Don’t Shrug Off Shoulder and Elbow Pain

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Speaker 1:

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Kendra:

Hi and welcome back to another episode of HealthTalks NOW, your trusted source for the health, news, and topics, that matter to you most.

Kendra:

On today’s episode, I sat down for a phone conversation with renowned orthopedic surgeon, Dr. Brent Morris. Dr. Morris is a leading area physician, who specializes in the treatment of shoulders and elbows. And together, we discussed some of the common and easy to ignore injuries that can affect these important joints. You’ll want to listen till the end for tips about arthritis, and how to know when everyday injuries should not be treated at home.

Kendra:

So without further ado, let’s listen in to my conversation with Dr. Brent Morris.

Kendra:

We’re a new face to Baptist Health but certainly not to Kentucky, or rather, the region. We’re glad to have you on the show with us today, Dr. Brent Morris.

Dr. Brent Morris:

Yeah, thank you Kendra. It’s a real pleasure to get to spend a few minutes with you here, and thanks for setting this up.

Kendra:

Yeah, of course. Well, let’s start by telling our listeners a little bit about you and what it was like for you to grow up out near the Red River Gorge?

Dr. Brent Morris:

Yeah, what a nice place.

Kendra:

It’s gorgeous.

Dr. Brent Morris:

I mean, we are happy to be back in Kentucky in the Lexington area and obviously have a lot more access to our hometowns. So I grew up in Clay City, my parents are still there, and an older brother and younger sister. And all of us are back in Kentucky now, so very exciting.

Dr. Brent Morris:

Yeah, what a beautiful area Eastern Kentucky and the Red River Gorge, Natural Bridge area. Growing up as a kid, you don’t have that [inaudible 00:02:20], you don’t always appreciate what’s out your back door. But as I’ve gotten older, any time we’re able to fly back from Texas, we would go back. So we would take the kids too the Natural Bridge area, and we’ve been up there several times since we relocated. So yeah, beautiful area. And glad to be back to our roots.

Kendra:

It’s such a beautiful hiking spot.

Dr. Brent Morris:

Yes.

Kendra:

So much good outdoor stuff to do out there.

Kendra:

Well let’s move now into your career. So how did you become interested in the field of orthopedics?

Dr. Brent Morris:

Yes. So orthopedics is great. So I had a good experience in medical school here in Lexington and then had some good mentors and good exposure there at the university, and really just fell in love with it. My older brother went into ENT, or ear, nose, and throat surgery. And so I looked at that as well and thought, “Really great field, great people.” But the procedures we did in orthopedics; awesome people and procedures that really kind of blew my mind. You take a person with a … Say, for example, even a shoulder fracture, are you going to do nose surgery? Are you going to do a plate to fix it? Are you going to do a nail to fix it? Are you going to do a replacement?

Dr. Brent Morris:

It’s kind of the same name. It’s a broken shoulder, fractured shoulder, all the same. But the complexities, even though what we do is fairly simplistic, we kind of put people back together and put parts in when needed. Now, but really get this immediate gratification when you take a person who can’t use their arm, or can’t walk, and you can immediately get them back going. So that was kind of my big … Kind of interested me the most early.

Kendra:

Sure. I mean mobility is such a key part of quality of life.

Dr. Brent Morris:

Absolutely.

Kendra:

So I imagine it’s really gratifying to see that. And there’s got to be a satisfaction in the problem-solving puzzle component of it too?

Dr. Brent Morris:

Yes.

Kendra:

Figuring out what’s going the best course of treatment for each individual patient. It’s got to be kind of interesting.

Dr. Brent Morris:

Absolutely.

Kendra:

Well, we’d like to spend a little bit of time today with you talking about shoulders and elbows, which are really your area of expertise. So let’s jump right in.

Kendra:

How do shoulders most commonly get injured? It’s not always sports-related or a weight-bearing exercise, right? Can you explain how something like an everyday activity might factor into those types of injuries?

Dr. Brent Morris:

Yeah. It does often occur with athletic activities. Certainly, shoulder injuries can occur with athletics and excessive repetitive overhead motion, especially with our throwers but also swimming, tennis, weight-lifting, among others. But it also occurs with everyday activities. I mean, the majority, even if you see a lot of athletes, which we’re fortunate to see a lot of athletes here at Baptist as well, especially in the shoulder, elbow realm in our sports colleagues as well. But the bulk of the visits are still weekend warriors, you know?

Kendra:

Yeah.

Dr. Brent Morris:

Regular people like us who like to stay active. Or even people that maybe aren’t as involved in athletic activities or exercise, but you develop this wear and tear over time. The body, things just take its toll over time, especially with rotator cuff injuries, labral tearing, things like that.

Dr. Brent Morris:

So yeah, it’s not always elite level athletics. A lot of it’s just normal people like us, that the body just kind of wears down over time.

Kendra:

Yeah.

Kendra:

Well the shoulder is one of the largest, most complex joints in the body. And fun fact for our listeners: Unlike the hip, the shoulder doesn’t have a socket. And this might sound kind of rudimentary to you, but how is that possible? How does the shoulder actually work?

Dr. Brent Morris:

Yeah. I try my best to explain it every day. And even sometimes, we will even mention it like a socket. But we try to distinguish that it’s clearly different. I mean, the knee and the elbow, although complex, and the elbow especially being smaller, are hinge joints. They’re hinge joints. The hip is a ball and socket, and especially on the replacement side, hip replacements just do phenomenally well. Because it’s a fairly basic joint, reasonable range of motion, but it’s a cup, a ball and cup. God was a pretty smart guy when he designed that.

Dr. Brent Morris:

So similarly with the shoulder, pretty genius how it was designed, but it’s really held together. Unlike the hip, which has a socket as you properly point out. It’s held together by a ligaments and tendons that really kind of hold it together in a capsule to keep that together. So really, what it allows is the ball to lever off of or go against the glenoid, which is the “socket” if you will, on the shoulder even though it’s not a cup, it’s a flat surface. And relatively small surface.

Dr. Brent Morris:

So yeah, extremely complex to really lend to the extreme amount of range of motion that we have. And some people naturally have even more range of motion than normal. So really, the shoulder, you can get a lot of increased mobility. But that puts it at risk. It puts it at risk for strain, repetitive injuries, and other things as our joints age and those ligaments either get too loose or too tight over time.

Kendra:

Yeah. So I read that shoulders are one of the most commonly injured joints in our body. And it sounds like that might be a big contributing factor, is just that extreme range of motion allows us to do more with it.

Dr. Brent Morris:

Absolutely.

Kendra:

Let’s get into a rotator cuff tear. And as I understand it, it’s one of the most common shoulder injuries? How common is it? What causes it? And how might someone know that they’ve torn their rotator cuff?

Dr. Brent Morris:

So as a shoulder and elbow surgeon, that’s one of the most common things that I, or anybody that does that type of work, will see. They’re very common. I feel like it’s almost like a hidden secret that … And I tell all my patients or try to remind everyone that they’re actually very common. Up to 20% of the general population. And it really goes by decades, as we get older, tears are more common. So after the age of 50, we do start to see an increase over time. And some data, over the years, which showed that about 50% of people or more, in their 70s, actually do have a rotator cuff tear.

Kendra:

Oh, wow.

Dr. Brent Morris:

So, some people are surprised by that. Yeah, they say, “Wait a minute, it’s only been hurting me for a month or two.” And so it doesn’t mean everybody has a tear, but it means if we MRI’d everybody that walked into the building over the age of 70, it’s actually pretty high chance, at about 50% chance they would have a tear.

Dr. Brent Morris:

And what’s crazy is even on the other side. Say I’m seeing a person for their right shoulder, it’s very painful, MRI proves a rotator cuff tear. Their contralateral side could actually have a partial rotator cuff tear as well.

Kendra:

Wow.

Dr. Brent Morris:

And the key with that is partial. Because some of those injuries that we do see as we age, are partial tears that are often treated non-surgically. So that’s why we really harp on physical therapy, activity modifications, safe medications, things like that, before we jump right into surgery, we certainly want to exhaust those things.

Dr. Brent Morris:

But not to confuse that also with acute rotator cuff tears. Meaning, if somebody was lifting a really heavy object, trying to put something at the back of their truck and pop, pow, acute tear. Those are treated differently. Those are typically surgery, sooner rather than later.

Dr. Brent Morris:

But the ones that kind of wear and tear over time, those are actually quite common. And the way folks often know; obviously pain, they will have weakness, trouble going overhead. The whole purpose of the shoulder is to get your hand in space, especially overhead. And if you have big tears you can get profound weakness. And a lot of folks do have a lot of night pain and a lot of sleep disturbance. We’ve published on that for shoulder replacement patients, and also that’s been published on with the rotator cuff tears too. So a lot of night pain and trouble sleeping, and that’s often a big reason why folks come in.

Kendra:

Makes sense.

Kendra:

So excluding acute causes, like you mentioned, and looking at lifestyle with those injuries that occur by repetitive use over time, let’s address some common questions that our listeners might be wondering right now.

Kendra:

Can you injure your shoulder by sleeping on your side?

Dr. Brent Morris:

That’s a great question and I get this quite a lot. This is one of my favorite that folks will bring up at church, or off the cuff, or this kind of thing. Like, “Hey, if you don’t mind, let me ask you. I slept rough on this the other day, do you think that’s why my shoulder hurts?” It’s a great question. As far as I know, there’s no evidence to suggest that we actually hurt ourselves by sleeping. But people are very, very strongly opinionated that that’s absolutely the case. And that’s okay. I mean, I believe them.

Dr. Brent Morris:

A couple things though: We know that the pain in the shoulder, especially the shoulder, more than other joints, is really painful at night. So if you have a rotator cuff tear or arthritis and you fight it all day, consciously fight it. At night, the theory is, at least for most of us, that it kind of catches up with you. You know what I mean?

Kendra:

Right.

Dr. Brent Morris:

In the still of the night, things are quiet, you’re like, “Man, why is this thing winding me up at this point?”

Kendra:

Yeah, you notice it much more.

Dr. Brent Morris:

And sometimes if you “sleep wrong” you know what I mean?

Kendra:

Right.

Dr. Brent Morris:

Be a little bit fired up. But one common thing we do see too, are frozen shoulders. And the most common thing is folks do associate that with, “Maybe I slept wrong?” Because they wake up and it’s really painful and it’s really stiff. And it’s probably unrelated to the actual act of sleeping, it’s just that, for whatever reason, the shoulder capsule got inflamed. But we often see that, people try to recollect, they’re like, “Well, maybe it’s because I did extra gardening yesterday, or this, or that, or had that trauma?” But most of the time it’s not. They don’t fashion frozen shoulder, it kind of comes on out of nowhere and often it can happen during nighttime too.

Dr. Brent Morris:

Yeah, but typically you don’t actually injure it by sleeping on your side. So feel free to … I tell folks, “Sleep in whatever position that is comfortable that way, but the shoulder itself should not be injured by sleep.”

Kendra:

Oh, that’s good news for a side sleeper over here.

Dr. Brent Morris:

Absolutely.

Kendra:

So how about lifting or carrying a child? Or carrying a heavy purse?

Dr. Brent Morris:

Similarly, that comes up a lot there Kendra. And the joke I make with a lot of awesome grandparents is that, “Don’t worry, I won’t blame it on your grandchild.” Because someone will sheepishly admit, they’re like, “Gosh, I was holding my two-year-old,” and I have one of those, so I feel for them, I understand.

Kendra:

Same.

Dr. Brent Morris:

But their two-year-old grandchild … Exactly, so you know.

Kendra:

Yeah.

Dr. Brent Morris:

And it definitely can make your shoulder sore, there is no doubt. Especially if you’re holding a child the bulk of the day. I mean, there’s no doubt. And the same with the heavy purse. But it would really be a reach … Kind of usually that reach, like if you’re in the driver seat and you’re reaching back into the back seat to get a heavy purse, heavy book bag, heavy something.

Kendra:

Oh, okay. That makes sense.

Dr. Brent Morris:

That’s a no-go. I do not like that move, that can be very painful. I recommend just kind of going to the back seat, that way.

Dr. Brent Morris:

But as far as lifting a child, a similar thing, it’s pretty rare for me to see somebody get injured and need a surgery or something like that. But it certainly can exacerbate some underlying shoulder issues. There’s no doubt.

Kendra:

Okay. Yeah. That makes sense.

Kendra:

When do folks know, “I can treat this at home,” or, “I definitely need some kind of intervention or professional treatment?”

Dr. Brent Morris:

I mean, I think a lot of that is mechanism dependent, meaning if you fall off a ladder, there’s a deformity. Yeah. For sure. But if it’s like, “Gosh, it’s just been a little sore. I’ve been exercising more frequently. I’m doing something new and different.” Those folks I usually say, “Hey, kind of cool off. Ice it. Rest it. Give it some time. Anti-inflammatories, Tylenol, these kinds of things.

Dr. Brent Morris:

But the pop, pow, “Something is different. I’m weak. My arm is profoundly weak.” Those are the ones, sooner rather than later and you need to get in. But the ones that are kind of wear and tear, you know, “Gosh, it’s been hurting me for a few months,” I think it’s maybe making some adjustments that way, modifying your activities. But obviously on the shoulder, elbow front and orthopedic front, we’re always happy to help.

Kendra:

Yeah.

Kendra:

You mentioned on those wear and tear cases that you typically try to go through the procedures of a non-surgical treatment first and look at other options. What role does PT play in these kinds of cases, if any?

Dr. Brent Morris:

Physical therapy is huge. I mean, they’re kind of our right hand. I mean, the therapists are phenomenal, that we get to work with. And the goal of therapy is really to just put the shoulder in a position of optimal function. Sometimes I tell folks they have a limp. We say that with legs all the time, or ankle injuries, “You’re limping.”

Dr. Brent Morris:

The shoulder you can mask that limp. And Ben Kibler, one of our kind of legends of orthopedics, and here locally, that talks about that, scapular dyskinesis. So we call that a limp, where the shoulder is just in an improper position to function properly. And the therapist can really help with that. And it takes a lot of buy-ins. It takes buy-in, the surgeon understanding what can respond to therapy, the therapists clear. But also from the patient just saying, “I believe this will work,” and we know those folks can do well.

Kendra:

Yeah. We’re really outlining the patient journey here, from how it happens, to your non-surgical options. Let’s look now at the surgical option. For a patient whose maybe exhausted at home or alternative therapies, or had one of those acute incidents, and is a candidate for surgery. What does that surgery look like? What’s the process from injury to recovery?

Dr. Brent Morris:

Yeah. So, for example, an acute rotator cuff tear, those usually heal up quite well. They’re way different than the ones that have been brewing for years and years. And so those, we usually get to the repair more quickly. It’s minimally invasive surgery. Still pretty big recovery, there’s no doubt about that. They’ll be in a sling for about three weeks and then physical therapy will start after that. The healing time, that’s the kicker. The healing time takes about three months. Just like a broken bone, the rotator cuff tendon to heal down against the bone takes about three months. And so, then we can start strengthening. So it’s kind of a five to six month “full recovery”. But most folks can tell the difference pretty early.

Dr. Brent Morris:

Now, contrast that with a fracture. Somebody has a bad elbow fracture, humeral fracture, proximal humeral fracture. Those, they’ll take three months to heal. But the therapy can be pretty aggressive, even in the sort of four to six week phase. So they can tell a big difference pretty quickly, that they went from having an arm that was kind of floppy, not functioning at all, to now they’re kind of put back together, if you will.

Kendra:

Wow. How about joint replacement or total shoulder replacement? Walk us through that and how that looks like for someone who gets to the point of needing a total shoulder replacement.

Dr. Brent Morris:

Yeah. So, great question. And a really big part of my career is dealing with primary shoulder replacements, meaning the first time around. And sometimes being that surgeon available if someone’s had one in the past and trying to help out with we call a revision shoulder replacement.

Dr. Brent Morris:

So a lot of those are through arthritis. No different than hips and knees. But we don’t walk on our shoulders, right?

Kendra:

Right.

Dr. Brent Morris:

So they’re just not quite as common. But some injuries can predispose you to developing arthritis of your shoulder. Or those rotator cuff tears we talked about that are quite common, some can develop really big rotator cuff tears, and they get to where they can’t lift their arm and they get arthritis too. So their rotator cuff is gone and they have arthritis. So those are good candidates for reverse shoulder replacement, which is another type of shoulder replacement.

Dr. Brent Morris:

And so we still try to exhaust conservative measures, resting it, safe medicines. Some types of therapies can help, obviously you can’t overcome the joint being extremely arthritic. But once they’ve kind of exhausted those things, and a lot of times their X-rays and CT scans kind of tell the story pretty well. And a lot of people are very stoic, I mean they can go quite a long time with this severe shoulder arthritis, which is amazing to me. But then it gets to a point where it’s too painful, they can’t sleep at night, the pain’s too much, and the function is so poor. So it’s a very gratifying operation, to really be able to restore folks.

Kendra:

Oh, sure.

Kendra:

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Kendra:

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Kendra:

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Kendra:

We’re back with orthopedic surgeon Dr. Brent Morris.

Kendra:

What does life look like for someone after joint replacement? Are they back to good as new, or do they have lifelong limitations to preserve that joint?

Dr. Brent Morris:

Yeah. I mean, for the most part, we let folks kind of get back to life. We try to avoid heavy labor, so a lot of heavy overhead lifting. Some folks come in and powerlift or something, I’m talking heavy weight lifters, that their shoulder joints just wear out. So those folks we’re just honest with and say, “It’s probably not a good idea to put that metal and plastic through those kinds of loads.” But as far as even light lifting, tone, reps, these kinds of things, we still encourage folks to kind of get back in the game a little bit. Not as much with contact sports, obviously. For replacements you worry about fracturing, things like that, if they have a big trauma.

Dr. Brent Morris:

But it’s such a gratifying thing, and I tell folks, “The main three goals, really, are pain relief, pain relief, pain relief.” That’s what we want to focus on. If somebody doesn’t have that much pain even if they have a bad looking X-ray, we can kind of keep on keeping on. But if it’s to the point where their pain is severe, their arthritis is severe on X-ray too, that it’s very reasonable and a lot of people can tell a big difference in short order, they’re like, “Wow, I’m so glad I did this, because now I can actually lift my arm again.” So it’s a big change.

Kendra:

Wow. That’s fantastic.

Kendra:

How long does a shoulder replacement typically last? Is that a lifelong thing?

Dr. Brent Morris:

We’re looking at this a lot. So couple of responses there. The anatomical total shoulders, kind of the way God built us, with a metal ball and a flat plastic piece, those we have pretty good data. So those, historically, fail at about a rate of 1% per year. Meaning, if you had the total shoulder for 30 years, there’s still a 70% chance that you’re pretty happy with the shoulder and it’s still doing well.

Kendra:

Wow.

Dr. Brent Morris:

Yeah, so the anatomical’s can be pretty good.

Dr. Brent Morris:

Now, we know if you put it in a young patient, young being usually less than 50, or even someone in their early 50s that’s really going to use it a lot. That’s probably different. They may wear it out a little bit sooner. And then the other one is the reverse shoulder, which has only been in the United States since 2004. So obviously, even if you put one of the first one in in the country, you’re only about a 16 year long process.

Dr. Brent Morris:

And so we’re actually in the process with my Houston team, where we were before, and we’re actually presenting it here soon, on our 10 year data. So 10 years of after reverse in America, one of the largest and longest series of reverses in our country at least, as opposed to France where they’ve done it longer. But really happy actually at the 10 year data. So 10 years and counting, at this point.

Dr. Brent Morris:

So most people, I think, tell folks, “10 to 15 years,” feel pretty confident about that. But we’re hopeful that the long-term data will be even more, giving folks 20, 25 years, depending on when they get it done.

Kendra:

Yeah, well that’ll certainly be interesting to follow along with.

Kendra:

Before we move further on to discuss arthritis and then to look at elbows, let’s talk about prevention. So as far as those wear and tear injuries, obviously the acute injuries may be more sudden, you may not have so much prevention. But as far as the wear and tear injuries, can you comment on the everyday activities, or the weight lifting, or the exercise, anything activity of this nature that would cause that repetitive movement and have the potential for overuse. What are some of your best tips on how to do that safely? How someone can protect their shoulders, and how to prevent those wear and tear injuries as best they can?

Dr. Brent Morris:

Yeah, I think those are all great points and great questions there Kendra. So, I think, the joints we do know with good science, the joints throughout our body love to be loaded. They love to be used, you know?

Kendra:

Yeah.

Dr. Brent Morris:

And that’s our goal as orthopedists, is to give people the ability to move. Even if you fix a lot of our fractures, we still want to load the joint and move the joint so they don’t get stiff. And it’s always this tightrope act. And so, it’s kind of one of those too much of a good thing. So weight lifting, in general, is great. But if you push your body beyond what limits it can handle, then it can work the other way.

Dr. Brent Morris:

Similar with CrossFit-type exercise. Years ago, I treated so many injuries from CrossFit-type injuries that I was a little skeptical about the types of demands that were put on the body. But I’ll tell you, for the last many years now, I’ve actually participated. My joke is I’m one of the only probably shoulder and elbow surgeons that actually does CrossFit, which is probably not accurate. I mean, there may be thousands, who knows. There just aren’t many of us.

Dr. Brent Morris:

But I’ll tell you, a lot of the folks I’ve worked with really emphasize form over heavy weights and things like that. And so I think you can kind of ruin any good form of exercises, just like you can make it proper and healthy. And so I’ve been really pleased with that experience, because I do think cardio work for our general health is great, but also some weight lifting to help load our joints. And some of those Olympic-type lifts can be helpful. But even things like push-ups, pull-ups, sit-ups, it’s hard for me to kind of complain that those are harmful to me, as long as they’re done in moderation.

Dr. Brent Morris:

So, I’ve been happy with patients that participate in these things and like you say, I’m kind of biased in that way. Right? I don’t see all the happy, healthy customers, I see the patients that come in who’ve been injured from doing some of these forms of weight lifting. They’re actually quite uncommon. And usually most folks kind of admit, “Gosh, I just went too heavy. I did too many of that thing.” And so-

Kendra:

Yeah. That makes sense.

Dr. Brent Morris:

Yeah. So I think ways to protect it are being aware of them and kind of giving the shoulders some attention, and elbows as well. And really a lot of our repetitive overusing is actually, unfortunately, our younger athletes with throwing. So we’re also having to … There’s a lot of good public health site stuff out on that already and continuing. Just to remind our young throwers that throwing should not be a painful thing, and if it’s painful that we need to shut the arm down and let them have a chance to recover.

Kendra:

Yeah. That makes sense.

Kendra:

Well now, let’s look at arthritis. We talked a little bit about this in the shoulder. This is a condition a lot of people are familiar with the term. But most of us, probably, like we said, don’t consider it in our shoulder and elbow. How common is arthritis in those areas?

Dr. Brent Morris:

Yeah. So, great question. So, again, since we don’t weight-bear or put our weight [inaudible 00:23:31] our full body over our hips and knees, we don’t do that over the shoulder and elbow. So I would say, the elbow is far less common than even the shoulder. So we’re taking the shoulder which is kind of secondary, tertiary, to the behind the hips and knees. But the elbow is even further behind. So osteoarthritis would be the most common that we talk about, kind of wear and tear.

Dr. Brent Morris:

So mostly the shoulder joint, we call that the glenohumeral joint. But it is quite common to get acromioclavicular joint arthritis, or AC joint arthritis. And that’s actually common and pretty asymptomatic. So when a lot of people say, “Oh I have arthritis in my shoulder. Somebody looked at my X-ray and said I have arthritis in my shoulder,” often they’re referring to the AC joint. Which honestly, is actually okay. Most people get arthritis there, and it’s mostly asymptomatic, meaning they don’t feel it. Whereas the shoulder joint itself, when it gets arthritic it’s not subtle. I mean, they know, popping, catching, big bone spurs inside the joint.

Dr. Brent Morris:

And then you contrast that with rheumatoid arthritis, which is not as common now because it’s so well-treated. Or at least, maybe the ill-effects are not as common, because our rheumatologist and primary care doctors are so good at treating it and the medicines have improved. But that can impact. Inflammatory arthritis can impact the shoulder and elbow joints as well, but it seems to show up a lot in the elbow. So the elbow is definitely not as common and often can be treated, fortunately conservatively, avoiding surgery of the elbow. Although elbow replacements are performed.

Kendra:

For people who aren’t maybe familiar with arthritis, what are some of the symptoms they should look for? Is it a stiffness or a frozen feelings?

Dr. Brent Morris:

That’s a good point. So, you can get a frozen shoulder without the arthritis. But if you’re getting kind of popping, clicking, catching, pretty robust. Not just, “Oh, I can pop my shoulder.” But like, “Wow, I’m very stiff,” and it kind of catching up with you really over years, then that’s more the arthritis kind of pathway. If it’s, you wake up, shoulder’s very irritated, painful, and it just came on out of nowhere, that’s probably a true … We call idiopathic frozen shoulder, which is different.

Dr. Brent Morris:

But yeah, they’re definitely very stiff and painful, a lot of night pain. And no different than the hip and knee arthritis for the folks that really experience that. It’s just that we can mask it a lot better with our shoulder, some people just won’t use that arm as much. Whereas with our legs, we have to use them to get around.

Kendra:

Right. You mentioned that arthritis is pretty well-treated, how do you treat arthritis?

Dr. Brent Morris:

Well it’s pretty well-treated with surgical intervention, yeah. So perhaps, maybe rheumatoid arthritis we have good medicines for, and the hope is that we’ll eventually have good medicines for osteoarthritis, and that would be an absolute game changer. Somebody’s going to win a Nobel Prize right now, working on that right now just to cure the ails of the world, because it’s so common. But the key is, we can really deal with it effectively once it’s kind of too far down the road. So we do have a good surgical solution. But yeah, prevention would be far better.

Kendra:

Gotcha. Yeah.

Kendra:

Well let’s jump on into elbows then. And before we get serious about elbows, tell us about the funny bone. Why is it called the funny bone and why does it hurt so bad when you hit it?

Dr. Brent Morris:

Yeah. So, the funny bone, the humerus, longest bone in the upper part of the body. And on the inside of your elbow, you’ve got a little place, a little bony bump called the medial epicondyle. God is a pretty smart guy, and right behind that medial epicondyle, what it’s protecting, is there’s a little groove there for the ulnar nerve. And so what you’re doing when you bump that … And we’ve all done it, feels terrible. Now you’re bumping that ulnar nerve and it sends shooters, usually down your fourth and fifth digit, your small fingers. That’s what you’re hitting. So you’re actually, literally, hitting a nerve when you bump it right there. You can actually palpate your own ulnar nerve there, just kind of rest behind that bony bump on the inside of your arm. And it is not fun.

Kendra:

Gotcha.

Kendra:

Well, let’s talk about tendonitis in the elbow. I think sometimes this is more commonly referred to as tennis elbow. Is this one of the more common elbow injuries that you see?

Dr. Brent Morris:

Absolutely. So there’s two varieties. One is on the outside of your elbow, called tennis elbow, or lateral epicondylitis. One is on the medial side, or inside of your elbow, kind of like we were just talking, and that’s golfer’s elbow or medial epicondylitis.

Dr. Brent Morris:

So, extremely common. In a given day I’ll see lots of folks with this. It’s very irritating, it’s painful, and it takes a long time. It can take up to one year of conservative measures to get it better. Rarely does it ever need surgery. Sometimes a shot will help and some modifications that way, and therapy’s a huge help. But it’s very, very common.

Kendra:

Hmm. It doesn’t only affect people who play tennis or golf though, correct? I mean it’s more colloquial name.

Dr. Brent Morris:

Yeah. Absolutely. Really, I’m not a big fan of those names because it’s rare how I ever see a tennis player with an actual tennis elbow and vice versa, because it can go both ways. And it’s a bit of a misnomer as well, because it’s not really a true tendonitis, where the true nerves out there, the histopathology of it, or whatever. It’s really kind of a tendon gone bad, rather than an inflamed tendon. But the name tendonitis has stuck, which is implies that the tendon has inflammation. And usually an inflammation gets better with anti-inflammatories and medicines. And this one’s just different, it’s just that kind of tendon wears down over time. But it still can improve on its own, which is pretty remarkable.

Kendra:

Yeah, that’s amazing. Our bodies are pretty awesome things.

Kendra:

What exactly does that feel like, the tendonitis in your elbow? What might someone experience symptomatically?

Dr. Brent Morris:

Yeah. So, a lot of it’s point tenderness. I mean, I can just feel that very spot and they know exactly where it’s going to be. And any time they grasp coffee cup, their purse, their laptop bag, whatever. Now, anytime you engage those extensor tendons when you extend your wrist, when you think about it, when you grab something your wrist extends and so it really lights that area up.

Dr. Brent Morris:

So yeah, it’s kind of point tenderness at that very spot.

Kendra:

That makes sense.

Kendra:

Say someone is really conservative in their resting and they’re taking measures to really recoup that area of tendonitis. Can it recur? Is this something that they would continually need to be cognizant of and careful to avoid?

Dr. Brent Morris:

So it can, but usually recurrences is probably less common. Once folks really kind of fight through that initial period, which again, can be six months to a year, it’s a very long time. But we know that about 95+% get better. So once they kind of have the confidence to know, “Okay, this thing will go away.” Sure, it can come back, especially if they go back to some of the similar activities, but it’s not as common.

Kendra:

Well, here’s something that caught my attention as I was reading and preparing for our conversation today. That even reading a book could potentially cause an elbow condition. Keeping your elbows in a bent sitting position for too long could lead to a cause of ulnar neuritis, or inflammation of the ulnar nerve, which could lead to numbness, weakness of the fingers and hands.

Kendra:

And I read that it’s a lot more common these days because of our habits with cell phones, unfortunately. Probably even more commonly in the last couple of months, with everyone isolating at home.

Kendra:

It’s a tingly feeling, I read, in the pinky and the fourth finger. What more can you tell us? And is this something that we should be concerned about with our current state of society?

Dr. Brent Morris:

Yeah. Good question. Maybe we should all be spending more time at the Red River Gorge and less time on our phones, how about that?

Kendra:

How about that.

Dr. Brent Morris:

So, all of us are probably guilty of that, spending a lot of time indoors, especially during this COVID-19 pandemic. But yeah, that’s interesting how a lot of common activities can really … That lead to that ulnar neuritis. Most of us have probably felt that. That’s where you kind of … The same thing, the funny bone, it’s the same nerve. But it especially … And I’ve seen this too, if you’re especially laying flat. So you’re sitting in bed and you’re reading an iPad over your head or a book over your head, it’s just … Yeah, bending in that flexed elbow position can really irritate that nerve. Certainly if you hit it on something too.

Dr. Brent Morris:

But yeah, just being cautious and most of those kinds of things I would put in the camp of: Modify your activity. Read a different way. Take breaks. Certainly never want to discourage reading though, that’s pretty awesome. But maybe some of the other tablet-based activities, just being cautious. Kind of in a more ergonomic way, if you will.

Kendra:

Yet another reason to put your phone down.

Dr. Brent Morris:

There you go. Absolutely.

Kendra:

Well, it is summertime, and injuries like this obviously can occur at any time of the year, but do you typically see more instances of shoulder and elbow injuries as people are spending more time outdoors, playing sports and being physically active?

Dr. Brent Morris:

Yes, certainly. And I’ve talked to a lot of colleagues, with our hip and knee colleagues as well, especially with ACL injuries, and those things with the knee. We do know that with schools,

we have not been doing a lot of summer sports during the pandemic, that some of those injuries have gotten better. Which is obviously good news, we don’t want people to get hurt. But we want them to stay active and do the things they enjoy.

Dr. Brent Morris:

So certainly, there’s more people are active, bikes, other things too, that can be a common reason for injury, especially in the shoulder and elbow. So, yes, certainly more activity can lend to that, especially with better weather and more people being outdoors.

Kendra:

Yeah.

Kendra:

I would imagine that strains, sprains and breaks are something you see a lot of in your practice. We’ll start with breaks. That’s pretty self-explanatory, but I did find this interesting, I read that trampolines are the number one cause of elbow fractures in children. Do you see much of this? Do you see many children in your practice? And if someone breaks an elbow early in life, say on a trampoline, or from falling off a bike, can that person expect a greater incidence or a risk of arthritis or difficulty later in life?

Dr. Brent Morris:

Yeah. All great questions. Again, kind of what we said with heavy weight lifting, or CrossFitting, or whatever. Everything kind of in moderation. But even despite best efforts, accidents happen unfortunately. And then can be pretty severe. But more so during my time at Vanderbilt, at the children’s hospital, did we see obviously a lot of trampoline injuries at the children’s hospital.

Dr. Brent Morris:

So I do see … Actually, on the older side of children at this point. More in the 12, 13 and above. So not seeing as much of the smaller children, as far as the breaks of the elbow go, but those are still quite common. And if they’re fixed and treated, not all of them need surgery, but if they’re fixed or do well with casting, not necessarily destined to have arthritis in the elbow. Some of them that are extremely challenging may be a little bit higher risk for development of arthritis over time, but for the most part, on the type of elbow fractures that kids have, they’re not in the joint, for the most part. And so, they actually do really well.

Kendra:

Okay. Great.

Kendra:

Well, let’s transition now to sprains and strains. What do listeners need to know? What might cause a sprain? Or what might indicate that they have a sprained elbow?

Dr. Brent Morris:

Yes. So these would usually be a load to the elbow. It could be repetitive overuse as far as throwing, things like that. But often a sprain is going to be a fall. Somebody falls, they land awkwardly, fortunately they didn’t break their elbow, but the ligaments did take the blow. Always say, “Somebody has to lose,” you know? Especially if you dislocate your elbow, dislocate your shoulder. Either the soft tissue, somebody has to stretch, strain, sprain, tear, or the bones have to break.

Kendra:

Yeah, that makes sense.

Dr. Brent Morris:

So sometimes all of the above happens, unfortunately. But the sprain and strain would imply that the bones held, but the soft tissues did not. So those are ones where resting, icing, kind of immobilizing for a period to kind of get a feel for things. And if it’s still kind of unsteady or not working quite right, then obviously that’s a good time to get in and see an elbow expert.

Kendra:

Yeah. That’s a good nod to the acronym RICE that we all have probably heard growing up.

Dr. Brent Morris:

Yeah. You bet.

Kendra:

Rest, ice, compress, and elevate.

Kendra:

Will strains cause long-term issues that need attention? Or are these pretty easily treated and then you move on?

Dr. Brent Morris:

Most of them you treat and move on. I mean, sometimes if you keep hitting the same spot with a specific activity, repetitive activity, it can catch up with you. But for most kind of activities of daily living and things like that, once we’re kind of back in the game, good.

Dr. Brent Morris:

Now, the higher-level athletes and workers that are doing very specific duties, sometimes can still tell over time. But for the most part we can get those better and kind of get people back to life.

Kendra:

Yeah.

Kendra:

Was there anything else that we haven’t covered today, that you’d like to share or tell our listeners about?

Dr. Brent Morris:

No, just really appreciative of the opportunity, Kendra.

Kendra:

Of course.

Dr. Brent Morris:

It’s a real pleasure to share on some of these topics. And certainly want to be available to folks that need help on the shoulder and elbow front, that we kind of see from sprains and strains up to fractures and replacements and even revision replacements. So that’s kind of our passion and surrounded by an incredible group of colleagues in the orthopedic department here at Baptist. And just a really incredible support group in our office and all the different ancillary support and other providers and practitioners we get to work with.

Dr. Brent Morris:

So really amazing family to be a part of. And yeah, thanks for the time.

Kendra:

Well if you’re up for it, before I let you go today we’d like to play a little game of rapid fire Q&A to help our listeners get to know you a little better. Are you down for it?

Dr. Brent Morris:

That sounds great. Absolutely.

Kendra:

Okay.

Kendra:

Are you a morning person or a night owl?

Dr. Brent Morris:

Morning.

Kendra:

Tea or coffee?

Dr. Brent Morris:

Coffee.

Kendra:

Yes.

Kendra:

What’s the best book you’ve ever read?

Dr. Brent Morris:

The Bible.

Kendra:

Yes.

Kendra:

What is something you like to do to spend time with your kids?

Dr. Brent Morris:

Be outdoors. So they’re into sports and playing tag and wrestling. They love to wrestle, especially my four-year-old son. So we do a lot of wrestling. So, just anything they want to do, we’re up for.

Kendra:

Mine are into the wrestle phase right now too.

Kendra:

What is your favorite restaurant in the Lexington area?

Dr. Brent Morris:

Oh, great question. That’s a tough one. We really like … I probably can give a top five list.

Kendra:

Go for it.

Dr. Brent Morris:

But I really like OBC Kitchen, Coles. Those have been some of our longtime favorites.

Kendra:

You’ve got good taste.

Kendra:

All right. Last, but not least: What is your favorite Bible verse or quote that you live by?

Dr. Brent Morris:

Oh.

Kendra:

I know. Lot to choose from there.

Dr. Brent Morris:

That’s a good one. Was it Matthew … May botch it, we just wrote it down for our kids recently. I think it was Matthew 7:12, basically the Golden Rule. That’s the Golden Rule. I may have misquoted it but, “Do unto others as you would have them do unto you.”

Dr. Brent Morris:

Yeah, I think it’s a great way to remind ourselves to be kind and recognize who we represent. Not just our family and children and coworkers, but we represent our faith and just to be kind to people and give them the benefit of the doubt and put the shoe on the other foot.

Kendra:

That’s exactly right.

Kendra:

Well Dr. Brent Morris, it’s been an absolute pleasure having you on the show today. Your expertise in the area of shoulders and elbows is quite evident and we feel very fortunate to have you as part of the Baptist Health family.

Kendra:

If someone is seeking orthopedic care or would like to make an appointment with you, how could they get in touch with your office?

Dr. Brent Morris:

Yes, so our office line. We have one appointment line, they try to make it as smooth as possible. It gets you directly to a person, so it’s (859) 899-7950. And we try to be available. In surgery a couple days a week and then clinic three days a week. But really try to get folks in same day when possible, especially if they have an acute injury. So we really just try and accommodate and get folks in and look forward to helping out anyway we can.

Kendra:

Perfect. Well thank you again, it’s been really good to talk to you.

Dr. Brent Morris:

Awesome. Thank you so much.

Kendra:

Thanks so much for tuning in today. I hope you found my conversation with Dr. Morris helpful and informative. If you enjoyed today’s show, hit the subscribe button so you won’t miss an episode. And if you’re not already, follow along with us on Facebook, Instagram, and Twitter for the latest Baptist Health news and updates.

Kendra:

We’ll see you again next time on HealthTalks NOW.

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