welcome to medical matters again with doktor norm bottom from again doktor bottom and i think we have a great subjects to talk about because you and i both the fat incurred says only that occurrences rotate her calf s can you explain what actually rotate her cousin s shirt for everyday use that term and our most taught by road here coffin and for those who haven't for that turned before it pertains to the muscles and tens round the shoulder so those muscles and tenants actually literally format cuff of muslin tenant round the shoulder which allows a shoulder to do many amazing things because the shoulder is the most mobile joint in your body it's the most rotate or piece of moving all kindly arranged tat they had ball sitting on a flat plate and the beauty of it is you can throw your arm and all kinds of amazing directions that you cannot do with any other joints because while the hinge joints they move forward and backward and that set the hip deal more range emotion but your shoulder you can put through amazing degrees of activity and which is an enemy amazing thing met humans have unfortunate comes with a car that's where the cost comes in as people run into trouble is it thousands of dollars or just couldn't be thousands of dollars depending on what you're here you're doing with it but so the rotate or cuff so it is it is part of the group of muscles a cover your shoulder the bigs muscle were the shores gotta deltoid technically that's not further rotate or cuff it's less likely injured souls serve internal muscles that run over the top of the shoulder behind a shorter in front of the shoulder that are responsible for that rotation and the amazing thing they do working together to move that shoulder round and if one of those muscles is tenens is giving you issues then the whole situation comes to a halt so that's that's where the rotate her cup comes in because it's all though ali muscles all around that rotation that's your cunning brahma comes from so yeah couple the murmur particular you know we can sort of grime off the interest beneath us and super spin edison and substantial errors but some someone for particular activities are more likely to be irritated but again when one of them is irritated damaged torn inflamed it changes the whole dynamic so the rotate or cuff now that so explain the difference here because you got yours sweeping at curling right i ain't mine happened when i was pitching to my son i pitched him a whole bunch of pitches one day because he was taking batting practice and the next thing i know i couldn't move my arm shirt so there's different rotations there obviously that have affected yours in affected my can you just explain at a little tiny bit well one of the main culprits and probably we both experienced the same thing just different things cause it there is one muscle i mentioned the super spin etas that runs undertake a canal and that can alice form by your shoulder blade and your collarbone sort runs underneath a bony tunnel and if that tenant is pushed up against the surface of the tunnel then it can become irritated from friction so repetitive pitching could do that cause you're throwing your arm over your head and pension that tenant with curling and sweeping answered lifting my arm up to hold my broom and sweeping back and forth so i may be rubbing that tenant in that can outlets in my experience as a sports physician that's most common area whether as problems sometimes youll get issues with repetitive lifting activities so that might affect the front of the shoulder and the biceps tenant if you're sort of doing a lot of backwards reaching which has a common activity buddy in certain situations if you're working that say as a store clerk and you're moving groceries through a tellin ya gotta sweeping movement back and forth so that could irritate other parts of your tear cuff so yours and mine i think are actually very similar costs that tunnel is a programme of commentary whereas voltaire cuff is irritated but it's a repetition of of putting it through strains and stress and compression that cause us to happen how can somebody identify the dead the injured that review that tunnel sure what went on what are some i know with mine i couldn't live my arm up picture so and because of usually because of pain so that'll usually the first sign an interesting and people say well doesn't hurt during the day but at night when i lay in bed it hurts and animal feed your dear eyes are going up say that because what will happen is during the day the muscles or lose their relax the tissues are flowing back and forth fairly freely but when you stop moving at such as at night or if you just rest and for a long period of time often you'll develop a deem our swelling in those in that area and that a deemer swelling puts increased pressure on the tissues and with more pressure pushing manoeuvres it causes more pain so people say you can't sleep a night i can't rely on my left shoulder right shoulder whichever shoulders bothering them because it hurts but once you get it moving during the day so often with the earliest signs as rest pain and then as it progresses they can develop daytime paints oh yeah everytime i sort of reach up to get some dishes off the shelf my arm hurts i was painting a wall and i can't sort of dew overhead painting anymore cause it hurts too much so ag daytime activity then they'll say why literally cannot move my arm so sometimes the inflammation is enough that you literally even if you sort of pushed it or something lifted your army camp move it to certain point and in situations where you can't move at all you could have developed mega frozen shoulder which is sometimes an outcome of of injury or damage where you literally the tissues frees up for a period of time now that now that doesn't mean from cold not impose a term used because the shore literally locks up and it can take months furtive to ease up and move again on its own it used to be procedure the earthy exercise would go and try to force through the range of motion try to get it back again but they found that was actually counterproductive and then if the rotating coffers irritated enough or maybe you ve got a week rotate or cuff and we can talk about why you might have a weak rotate or cuff and you suddenly left something heavy you can ashy terror rupture the muscles is are they repairable they are repairable so but what can you do to prevent that sure so again you want to recognise assemblers very early if you are somebody who's physically active try to maintain a reasonable level physical activity and maintain the strength of your muscles this week muscles going to be more prone to irritation so if you do very little activity and you decide you can update your house one week and you spend six eight hours a day paint brush up and down roller up and down or doing ceiling during the ceiling then that sudden change in activity is something that's going to irritate your shoulder for me you know the first night of curling i sort of order a lot of sweeping and that that did it my shoulder wasn't used to it although i consider myself fairly active person buddy cut me by surprise and i've had this will make some adjustments took over overcome that but if you're not used to certain activity than be mindful of that activity he is active don't smoke smokers are much more prone to rotate or cuff so i think that the current theory is the ten tendons in your body have very poor blood supply shall patients a model of my office muscles are very red and beefy is lots of blood tenens are white and if a surgeon would open up your shoulder he could identify the tenants very easy because they have a very sort of white white or yellow appearance so very little blood flow through there but there is but folk as you have to maintain those tissues when you're a smoker it causes the tinier vessels in your blood vetted in your body to constrict so if the tenants are not getting adequate blood flow on a regular basis than those tenants can actually begin to deteriorate on their own something happens with lumbar deaths so smokers are more prone to this disease in their back while some of these tissues that don't have great blood supply i think our compromise by years of of smoking so the more prone to attend an injury and if you have a ten an injury it can take longer to recover if your smaller so therapy will include you know in the early stages of this no tears work on reducing your pain anti inflammatory medications ice packs acupuncture ultra sound cortisone there's lots of different therapies that can be used to reduce europe pain but eventually even want to build up those muscles and tenants and that's where sir therapy can come in so initially you not seeing a cardiac massage therapist physiotherapy may help you the symptoms but eventually i think you need to end up in the hands of a good physical therapists athletic therapists are personal trainer who skilled in strengthening the rotate or cuff muscles there's something you mentioned that sort of caught me by the ear here you said cold in other words ice packs church now sometimes you say use a warm pack right versus an ice pressure what is the difference in this case sure so so if pain as your main issue my experience has been that ice tends to work better for reducing pain especially the rotor cuff however if if trying to get better faster is important to you and your willing to put up with pain what he will do is help relax the tissues so if you still have some stiffness in your shoulder the heat may be better will be better in helping looseness shoulder up building the heat will do is help dilate the blood vessels and if you dont have good blood flow or good blood supply the more you can delete the blood vessels the more healing may go on the more blood will you get possibly the more i deem our swelling so you may be compromising sort of pain management for quicker healing so it certainly a trade off amity a trade off socialism is all you should ever use called on things well yeah if you can't walk on a really sore ankle or move a sore ne or move us or shoulder pay management can be first priority and then once you get the paint or to control then you gotta worry about healing so often all move people from coal to heat as they're moving along as opinion under better control to get range of motion bacchus the shoulders a great joint and you want to get as much motion back as you can sickens or play catch with your kids and go curling and then paint your ceiling nancy want to get back to those active is the reason i asked at it because you know you always here well put heat on output called on it what's the difference was reno and explaining the difference now make sense sure so is that helps so you know when we should look at these things at all for not sure what's going on as are other issues that could be happening with airfares trauma maybe there's a cop fracturing your shoulder maybe you ve had a really bad injury to your shoulders so something a shorter dislocation really disrupts the rotate or cuff significant way and we got us put the shoulder back in place so the retailer cuff is probably partially torn you may have done some damage to the bony structures in that shorter with a dislocation so is it just the rotating cup anymore or is it should have more to do with a shoulder joint itself more to it than just the religious ok maybe more to it so you might benefit from getting an x ray for starters you may need an ultrasound of his shoulder which does a great job assuringly rotate or cuff or you might need an mri which will look at the deeper structures or even further an mri arthur ground so they actually injected die in your shoulder and then do the mri which would show the bony structure of the shoulder joint and cartilage around the shorter and more detail so things can become complex in a hurry dead thing you know dimension starting with the x rays sometimes just a bit of arthritis and arthritis will put stress on the router cough if you ve got arthritis where the collar bone in the shoulder blade meat that's a very common spot that little canal but i talked about doesn't open or move as freely so you're more prone to pinching so some of these problems can be overcome by proper therapy in south america situations we have to learn to live with it and work around it if this significant arthritis or we have to deal with their three citizen the surgeons can get in and help you these days they can actually clip out part of your collarbone to open up that canal they can put in a new shoulder they can repair the tissues if you ve had a shoulder dislocation and get going to repair some of the underlying tissues are not part of the rotating cuff or maybe brocade or cuff plus some underlying tissues cells becoming no different in replacing a near a hip or shoulders relations have become a lot more common and united earthly and that's an orthopedic surgeon and i shared orthopedic certainty we don't tend to see as much arthritis and problems with shoulders we do with unease in the hip but again if you ve been a very active person if you ve trauma to your shoulder in the past let's say you're in a car accident fracture humorous fractured your shoulder blade then you can be more prone to developing arthritis now how it would not your invention you know if you get this rotate or cuff how do you know if you have rotate recover if it's just you know some little irritation or something sure but i think you know with anything in my case united out curling my shoulders with sore natural tendency would be traced mice baxter s manned inflammatory hope it settles down in a week or two but if you ve got sort of joint pain that's fairly persistent it's not settling down quickly with simple over the counter measures over a couple weeks you probably should be seen sooner rather than later i'll get people to come in and i ve had shorter pain for three months six months and it can take that length of time or longer to reverse the damage has been done during that time so a typical rotate or cuff therapy might be forty six months so sooner is better than later soon as better later you're not coming right away many people settle down very quickly but a couple weeks you should be thinking ok i've had this for a couple weeks i've maybe should get this looked out from what's going on so that is good advice is there any further you can identify now think that pretty much covers at them now the rotating up when the most common things that i see in my sports clinic shoulders and knees and i think we'll talk a bit about knees and these are three areas but we can jump and not again sunday but shoulders another day exactly thanks doktor bottom end great advice in the text for clearing that up you're welcome take care tat set for this addition of medical matters if you have a topic you'd like us to discuss email us at medical matters canoe fm not com it will do our best to discuss it on leader programme medical matters can be heard every monday at eleven forty five a m thirsty at five forty five pm and sunday at ten a m on canoe fm one hundred point nine your community radio station for that halloween night my name is barry will help thanks for listening