edge membership at clinicaledge.co/freetrial

The handout for this podcast consists of articles referenced in the podcast. There is no additional transcript or handout available.

Links associated with this episode:

• Accurately assess, diagnose & treat stiff shoulders, including frozen shoulder, with this free videos series from Jo Gibson (Clinical Physiotherapy Specialist)
• Improve your acute shoulder pain diagnosis with 3 free videos from Jo Gibson
• Improve your confidence and clinical reasoning with a free trial Clinical Edge membership
• Join Jo Gibson live on Facebook & ask your shoulder related questions every Monday
• Download and subscribe to the podcast on iTunes
• Download the podcast now using the best podcast app currently in existence - Overcast
• Listen to the podcast on Spotify
• Jo Gibson on Twitter
• Let David know what you liked about this podcast on Twitter
• Review the podcast on iTunes
• Infographics by Clinical Edge

Articles associated with this episode:

• CLICK HERE to download the articles associated with this podcast

• Agout C, Berhouet J, Spiry C, Bonnevialle N, Joudet T, Favard L, Society FA. Functional outcomes after non-operative treatment of irreparable massive rotator cuff tears: Prospective multicenter study in 68 patients. Orthopaedics & Traumatology: Surgery & Research. 2018 Dec 1;104(8):S189-92.

• Cavalier M, Jullion S, Kany J, Grimberg J, Lefebvre Y, Oudet D, Grosclaude S, Charousset C, Boileau P, Joudet T, Bonnevialle N. Management of massive rotator cuff tears: prospective study in 218 patients. Orthopaedics & Traumatology: Surgery & Research. 2018 Dec 1;104(8):S193-7.

• Cools AM, Van Tongel A, Berckmans K, Spanhove V, Plaetevoet T, Rosseel J, Soen J, Levy O, Maenhout A. Electromyographic analysis of selected shoulder muscles during a series of exercises commonly used in patients with symptomatic degenerative rotator cuff tears. Journal of Shoulder and Elbow Surgery. 2020 Oct 1;29(10):e361-73.

• Levy O, Mullett H, Roberts S, Copeland S. The role of anterior deltoid reeducation in patients with massive irreparable degenerative rotator cuff tears. Journal of shoulder and elbow surgery. 2008 Nov 1;17(6):863-70.

How do CAB Reports, your SAFER score, and other data affect your company's insurance rates

Most of the problems in this industry need to be discussed in order to fix them. That's what we do in this episode. We each took a few of our top subjects, complain about them, offer ideas on how to fix them, but most importantly want others to discuss these problems and offer their solutions too.

We speak with Lacey Harner of Lacey Harnar CPA about the proper structure and accounting basics every tow company owner needs to know.

Jeff & Brad got interviewed. Matt Ruth from Tracker Management, Clarissa Powell from Tow Times, and Sam Johnson, The Blue Collar Guy ambushed Jeff & Brad with some really great questions during a 2.5-hour interview.

It seems like the companies that are well diversified seem to handle downturns in the economy better. We offer some ideas on how to increase revenue with the equipment you may already have.

Dr. Bethany Dixon, known as The Driver's Doctor from https://drivershealthclinic.com/ joins us to discuss the importance of maintaining a healthy lifestyle while on the road. Learn about some of the small changes we can make to get big results.

Wichert Insurance joins us again to discuss driver selection and other tips to help control our insurance rates. You can reach them at Wichert.com or 740-654-0532

This week on the Exercise Is Health podcast, Julie and Charlie discuss the rotator cuff and why what you may be experiencing as a rotator cuff symptom may not actually be a rotator cuff issue. The rotator cuff gets a lot of press about often being too weak or dysfunctional, but there is a lot more that goes into the rotator cuff than just the shoulder itself. Check out all of the details in this week's episode!

Links referenced in this week's episode can be found below:

• List of certified Muscle Activation Techniques® (MAT®) specialists
• Non-Shoulder Exercises To Help Support Your Rotator Cuff
• What is rotator cuff disease?

There are certain tools and equipment that every tower and tow truck should have. We go over some old must-haves and some new must-gets. We also discuss who should pay for them and why.

Sam Johnson came from an automotive family. Things were going great, his business was booming, then he received the death blow. Listen to how Capital City Towing not only survived but has succeeded in a big way.

Towing insurance rates have increased drastically over the past few years even putting some companies out of business. Today more than ever it is important to have the best agent, the best coverage, and the best partners when it comes to insuring your business. If they don't know towing, find someone who does. Wichert Insurance knows towing.

In this episode of the Princeton Spine & Joint Center Podcast, Dr. Marco Funiciello, Co-Director of the Interventional Spine Program spoke with Dr. Freddie Song, an orthopaedic surgeon specializing in knee and shoulder injuries and surgery.

This podcast is about the topic of rotator cuff, rotator cuff tears, rotator cuff tendinopathy, and dives into the intricacies of surgical evaluation and surgical approach.

Frederick S. Song, M.D.

Dr. Song graduated cum laude from Colgate University with honors in Molecular Biology. During his undergraduate career, he was a four year starter on the varsity soccer team. As a senior, he served as team captain and was the Patriot League Player of the Year. After graduating from Colgate, he received his Doctorate of Medicine from Jefferson Medical College, where he was elected to the Alpha Omega Alpha Honor Medical Society during his fourth year. Dr. Song completed his surgical internship and orthopaedic residency at Albert Einstein Medical Center in Philadelphia, Pennsylvania. As a resident, he served as an assistant team physician for the LaSalle University basketball and football teams.

Following residency, Dr. Song completed a sports medicine fellowship at the Steadman Hawkins Clinic of the Carolinas in Greenville, South Carolina. Under the guidance of Dr. Richard Hawkins, he received specialized training in knee and shoulder arthroscopy, as well as complex knee and shoulder reconstruction. During his fellowship, Dr. Song served as an assistant team physician for the Colorado Rockies Major League Baseball team and the Boston Red Sox affiliate Greenville Drive baseball team. He is currently the team orthopaedic surgeon for the Peddie School and Ewing High School and serves as a consultant for numerous other high schools and colleges in the area.

Dr. Song has authored several peer review journal articles and text book chapters on a variety of orthopaedic topics. He recently completed a chapter on massive rotator cuff repairs published in the Instructional Course Lecture series by the American Academy of Orthopaedic Surgeons. Other recent publications include a chapter on subscapularis repairs in DeLee and Drez’s Orthopaedic Sports Medicine and a chapter covering shoulder replacement surgery in the textbook, Orthopaedic Care of the Mature Athlete.

Dr. Song currently serves as an associate instructor for the Arthoscopy Association of North America, instructing other surgeons on techniques in shoulder arthroscopy.

His orthopaedic interests include arthroscopic surgery of the shoulder and knee, as well as knee and shoulder reconstruction.

Dr. Marco Funiciello, DO, is a board certified physician specializing in the non-operative care of spine, joint, muscle and nerve pain. Dr. Funiciello is the Co-Director of the Interventional Spine Program at Princeton Spine and Joint Center. https://princetonsjc.com/ After graduating from the University of Scranton, Dr. Funiciello received his medical degree from UMDNJ-School of Osteopathic Medicine. Dr. Funiciello then received his specialty training in Physical Medicine and Rehabilitation from Saint Vincent’s Hospital in Manhattan where he was honored to serve as Chief Resident. Dr. Funiciello has extensive additional training in Osteopathic Manual Medicine and often utilizes this skill set to complement his conservative and holistic approach to his patients. Dr. Funiciello has authored numerous chapters and papers and lectures widely. He is consistently rated as one of the best doctors in the country by his peers and by his patients.

We did this a little different this time. We recorded later at night at our homes for a more relaxed show and had a lot of fun with it. Several listeners provided great questions and Brad and I responded with our thoughts and opinions.

WORKSHOP DETAILS

SHOW NOTES

The shoulder labrum is a common structure of the shoulder that is blamed for shoulder pain, especially with throwing athletes.

A listener brought to my attention that it is a diagnosis I have not covered in detail.

In a coming episode, I plan on interviewing someone with a shoulder labral repair to hear exactly what occurred and what it took to recover.

Docs: Please share this episode with a patient you know whose' suffering from shoulder pain they believe is from a labral issue. It will help them understand many of the consideration surrounding diagnosis and misdiagnosis of the labrum as the pain generator.

References can be found at www.p2sportscare.com.

Low back book written by Dr. Gonzales can be found here.

Today we’re going to reach into my bag of papers that have been sitting and gathering a little dust waiting for their time in the sun. We’re talking about government-regulated rehab. Is it any more effective than doctor-regulated? Do you send rotator cuff issues straight to a surgeon and is that the smartest thing? We’ll also skim over some new info on carpal tunnel. 

But first, here’s that “goes down so smooth” bumper music

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OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have Frankenstein-shuffled into Episode #63 all creepy like

Introduction

Why does this podcast even exist? We’re here to advocate for chiropractic and to give you some awesome information to make your life easier from day-to-day. We’re going to keep you from wasting time through your week by giving you confidence in your recommendations and in your treatments. 

This is something I feel confident in guaranteeing you if you listen and stick to it here at the Chiropractic Forward Podcast.  I’m no guru but I do believe I was blessed with some amount of common sense that somehow continues to keep me in the game. You are ABSOLUTELY going to pick up some nuggets that you can use in your own practice. 

Store

Part of saving you time and effort is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for your. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. My goal is to get enough pre-orders to pay for all of the intiial order before the end of March. If you guys will go to chiropracticforward.com…..Just click the STORE link at the top right of the home page and you’ll be off and running. 

https://www.chiropracticforward.com/shop/

We can order any of the posters whenever but, I want to get pre-orders in place for the brochures since they have to be ordered in bulk. With pre-orders helping me do that, I can get them ordered at the end of March, get them to me in about a week and then get them to you in a week so, they’d be in your hands roughly mid-April. So, if you’re team Chiropractic Forward, go check them out and order up. I’ll make it happen for us all. 

I’m getting them for my office as well ya see. I can’t wait to get them. And, I have a ton more I’m working on. But, I’ll be using funds from the first batch, to fund the next batch of these brochures. Rome wasn’t built in a day folks, cut me some damn slack. Help me out with the first batch and we’ll be up and running. Who knows what we can get done around here together?

DACO

DACO talk, hell yeah. I’m back to rocking and rolling thanks to the guys down under in Australia. They are very intuitive and really do go out of their way to make sure you’re enjoying the courses and getting what you can out of them. 

Recent courses for me have been Acute Torticollis in the Adult and Osteoporotic Compression fractures - Recognizing the Clues. 

I dreaded stepping into the whole idea of 300 hours added to an already full load of work, family, and hobbies. Honestly, I’ve said before, I see 60-70 new patients a month, wife and two kids, I build live edge furniture, I’m a musician many weekends, and a sculptor who’s trying to teach himself to paint and…well…I like to get ornery and have a beer here and there on the weekends too. (you need to grow up)

I don’t say that to brag and say Oh look at me look at me. I’m trying to make the point that, if I can do it, you can do it. Here’s the deal, I was always learning and adding and reading research papers and all of that stuff anyway. I thought I’d take one live class and get some continuing education hours. Hell, I figured I’d sit in the class for a couple of hours and then go have lunch with my wife. 

Yeah, that didn’t happen. In fact, I’m blaming it all on Dr. Tim Bertlesmen for getting me into it. He and Dr. Brandon Steele are the partners in ChiroUp and he was teaching a class here for the Texas Chiropractic Association’s state convention last summer. I saw him in the expo hall and he told me to come check the class out. I said I’ll check it out for a bit. He said, “You’ll like it. You’ll stay for the whole thing.” Dammit if he wasn’t right. Lol. Just amazing information that could be used immediately and I literally feel that way about every class I’ve had since then. So, you see, it hasn’t been stressful. It hasn’t really been any work. It’s just been enjoyable learning that I would have been doing anyway. I might as well get something out of what I was already doing anyway, right?

When the hell do I have time to add 300 hours to my plate? Well, I take off about 2:30 on Tuesday afternoon to do a class. I usually take one on Saturday morning when I’m up before the rest of the family. Sometimes I’ll take another on Sunday. That puts me at about 9 hours a week. Easy peesy. 

This week on the Exercise Is Health podcast, Julie and Charlie interview Dr. Thomas Obermeyer of Barrington Orthopedic Specialists to discuss one of the most common shoulder issues plaguing many people today - rotator cuff disease.  What is rotator cuff disease?  What are contributing factors to it?  What can be done about it?  Check out all of this and more in this week's episode!

This week on the Exercise Is Health podcast, Julie and Charlie discuss a predominant myth in the fitness world - the Magic Muscle Myth.  The idea behind the Magic Muscle is that there is one muscle that, if released, relaxed, or strengthened, will be the fix-all to ALL of your physical health issues.  Julie and Charlie discuss three of the most common muscles that are promoted in this manner - the psoas, the piriformis, and the rotator cuff muscles.  Check out this episode to hear why the Magic Muscle idea is nothing but pure gym myth!

Successful phase 3 data for new headache medications (rimegepant, ubrogepant, lasmiditan) are finally raining in after a lengthy drought. Also today, interferon status and family history predict autoimmune connective tissue disease, steroid injection before rotator cuff repair predicts revision, and the CMS resumes risk adjustment payments for 2017.

SHOW NOTES

I’ve gotten a lot more emails from listeners over the past few months about their “rotator cuff tears,” “carpal tunnel syndromes,” or “tennis elbows,” which I’m thankful for, but the sad thing is based upon what these people say there’s a strong possibility that their ongoing pain is rooting from a neck condition (or some other region).

These people have been seeking care and advanced imaging for the region of their pain for years with little success. It affects what they can do in life (leisure and daily tasks) leaving them frustrated with the healthcare system. Why has nobody figured this out for them?

This is common… when you go into an office directing the clinician’s attention to the rotator cuff, they will tell you if it appears “normal or not,” leaving you with minimal direction of how to resolve the condition. If you have a condition that’s not getting better despite great treatment/ rehab, you should consider the strong possibility that your missing the correct diagnosis.

Here’s a few situations when we need to consider the neck (painful or not) as the root cause of symptoms:

• Change of sensation of any type into the arm, hand, elbow or shoulder
• Stabbing pain in to the shoulder blade region
• Headaches
• Neck loss of motion
• Symptoms increase when you look down, up or in other directions
• Past neck condition (resolved or not)
• Past neck trauma
• Pain above and below the elbow
• And much more

Quotes:

• Where is your referred arm pain coming from?
• Nobody chases the arm pain associated with a heart attack
• No muscle travels the entire distance of the upper limb
• The neck doesn’t have to hurt to be connected to your unresolved shoulder condition
• All muscles of the shoulder complex can be affected negatively when neck integrity is compromised

Sebastian’s Youtube Channel

Attention Docs and Fitness Professionals: Access your client educational products, banners and posters here.

Dr. Sebastian Gonzales is an expert in trouble shooting sports injuries and overuse conditions. This podcast is intended for sports medicine topics to become easier for patients and athletes to understand. Don’t get confused by what your doctor told you in your appointment. If you like in Orange County CA, book an exam with Dr. Gonzales, your Huntington Beach Chiropractor.