>> Burdens are for shoulders strong enough to carry them.

But what happens when those shoulders are down and you can't get back in the game?

Stay with us as we talk with shoulder specialist Doctor Caleb Davis about repairing and protecting our shoulders.

Next on Kentucky Health.

>> Kentucky Health is funded in part by a grant from the Foundation for a Healthy Kentucky.

[MUSIC] >> Scarlett O'Hara in Margaret Mitchell's Gone With the wind says burdens are for shoulders strong enough to carry them.

In literature and in life, we often attribute great strength and steadfastness to the shoulders.

Think, put your shoulder to the grindstone, put your shoulder into it, or atlas, bearing the weight of the world upon his shoulders.

The shoulders may be all that, but in fact they are so much more.

If you, unlike me, has not injured or either temporarily or permanently lost function of your shoulder, then ask someone about the pain, discomfort, and dysfunction associated with shoulder damage.

Like so many things in sports medicine and orthopedic surgery, there have been many advances in ways to prevent shoulder injury, speed rehabilitation, and limit the disability associated with chronic musculoskeletal diseases of the shoulder.

Add to this there have been many advances in surgical techniques and appliances used to repair damaged and or injured shoulders.

To give us an insight into all things shoulders we have as our guest today.

Doctor Caleb Davis.

Doctor Davis is a graduate of the University of Tennessee Health Science Center College of Medicine in Memphis, Tennessee.

He completed his residency in orthopedic surgery at the University of Louisville, followed by a fellowship in shoulder and elbow surgery at the Florida Orthopedic Institute in Tampa, Florida.

When not playing his cello, doing his podcast, or teaching others on the newer techniques of shoulder surgery.

Doctor Davis is in practice with the Norton Orthopedic Institute as a shoulder and elbow specialist.

Doctor Davis.

Caleb, thank you for being with us today.

>> Thank you for having me.

It's my pleasure.

>> All right, man, you played cello.

Most orthopedic surgeons have some kind of sports related thing.

Is there a thing called contact cello?

>> There is not.

There is not.

You know, it's a funny mixture, but I think that just as a lot of athletes get into orthopedics because their injuries, we have these injuries in music as well.

Really, it's not as cool and exciting.

But you play in college.

I played six hours a day.

You get all these overuse injuries.

I had a lot of shoulder pain.

I had something called a winged scapula where your shoulder is in a bad position.

My wife had the same thing.

She's also a cello player, so it's not as exciting.

But we get injuries too.

>> All right, so out there, there are some young woman or young lad who says, I want to be like him.

So what is the journey to becoming orthopedic surgeon in particular?

Why?

Shoulders?

>> Well, it's a it's a long road, I'll tell you that.

Getting into medical school and doing residency, the shoulder for me in particular, to me, it's the most complex joint in the body.

Some people say it's the hands and no doubt the hands are very intricate.

But without the shoulder you can't put the hand anywhere.

And the shoulder has the most range of motion of any joint, which inherently makes it a little bit more unstable.

Which some people don't know this, but the shoulder is the most commonly dislocated joint in the body as well.

>> Did not.

>> Know that, and I think that has a lot to do with the fact that it's so dynamic that it's also more prone to instability.

But I like to tell people, you don't realize how much you use your shoulder until you can't reach up and grab something anymore once it's hurt.

So just the complexity of the shoulder is what drew me to it.

As far as the pathway to get to be a shoulder surgeon, it's a long one.

Four years of undergraduate school at a minimum.

Medical school is another four years, an orthopedic surgery residency is a five year commitment.

And then typically we do a one year fellowship, which for me it was shoulder and elbow surgery.

So right there, assuming you go straight through with no breaks, that's 15 years post-high school now.

>> It used to be we said that folks, and I teased about sports background because people had to be real strong to manipulate these.

Right now you don't.

It's strength is not a big feature of things nowadays in orthopedic surgery.

>> I think that's a common perception, but maybe a misconception.

I know, I know plenty of smaller people who are very successful orthopedic surgeons, although there's some days where you're in the emergency room trying to put a hip back in the socket, you might use a little brute force.

You don't you don't have to be an athlete, but it sometimes comes in handy.

>> But it's good to be a cello player.

What type of joint is the shoulder?

You talked about all the things it does.

So what kind of joint is this we're talking about?

And that is big function just moving the hand.

>> We talk about hinge joints and we talk about ball and socket joints.

So most people refer to it as a ball and socket.

Although really the socket is very shallow.

We like to call it a golf tee because it's so shallow.

It's not like a cup.

So what we refer to as a ball and socket, but its job is to be able to position our hand in space, to be able to manipulate objects between the ball and socket, plus the scapula, the shoulder blades, as it moves along the rib cage gives us that immense dynamic variability.

>> Really?

So is it akin to our hip joints?

Are there any similarities there, or is it.

>> That comparison is made a lot, but the hip has a much deeper bony socket where the shoulder is more shallow, which gives us so much more range of motion than your hip?

I don't know about you.

I can't do the splits, so my shoulder is much more stable, more dynamic than my hip.

>> I can never do a split.

What are the common problems that people come to see you about?

>> Most people, I'd say vast majority, say my shoulder just started hurting.

I'm not sure why now.

Obviously people fall.

They have a trauma of some sort.

They drop something and that's a little bit more clear cut.

A lot of times though, it's just overuse.

Chronic bursitis, tendinitis of the shoulder.

Everyone asks me the same thing.

Is that doctor, is it my rotator cuff?

Did I tear it?

Yeah, and sometimes it's a tear.

But a lot of times I find that it's just from overuse.

We get a lot of mechanics, people working on the the manufacturing lines, people who are working overhead a lot and just doing it over and over.

A lot of times it has to do from an imbalance of the shoulder, the scapula muscles just maybe aren't working the way they should, which make us more prone to injury.

>> Now, you made a point of talking about with playing the cello, I guess because you're leaning forward and making that motion.

Does posture enter into this?

>> Posture plays a very large role.

The more hunched forward you are, the more your shoulder blades sit forward.

My this this is highly debatable.

People debate all the time, so I'll give you that disclaimer.

But I feel that the more forward you are, the more prone you are to getting this bursitis inflammation impingement problems in the shoulder.

So yes, absolutely.

>> You mentioned a couple of occupations people are having to work over repetitive.

Is this something we're going to more likely see in younger people or older people, men, women.

How does it go?

>> I would say just because you may see more men in the more occupational fields like mechanics.

I see a lot of mechanics, carpenters, construction workers, more men in their 40s.

You don't see as many patients under the age of 40 unless they've had some sort of athletic injury.

Obviously we get them.

But for this chronic kind of recurrent pain, we're talking about probably between 40 and 50 for my more physically demanding jobs.

>> So the first thing that comes to my mind is the weekend warrior.

Those of us who do nothing during the week, but all of a sudden we're going to push it.

Is that accurate?

I mean, I've seen people, you know, and how are these mechanisms of injury going to manifest themselves?

>> And I see a lot of that too, especially you're talking about you go to the CrossFit gym, you play play pickup basketball.

And yeah, but a lot of that time that it can be an acute trauma, like someone ran into me, you know, they setting up a pick in basketball, they ran into me.

I hurt my shoulder.

That's more of like an acute setting where these chronic repetitive injuries and it's usually presenting as front pain, side pain and posterior pain in the shoulder joint.

And a lot of times when they're reaching overhead.

Another common presentation is pain at night.

You know, you're a side sleeper.

Yeah.

Oh, it wakes me up all the time.

It hurts so bad at night.

And that's one of the number one reasons people finally come to see me.

Because I can't sleep anymore.

>> Because of sleeping on that side.

>> That comes up all the time.

>> Yeah.

So we need to move around when we're in bed.

All right.

Now, I was out gardening.

I was blowing leaves, I slipped, I fell, and I tore my rotator cuff.

Am I an idiot or.

That's pretty typical.

>> That's pretty common.

Really?

Yeah, I'd say the most common.

Now, this is this is an interesting thing to think about.

The most common reason people have a cuff tear is just natural aging.

As we age, the blood supply to the cuff becomes less and you get degenerative, normal aging.

Just like like any joint gets arthritic, the rotator cuff gets aged.

So people have a trauma.

They have some partial tearing, but it was probably there before the trauma.

Now, obviously I have people also who had a trauma like you described and have a complete tear off the bone, and that usually is something that needs to be fixed with surgery.

Because of that.

>> We hear about arthritis a lot.

Now, I assume that that's something that can affect the shoulder.

>> Absolutely.

>> And what is the difference between arthritis as rheumatoid arthritis and osteoarthritis?

As far as the shoulders concerned.

>> Rheumatoid arthritis is an autoimmune disease, meaning there's a dysregulation of your immune system that's causing it to attack cartilage in your shoulder, and it degrades the cartilage.

Osteoarthritis also hotly debated topic, but traditionally it's thought more of just wear and tear.

Like think about the tread on your tire starting to wear down as we age.

Now, the reason this debate is because some people get it and some people don't, so you'd think it would be a linear normal progression with age.

But there must be some genetic and environmental factors that may make it worse for some people.

>> What can we do to minimize damage to the shoulder from daily activities, and then what are some of the things we can do to decrease our chances of developing osteoarthritis problems?

>> That's a great question.

And my number one piece of advice to people is focus on what I call scapular health.

All the small muscles in the shoulder blades, they're talking about the rhomboid muscles, the lower trapezius muscle and the serratus anterior.

I hope you're all writing that down, because that's a that's a long list of muscles.

>> Just in the morning.

Okay.

>> That's right.

And a lot of it has to do with keeping that those shoulders back and in good posture.

And I really think that leads to putting the shoulder in a better position, which puts less stress on the cartilage and the tendons.

And I think that's the number one thing you can focus on.

>> So we should be talking to our trainers and say, okay, what can I do to strengthen my shoulder girdle.

What are those exercises that we should do?

>> I really think that goes a long, long way.

You can get into the debate about metabolic health as well, perhaps if you're diabetic or if you have hyperlipidemia, perhaps having a higher a healthier diet with lower inflammatory foods.

Again, that's a I know I'm using this word a lot.

It's hotly debated, but I'm all about the controversial topic.

And there's something to be said about having a healthier blood sugar levels and lipid levels that may also decrease joint pain.

>> Might that be one of the reasons why we're seeing more people as we age coming in with shoulder problems?

>> I certainly think so.

>> What's the typical presentation for a person coming in to see you nowadays?

>> Most of the time it's that repetitive.

It got worse and worse as I went on.

There was no acute injury.

That's by far the most common.

>> And the sleeping on that side.

>> It wakes them up at night and they can't stand it anymore.

>> Wow, wow.

That's just amazing.

If a person comes in with osteoarthritis.

Tell me about the treatment algorithm that you put in for these people.

>> And there's a pretty basic approach to this.

So let's say they've got the ball the socket the cartilage is starting to thin down.

Sometimes it's what we call bone on bone arthritis meaning there's not really much cartilage left anymore.

The cartilage is that nice smooth surface that lets the shoulder glide nice and easy.

And if that cartilage is worn away, there's not really much we can do to replace it, unfortunately.

So there's non-operative things we can do.

Some people benefit from physical therapy.

That strengthening posture stuff we talked about.

Some people will do a cortisone injection that just helps reduce inflammation in the joint.

Unfortunately, that doesn't fix your joint.

It just provides relief temporarily.

So some patients need an injection once or twice a year.

Ultimately, if none of those things are working in a severe enough, we would do something called a shoulder replacement.

>> What about some of these platelet infusions that people are getting nowadays?

>> Yeah, you're hitting all the hot button issues.

I like that there's something called platelet rich.

You're the expert.

>> So I gotta ask you, man, you're here.

I'm gonna get we're gonna get our money's worth.

>> I'm all for it.

I'm all for it.

There's.

There is something called platelet rich plasma PRP, and it's actually drawn from your blood.

We put it in a centrifuge and spin it down.

So it has theoretically, it has a high amount of health healing factors in the blood.

And some people inject that into shoulders.

There's there's research saying it helps.

There's research saying it doesn't.

So there's controversial contradictory research.

In my opinion it can potentially help partial rotator cuff tears.

Soft tissue is my rule of thumb.

If someone has advanced arthritis, meaning the cartilage has worn away, I don't think that's very beneficial for people.

>> We see commercials where someone talks about they have their joint pain, they talk about their shoulders, knee, hip or whatever, and there are these various medications that one can take out costochondral and all that sort of stuff.

Any benefit from taking these over-the-counter medications?

>> I wish I could say there was, because I'm a believer in some supplementation.

I think some supplements and vitamins are very helpful, but chondroitin sulfate and glucosamine are the two ones that come up a lot.

Most large research studies that have looked at that with supplementation versus a controlled trial have shown there's not a huge, huge benefit.

>> We'll talk about trauma later.

But for the person that comes in, because as we are all aging, we're going to have more problems.

I'm assuming with osteoarthritis.

What age group are you seeing, by the way, who's coming.

>> For arthritis?

>> Yeah.

>> Typically 60 and above, although occasionally for people who've had a real hard life.

I'll see it in younger I, especially military men.

I see it a lot in males who are who are ex-military.

They seem to get beat up real bad in the line of duty, and so sometimes they have more advanced arthritis for their age than you'd expect.

>> When do you start considering surgical treatment for somebody with osteoarthritis of the shoulder?

>> Anytime I can try to treat non-operatively, I do.

So we usually go through our algorithm of treatment.

And if none of those things are working, that's when I'll consider surgery.

And the the younger you are, the more we'll pause and say, can we try to not do a shoulder replacement?

>> When you're talking to people, irrespective of the technique that you use, what do you tell them about the recovery in things that they can do before surgery that will make the recovery better?

>> That's a great question.

We call that prehab.

Instead of rehab, we call it prehab to help prepare for surgery.

Really.

And we're talking about shoulder specifically and replacement.

Really, the better and stronger your deltoid muscle is, the big muscle on the side of your shoulder and then also the scapular muscles.

The stronger those are, the better your recovery will be.

We also talk about some supplementation if you have a low protein intake, if you're not eating enough protein, that can Hart decrease your healing.

So I tell people I like them on vitamin D, I like zinc, I like magnesium, and I like protein.

Now, if you can get that from a whole food source like chicken, beef, eggs, that's great.

But if you have a hard time, I'll have them take protein powder.

>> Okay.

You were kind enough to send us a couple of pictures.

And looking at the operating room here, looks like you're going into space, man.

What's going on?

Why the get up?

And what kind of is this, a robotic technique?

Or are you doing what here?

>> This picture in particular is robotic.

We call this a robotic assisted shoulder replacement.

The reason that if you look at the picture I'm holding this, this apparatus, and it's guided by a robot, there's a burr on the end of it where we cut away the arthritic bone before we put the replacement in.

What we do is we get a Cat scan, a CT scan of your shoulder, and we make a 3D model, and we plan your whole surgery before we ever get into the operating room.

Really, we plan exactly how we're going to cut it and what size parts we're going to put in.

That robot helps us cut it to the millimeter that we measure.

That's where the robotic assisted comes in.

I'm still doing the surgery.

I'm controlling it the whole time.

So some people think that I just walk away and let the robot do the job.

Unfortunately, we don't have that yet.

>> But I think one of the things that I'm impressed by it, you're really trying to minimize infection, because I guess that's the big bane of surgery, but especially when you're working in these joints, I'd imagine.

>> Joint replacement, the bane of our existence is is infection.

Because once that infection gets in an artificial joint, it's hard to eradicate without more surgery.

So we are very cautious about sterility.

You know, we we make sure we're double gloved and gowned and covered from head to toe and everything's it's all about infection prevention.

>> All I could think about that when they're operating on ET and.

>> We call that the spacesuit.

Is that right?

We call it a toga.

We call it a spacesuit.

So there's a couple different names for it.

>> All right.

Now there's something called a standard anatomical shoulder replacement.

So you're not just repairing things.

I take that back.

You're putting something new in when you're doing this.

So I mean, you got to cut out parts of the body.

>> Yeah.

Think about the ball in the socket again.

You have a ball and socket.

They're both arthritic.

They used to be a smooth surface.

Well we got it.

We got to make a space to put new parts in.

So the anatomic replacement we call it anatomic because it mimics your anatomy.

So where the socket is we put a plastic socket where the ball used to be.

We put a metal ball and that's what we do.

But we cut that old part out.

So they replace it.

>> That thing that we're seeing that that bright piece is the new ball and socket joint that we're looking at.

>> That's correct.

The bright piece is metal on the socket side.

It's plastic.

So it doesn't show up so good on the x ray.

But that's what's there.

>> How do you get that into.

Because it's going into the bone.

So how do you get it down there.

>> So you make an incision through between two muscles between your pec and your deltoid muscle.

And we we find the shoulder and we take a saw and cut the bone off.

And then we're taking a metal piece that goes down inside the hollow part of your humerus bone.

But we use drills and saws and mallets.

It's like carpentry for medicine.

>> Isn't that something?

Just bang it on down in there.

That's right.

And I'm going to assume they come in different sizes.

>> Oh, yes.

And that's where the Cat scan really comes in handy, because I measure exactly the size and can plan what I want for.

But we have multiple sizes in two, four, five millimeter increments.

>> So when do you consider doing the stemless shoulder replacement.

What is that all about?

>> The benefit of the stemless is sometimes it helps us create a little bit more perfectly to your anatomy when we can place it.

And the stemless is considered a little more bone preserving, meaning we don't have to cut as much bone or violate the bone as much.

So the only reason not to do that in most cases, if your bones too soft and you need more stability.

So younger patients.

>> So it's just a little cap almost that you have going in there.

That's right.

You still have the plastic part on the other.

>> The plastic part is still there.

>> Is it more difficult to do these procedures and someone who's muscular, or is it better than somebody who doesn't have a lot of muscle there?

>> It's much more difficult to do it.

A muscular patient you're having to you want to preserve the muscle, not damage it, but you have to move it out of the way.

And there's a lot more bulk to it.

And so it can definitely be more difficult.

>> Are you at risk for damaging blood supply when you do these procedures?

>> Yes and no.

Anytime you have a surgery, you have a risk of infection and bleeding.

But where we know where the anatomy is, we move it out of the way.

And honestly, the axillary artery would be the closest major blood vessel to where we're working.

There's also the cephalic vein, but we find it, we move it out of the way and protect it.

The the incidence of bleeding in these procedures is pretty minimal.

>> In terms of healing is do you have to ensure there's adequate blood flow to the surgical site?

And what are some of the things that people can do?

Obviously, I would imagine you tell people who are smokers not to smoke prior to surgery, but is that the kind of thing you have to concern yourself with?

>> We don't worry about blood supply too much to the bone because we're putting in artificial parts, so that doesn't have to heal per se.

What I do worry about is your your skin and soft tissue healing after surgery.

Smoking is a great one.

If you smoke, the blood supply to your skin is poor and sometimes that skin doesn't heal if it opens up because it didn't heal, that opens you up to infection.

I see in certain techniques there's a tendon on the front of the shoulder.

You have to cut and then reattach, and that tendon has to heal back.

And so that would be another issue.

And that's where nutrition comes into play too.

With poor nutrition, sometimes you're not as good of a healer either.

People with diabetes who have very high blood sugar can be more prone to healing problems and infection as well.

>> After you do one of these procedures, how soon before you have them exercising and using things.

>> So you talk to a different shoulder surgeon.

You're going to get a different answer with these anatomic shoulders.

A lot of times people take that tendon off.

Yeah.

And so most people are in a sling for about four weeks before they really get moving much four weeks.

Now, the reverse shoulder, which we haven't even talked about yet.

>> Okay.

You brought it up, man, I was this makes no sense to me whatsoever.

So you're saying a reverse shoulder replacement?

Yes.

>> So what is it?

We talked about that ball and socket, right?

Yeah.

We literally switch them.

>> You switch.

>> Them, we switch it.

There we go.

We got a picture up.

So the where the socket used to be, we put a ball where the ball used to be.

We put a plastic socket.

So that's why it's called a reverse shoulder replacement.

Now why does that help.

Why does that help us.

Okay.

We talked about the rotator cuff.

Yeah.

That other shoulder replacement the anatomic we talked about.

You have to have a good rotator cuff.

A lot of people over 65 do not have a good rotator cuff.

So a lot of the patients we're seeing have this poor quality tendon or it's torn completely.

This deeper socket offers us more stability, helps move the shoulder down and put more tension so it doesn't dislocate and pop out.

That was one of the big problems before the reverse shoulder replacement was invented.

>> It it was popping out.

>> Yeah.

If you didn't have a good cuff, that shoulder was just moving around.

It didn't have any stability.

>> So you're not so much as shifting the shoulder around.

It's just that how you're where you're putting the tools the instruments in is different.

That's the reverse part.

>> And it also makes the whole construct deeper.

You know, I talked about that shallow socket.

We're creating a deeper socket.

We're also pulling the arm down further by nature of the mechanics of the shoulder replacement, which puts more tension and stability into the shoulder.

>> Does that mean you have to go out and get new shirts now, because one arm is going to be longer than the other one?

>> The length is not perceptible.

Although I will say some people notice there's a slight shift in the shape of their deltoid muscles.

Looks a little bit flatter after the surgery.

Sometimes.

>> No more off the shoulder gowns.

>> No, it'll it'll fall right off.

>> So is it.

Do people regain their normal strength back after this?

>> The majority of people do.

Yes.

And it varies.

People are very weak before surgery.

They're going to have a harder time recovering.

The more muscular people that I work on tend to recover faster because of that, that prehab we talked about, you know, I'll have people who are 80 years old and they haven't used their shoulder normally for five years because it's been in such bad shape that muscles atrophied.

It takes a while to recover.

But the main reason we do this is for pain.

You know, you're living with pain all the time and it's debilitating and the pain goes away.

So even if they don't get full range of motion back, a lot of these patients are very happy.

But I will say the majority of these patients get good range of motion, good function.

They're very happy with it.

>> What is the biggest complication?

>> I think the number one thing we worry about is infection.

You know, that's just the most problematic one.

The other one would be a dislocation because it can still happen with a trauma or a fall.

We see that sometimes.

And the third, especially in females with osteoporosis or softer bones, they can develop stress fractures after surgery.

>> Now.

There are a lot of us who do a lot of things, and then there are some people who do one thing well, you do one thing on show, but do one.

As we're looking to go someplace, should we be looking for what are the things?

If I'm trying to choose, I want to get somebody to take care of my shoulder.

What am I looking for?

>> Well, I'm going to be biased, obviously, but I am.

I am fellowship trained in shoulder reconstructive surgery.

So there are generalists who do all sorts of orthopedic surgery.

There are people who are specialty trained.

If I have a bunion, I want to see a foot and ankle specialist.

If I have a knee problem, I want to see a knee specialist.

So you want to look for a surgeon who is fellowship, trained in shoulder reconstructive surgery.

>> Out in the music world, are they seeking you out because they know that you are sensitive to the violins, the cello, the bass players?

Really?

Do you have a reputation?

>> Well, you know, I'm newer to Louisville.

I've just moved back recently, but back in my old practice, I was the the music population was definitely seeking me out because they know about my reputation and I also do Brazilian jiu jitsu.

So I got all the Brazilian jiu jitsu athletes in my in my clinic also.

>> Well, there are a lot of strains.

Now tell me if you would give me three things.

I think that we should bear in mind about our shoulders and then thinking about therapy for it.

>> You know, I think therapy should be your your first line treatment, physical therapy.

We should always strive to treat the shoulders non-operatively.

But if you're talking about longevity, I think the posture and the way we exercise and strengthen our shoulders are key.

So I encourage everyone of all ages, of all genders to work on strength training, especially those shoulder blade muscles.

And I think proper nutrition is very important, good protein intake and really taking our metabolic health seriously.

So we're not having all these inflammatory changes in our bodies.

>> What are the exercises that we should be doing and what are exercises that we may want to consider by age?

>> There's there's a whole multitude of exercises that you could do, but there are a few that are my favorites.

One exercise called a wall Angel.

If you Google it, you can look it up, but you bring your shoulder blades back against the wall.

You're moving your arms up and down.

Very simple.

You can do it in a wall in your home.

It doesn't require any equipment whatsoever.

You're pinching your shoulder blades together.

I tell people really to Google it, so I don't really have time to explain all of it, but it's one I do every day.

I also do something called scapular pull ups, where I just hang from a bar, but instead of doing a pull up, I'm just pulling my shoulder blades up and down against my body.

>> You're just hanging.

>> But your shoulder blades are pulling.

I'm not doing a full pull up.

It's just those little muscles of the shoulder blade.

You can really get a good workout from those two, but you know, if you have time to see a physical therapist or even hire a physical trainer to show you some different scapular exercises these days, you can go on YouTube and that whole routines and for for scapular health.

>> I guess that sounds good.

Well.

>> I think what we'll do, we'll all line up at your home and come use your bar and we'll follow all the cello, bass, viola and violin players.

>> That's right.

>> And see what's going on.

Doctor Davis, thank you very much for being with us.

>> It was my pleasure.

Thank you for having me.

>> And thank you for being with us today.

I hope that you have a better understanding of the complexities of the shoulder and how it functions, but more importantly, how to minimize injury and the options available for treatment.

If you wish to watch this show again or watch an archived version of past shows, please go to Keturah.

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I look forward to seeing you on the next Kentucky Health.

And please, if you're having any kind of pain and or discomfort, please talk to your primary healthcare provider.

>> Kentucky Health is funded in part by a grant from the Foundation for a Healthy Kentucky.

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