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How to Explain Rotator Cuff Pain & Tears to Patients, in a Very Simple Way
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How to Explain Rotator Cuff Pain & Tears to Patients, in a Very Simple Way
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Language: EN.
Segment:0 .
Hello, my friends, how are you? This is me, Dr. Sergio, here from São Paulo, Brazil. And in this video, I'm showing you a very, very interesting lecture about how to explain rotator cuff pain and rotator cuff problems to our patients in the office. This is a very nice way of explaining this common problem in a very easy language, with a very easy way.
So I hope you'll like it. Feel free. My good orthopedic surgeon, friend, or even physical therapist, to use not only these ideas, to explain this problem to our patients, in your respective offices, but also to use some of my images if you feel comfortable with that. So I hope you like it. Please don't forget to subscribe to the channel or show it to your friends.
Leave your comment. Give us your thumbs up, and let's see the video. So let's talk a little bit about cuff tears and frozen shoulder, which is something I deal with almost every day. So what is there? Can I? Can I go, please? OK, so so what is the rotator cuff? Well Uh, I'm just I'm just going to talk very shortly about anatomy, I'm talking not to doctors, to population, but let's understand just very simple aspects of anatomy.
The shoulder is a very complex joint that has three bones. This is the scapula, that are in the back. We have the clavicle, the collarbone, here, and this is the humerus. And whenever we elevate our shoulder, the humerus slides over scapula like a ball and a socket. As I'm going to show it now. So how does the shoulder moves? How do we elevate the arm?
So the shoulder is nothing but a joint as a ball and a socket. So what we are going to see, here, is a shoulder on the right side and a ball and a socket, and the shoulder elevates exactly as a ball riding upon a socket. So when we see this small video, which is very easy to understand, the scapula, here, on the left, is the socket , in a special part of the scapula, on the articulation of the shoulder, which is called glenoid.
No, no one has to figure on anatomical names just on the idea. And the humerus, which is the bone of the arm, it has, literally a ball, which we call the head, and this is the ball. So whenever we move our shoulder, this is what we are having. Ok? a movement from a ball over a socket that can put the shoulder in any, any place that we wish.
And first of all, what is a tendon ? So let's understand what is a tendon, so a tendon is a structure that literally. I'm sorry. I'm sorry, I'm sorry. So the tendon is a structure that literally connects a muscle to a bone. So let's understand the idea, the muscle is the one that generates power, that generates strength.
And the tendon is the structure, as I'm going to show you, guys, that transfers such power to bones and finally with bones, we can have our movements. So this is the easiest way to understand what is a tendon. I have a car, I have, I would say, a simple car, and I have a trailer, and I want the trailer to move. ,So the muscle is the car, the muscle is generating energy.
And the trailer is the bone, is what we need to move. But someone has to make the connection of the muscle to the bone, and is the hitch. So this is the tendon. The tendon is the structure that transfers energy from the engine, which is the muscle, to the trailer, which is the bone. So this is a muscle, a tendon and a bone.
This is a femur, but it doesn't matter. What matters is the idea. So this is the best way, in my mind, to understand what is a tendon, in a very simple way. So the engine is the muscle. Yeah, so the muscle generates energy. The trailer is the bone, is the bone that we want to move, and the hitch of the car is the tendon. So the tendon is the structure that transfers energy and load to the bone.
In the shoulder, we have a tendon ?? Yes, we have a group of tendons that help us to elevate the shoulder and move the shoulder. And this is so the rotator cuff, so the rotator cuff is a group of four tendons. They work together, allowing the shoulder to move. And all of the movements we can do to elevate our shoulders, to put our hand in the bag to pick up any object and rotate externally, they can only happen because of the rotator cuff.
And when can we have problems with the rotator cuff? So what we have to understand is that most of the problems of the cuff, see, we specialists we don't say rotator cuff, we usually say cuff. OK, so all of the problems with the cuff are very strongly in a relation to aging. So what happens to rotator cuff tendons as we get old, especially after 40 - 45 years old ?? So this is a fine way to understand.
So this is Arnold Schwarzenegger. This is Conan the Barbarian. It was a very important guy, when I was a child, in 10 year old,12-year-old. I'm talking about 1985, 1987. I was crazy about Conan, the Barbarian, because he was very strong, very resistant, and so this is a funny way to tell you that, until 35, 40-year-old, rotator cuff is a very resistant structure.
People, boys. This is something the general population doesn't know. Uh, 25-year-old boy, he can break the femur, he can break the leg, he can break the arm, he can break the spine. But it's very unusual to break the rotator cuff because it is extremely strong. But even Conan the Barbarian gets old and he loses resistance, and you see everybody gets old and become weaker.
So the rotator cuff after, 40 / 45, it's the opposite. It is super resistant when we are before 35, before 30, but after 40 - 45 it becomes a very fragile structure. And this is why we call it the weak link of the shoulder. I repeat, the weak link of the shoulder. And still, as we get old, many bone spurs can appear all over the human body, and also in the shoulder, and obviously they can bother the rotator cuff tendon.
But let us understand what is a bone spur, because everybody says, oh, I have a spur in my back, I have a spur in my heel. And I have the heel pain, which is called, in the foot plantar fasciitis. Everybody talks about it, the patients. But what is a bone spur? So let's understand what is a bone spur. So it seems difficult, but I'm going to show it, and it will become very simple to comprehend.
So bone Spurs are bony projections that appear in bony edges where bones should not be. And they are relating to joint degeneration in the knee, in the spine and also in the shoulder. Let make it very simple to understand this is a skeleton, and I am looking to a skeleton, from the lateral side. So let's take a closer look in the spine. This is the lumbar spine, a very, very young lumbar spine, with absolutely no problems, when I look at the lumbar spine.
Let's take a look at the lumbar spine in the lateral X-ray. We are seeing the same thing. And absolutely no spurs. I'm going to show you now. So this is absolutely a normal spine with no degenerative things. But let's see what happens in a very old lady. What can happen in a very old lady in the same x ray ? Absolutely different.
So we have spurs appearing in the bone in the bony edges of the vertebra. So this is a spur. And this is a spur, so they are bony projections that should not be there, but they happen because of aging. So let's compare, there is no bone, here, in front of the vertebra, because there shouldn't be, but, with aging, then we see a spur. So these are spurs, that we call osteophytes.
So let's see again, this is a very old spine with a lot of spurs. So this is the original bone. This is the bone that was done by nature and the very normal vertebrae. But these extra bone, here, this is the spur. OK, so this is a bony spur that we call bony osteophyte. and such bone spurs, they appear in the shoulder and they can bother the rotator cuff.
So this is a very normal shoulder. This is the rotator cuff, a group that four tendons that work together, there is a bone inside the rotator cuff, which is called acromion, it is part of the scapula, but, in this case, I see no spur. So there is no contact, no abnormal contact of the acromion with the rotator cuff, only physiological contact. Physiological means, in medicine,
what is normal, Pathological means what's not normal, and related to diseases. So here I see no spur, and this is another shoulder in which I can see, here, a spur, which is damaging, as a knife, so to say, the rotator cuff, and he's impinging upon the rotator cuff. And this is why we call the problem impingement syndrome. So this is a normal shoulder in the left, absolutely no spurs, and this is a right shoulder with a spur
Completely different scenario. So in the right, in the left side, no bone is going to bother the tendon, on the right side, this hooked bone can really bother the tendon. And what such spurs they do, over the shoulder, in front of this bone, which is named acromion ?? They can compress the rotator cuff, and this is why we call impingement. They can cause inflammation, some weakness,
and when these things become very chronic, ultimately, a rupture of the tendon can appear. So this is the usual scenario when we are very young. Our tendon is very good. We are young. We have a lot of resistance and still I am 25. I am 30. I am even 35. I have no Spurs.
So a good tendon. A young tendon. No spurs. So as a rule, my rotator cuff will be OK. This is obviously a big tendency. I see people with 32, with 28-year-old with problems in the rotator cuff. Yes, I do. I do this for 16 years, but it's really not common.
OK, so as a rule, this is the scenario rotator cuff problems they are not about to happen, in these moment of our lives. But what happens as we get older, especially plus 45-year-old ? Now the tendon is not so good, not so good quality. And still, I'm going to have those spurs, which can be small, which can be big. It depends on every case. And so when we do these mathematical accounts with the spurs, ultimately we can have a tear, a rupture of the tendon.
OK, so this is a rotator cuff tear, a rupture in the tendon, which is caused by weakness, because of aging, together with all of this spur, that is impinging and acting, let me use the word, as a knife, cutting the tendon. It's not the best way to explain, but it's very easy for general population to understand. So again, here I see. A normal tendon on the left and a tendon with a rupture on the right side. So how can the problem present in a clinical point of view?
Well, see. Uh, as I always say to my friends, doctors, medicine is not black and white, medicine is Fifty Shades of gray. Like the book? Ok? it's a funny way, but it's a very serious way of making doctors understand. So we have the black, we have white, and we have many scenarios in between.
So things start with inflammation of the tendon, and after that, we can have very small tears that can become big tears. So the thing is, see, there are different kind of tears. But this is something that I don't think is needed to explain, in very technical terms, what is a small tear, a bursal tear, a pasta lesion and an intrasubstantial tear.
This is something for the doctor to understand until you have a big tear. And what does the patient feels? This is important for the general population to figure. So the clinical scenario is very typical. OK, so we have some symptoms that are very typical. So first of all, rotator cuff tear leads to a pain in the lateral side of the shoulder, and a pain in the anterior part of the shoulder, in front of the shoulder, as we elevate.
In the middle of the movement of elevation, we have a lot of pain. This is a tendency, this is what we call the Neer's ARCH, but this is very technical. What I want people to understand is that in this space, 3 dimensionally, is where we will classically have pain. This is not mandatory, but is a huge tendency. And this is another important thing. When we look at the arm from the shoulder to the elbow, we always divide the arm in three pieces, in three parts, that we call thirds.
This is the proximal third. This is the middle third, and this is the distal third. So as a rule, rotator cuff pain will happen in the proximal third and in the middle third, in a way that, in the proximal and middle third, the patient will have pain, and, in the distal third, close to the elbow, rotator cuff pain usually doesn't happen. I'm not saying that this happens all of the time, but it happens in the vast majority of the cases.
And still, night pain is very common. So I have pain in my shoulder, I have difficulty to sleep. I need to find a position, and, until I do not find a position, it bothers me too much, and I wake up in the middle of the night. This is very common. So how do we do a diagnosis of rotator cuff tears and inflammation? Well, the diagnosis is super clinical.
A good doctor must have all of the understanding of how the disease work, in his mind, and then, depending on a very well-done consultation and medical history, and then the doctor will start to understand what the patient has. And then he must do a very physical examination and, see, this is not done in five minutes. This is done in never less than 15, 20 minutes and I take sometimes 25 minutes.
I know that we are having less time to talk to our But Doctor Sergio, we would. I would definitely want to say that your slides are really so self, so easy to understand. And the way you're going up, despite the fact that you're from Brazil, it's really, really good to know. And I think the viewers are already finding it very nice. So we are looking forward to more from your.
But I can I continue? Of course, you can. OK, I still have 20 minutes to talk. OK, something like that. So see. So the diagnosis is clinical and the doctor must do a well-done medical history and a well-done physical examination. People need to understand the diagnosis is never in
the MRI, is in the doctor's mind. Once the doctor understand the problem in his mind, once he does a well done medical consultation and a physical examination. And when he will ask for an MRI ? It depends on the clinical picture. This is a decision done in the office. So whenever we think I have a clinical suspicion of a rotator cuff tear, then I will ask for an MRI very rapidly for people to understand.
I have a 42-year-old man, and, in the physical examination, it's very clear that there is only inflammation, and not a cuff tear. I do a clinical diagnosis, and I'm not going to ask for an MRI. Whenever I have a 70- 80-year-old lady, who, for six months, she cannot elevate the shoulder. Very typical physical examination. I'm going to ask for an MRI, and it depends on case by case. How do we treat these cases?
The answer is, well, it depends. If I have only inflammation, if I have a small tear or if I have a big tear. Whenever I have only inflammation, the extreme majority of the cases will not need surgery, I repeat, non operative management is the super rule. I do this for 16 years. Surgery is a super exception, super exception.
We do a lot of things, physiotherapy, injections in the shoulder, strengthening. And so on. We can treat these cases for about two to three months. And they get really better. The extreme minority of such cases are to be operated. I operate one case of inflammation, I would say in a year max, sometimes zero, and I see a lot.
So the extreme majority will not need surgery. But I have small tears. Many of such tears will heal without surgery, but some, in many I will do physiotherapy, injections, strengthening, but some I will have to operate. I operated in 15 January, January this year, a 35-year-old lady with a small tear. She was unable to do anything, for five years, and I operated her, and she she's already in the gym, four months post-op.
So we have indications for partial cuff tears. But this is not for us to discuss here. This is something very technical to be discussed case by case in the office with a very good specialist. And big tears, I would say in theory, all of them need surgery. They cannot heal without surgery, and the vast majority of them will have lovely outcomes. The only thing is that I could spend 10 hours talking about this, but let me talk two minutes.
The thing is, many times you cannot operate big, big tears because the patient has a lot of co-morbidities. She's 80 years old. She has Alzheimer. She has not balance, She follows a lot, she had She already had two heart attacks, She had a stent in the heart. She has uncontrolled diabetes, so it's all a clinical scenario.
And what we call the personality of the lesion. I never see a knee in my office. I see a patient who has clinical comorbidities. He has a heart. His emotions, his family, his fears and his expectations. So we must put all of this together to take a decision whenever to operate or not. How is the surgery? This is a photo of myself.
11 years ago I was quite younger, but and with many less wrinkles in my face, by the way. This is a right shoulder. The surgery happens when we are looking to a monitor, so take a look. The shoulder is here, but my face is looking to the monitor and this is what we call arthroscopy. Very small incisions in the shoulder. Take a look.
The shoulder is here, But my eyes are in the monitor, so my hands are in the shoulder and my eyes are in the monitor. On the camera, and you'll see I am discussing with the other surgeons what to do and this is how we do the surgery. So my friends, I hope you like it and please don't forget, subscribe. Leave your comment.
Give us your thumbs up. Feel free to use all of these ideas and images you have just seen to explain this problem to your patients in your office, and we see each other in the next video. As Dr. Sergio always says, and we always keep saying, never stop flying. See you, my good friends, folks.
Segment:0 .
Hello, my friends, how are you? This is me, Dr. Sergio, here from São Paulo, Brazil. And in this video, I'm showing you a very, very interesting lecture about how to explain rotator cuff pain and rotator cuff problems to our patients in the office. This is a very nice way of explaining this common problem in a very easy language, with a very easy way.
So I hope you'll like it. Feel free. My good orthopedic surgeon, friend, or even physical therapist, to use not only these ideas, to explain this problem to our patients, in your respective offices, but also to use some of my images if you feel comfortable with that. So I hope you like it. Please don't forget to subscribe to the channel or show it to your friends.
Leave your comment. Give us your thumbs up, and let's see the video. So let's talk a little bit about cuff tears and frozen shoulder, which is something I deal with almost every day. So what is there? Can I? Can I go, please? OK, so so what is the rotator cuff? Well Uh, I'm just I'm just going to talk very shortly about anatomy, I'm talking not to doctors, to population, but let's understand just very simple aspects of anatomy.
The shoulder is a very complex joint that has three bones. This is the scapula, that are in the back. We have the clavicle, the collarbone, here, and this is the humerus. And whenever we elevate our shoulder, the humerus slides over scapula like a ball and a socket. As I'm going to show it now. So how does the shoulder moves? How do we elevate the arm?
So the shoulder is nothing but a joint as a ball and a socket. So what we are going to see, here, is a shoulder on the right side and a ball and a socket, and the shoulder elevates exactly as a ball riding upon a socket. So when we see this small video, which is very easy to understand, the scapula, here, on the left, is the socket , in a special part of the scapula, on the articulation of the shoulder, which is called glenoid.
No, no one has to figure on anatomical names just on the idea. And the humerus, which is the bone of the arm, it has, literally a ball, which we call the head, and this is the ball. So whenever we move our shoulder, this is what we are having. Ok? a movement from a ball over a socket that can put the shoulder in any, any place that we wish.
And first of all, what is a tendon ? So let's understand what is a tendon, so a tendon is a structure that literally. I'm sorry. I'm sorry, I'm sorry. So the tendon is a structure that literally connects a muscle to a bone. So let's understand the idea, the muscle is the one that generates power, that generates strength.
And the tendon is the structure, as I'm going to show you, guys, that transfers such power to bones and finally with bones, we can have our movements. So this is the easiest way to understand what is a tendon. I have a car, I have, I would say, a simple car, and I have a trailer, and I want the trailer to move. ,So the muscle is the car, the muscle is generating energy.
And the trailer is the bone, is what we need to move. But someone has to make the connection of the muscle to the bone, and is the hitch. So this is the tendon. The tendon is the structure that transfers energy from the engine, which is the muscle, to the trailer, which is the bone. So this is a muscle, a tendon and a bone.
This is a femur, but it doesn't matter. What matters is the idea. So this is the best way, in my mind, to understand what is a tendon, in a very simple way. So the engine is the muscle. Yeah, so the muscle generates energy. The trailer is the bone, is the bone that we want to move, and the hitch of the car is the tendon. So the tendon is the structure that transfers energy and load to the bone.
In the shoulder, we have a tendon ?? Yes, we have a group of tendons that help us to elevate the shoulder and move the shoulder. And this is so the rotator cuff, so the rotator cuff is a group of four tendons. They work together, allowing the shoulder to move. And all of the movements we can do to elevate our shoulders, to put our hand in the bag to pick up any object and rotate externally, they can only happen because of the rotator cuff.
And when can we have problems with the rotator cuff? So what we have to understand is that most of the problems of the cuff, see, we specialists we don't say rotator cuff, we usually say cuff. OK, so all of the problems with the cuff are very strongly in a relation to aging. So what happens to rotator cuff tendons as we get old, especially after 40 - 45 years old ?? So this is a fine way to understand.
So this is Arnold Schwarzenegger. This is Conan the Barbarian. It was a very important guy, when I was a child, in 10 year old,12-year-old. I'm talking about 1985, 1987. I was crazy about Conan, the Barbarian, because he was very strong, very resistant, and so this is a funny way to tell you that, until 35, 40-year-old, rotator cuff is a very resistant structure.
People, boys. This is something the general population doesn't know. Uh, 25-year-old boy, he can break the femur, he can break the leg, he can break the arm, he can break the spine. But it's very unusual to break the rotator cuff because it is extremely strong. But even Conan the Barbarian gets old and he loses resistance, and you see everybody gets old and become weaker.
So the rotator cuff after, 40 / 45, it's the opposite. It is super resistant when we are before 35, before 30, but after 40 - 45 it becomes a very fragile structure. And this is why we call it the weak link of the shoulder. I repeat, the weak link of the shoulder. And still, as we get old, many bone spurs can appear all over the human body, and also in the shoulder, and obviously they can bother the rotator cuff tendon.
But let us understand what is a bone spur, because everybody says, oh, I have a spur in my back, I have a spur in my heel. And I have the heel pain, which is called, in the foot plantar fasciitis. Everybody talks about it, the patients. But what is a bone spur? So let's understand what is a bone spur. So it seems difficult, but I'm going to show it, and it will become very simple to comprehend.
So bone Spurs are bony projections that appear in bony edges where bones should not be. And they are relating to joint degeneration in the knee, in the spine and also in the shoulder. Let make it very simple to understand this is a skeleton, and I am looking to a skeleton, from the lateral side. So let's take a closer look in the spine. This is the lumbar spine, a very, very young lumbar spine, with absolutely no problems, when I look at the lumbar spine.
Let's take a look at the lumbar spine in the lateral X-ray. We are seeing the same thing. And absolutely no spurs. I'm going to show you now. So this is absolutely a normal spine with no degenerative things. But let's see what happens in a very old lady. What can happen in a very old lady in the same x ray ? Absolutely different.
So we have spurs appearing in the bone in the bony edges of the vertebra. So this is a spur. And this is a spur, so they are bony projections that should not be there, but they happen because of aging. So let's compare, there is no bone, here, in front of the vertebra, because there shouldn't be, but, with aging, then we see a spur. So these are spurs, that we call osteophytes.
So let's see again, this is a very old spine with a lot of spurs. So this is the original bone. This is the bone that was done by nature and the very normal vertebrae. But these extra bone, here, this is the spur. OK, so this is a bony spur that we call bony osteophyte. and such bone spurs, they appear in the shoulder and they can bother the rotator cuff.
So this is a very normal shoulder. This is the rotator cuff, a group that four tendons that work together, there is a bone inside the rotator cuff, which is called acromion, it is part of the scapula, but, in this case, I see no spur. So there is no contact, no abnormal contact of the acromion with the rotator cuff, only physiological contact. Physiological means, in medicine,
what is normal, Pathological means what's not normal, and related to diseases. So here I see no spur, and this is another shoulder in which I can see, here, a spur, which is damaging, as a knife, so to say, the rotator cuff, and he's impinging upon the rotator cuff. And this is why we call the problem impingement syndrome. So this is a normal shoulder in the left, absolutely no spurs, and this is a right shoulder with a spur
Completely different scenario. So in the right, in the left side, no bone is going to bother the tendon, on the right side, this hooked bone can really bother the tendon. And what such spurs they do, over the shoulder, in front of this bone, which is named acromion ?? They can compress the rotator cuff, and this is why we call impingement. They can cause inflammation, some weakness,
and when these things become very chronic, ultimately, a rupture of the tendon can appear. So this is the usual scenario when we are very young. Our tendon is very good. We are young. We have a lot of resistance and still I am 25. I am 30. I am even 35. I have no Spurs.
So a good tendon. A young tendon. No spurs. So as a rule, my rotator cuff will be OK. This is obviously a big tendency. I see people with 32, with 28-year-old with problems in the rotator cuff. Yes, I do. I do this for 16 years, but it's really not common.
OK, so as a rule, this is the scenario rotator cuff problems they are not about to happen, in these moment of our lives. But what happens as we get older, especially plus 45-year-old ? Now the tendon is not so good, not so good quality. And still, I'm going to have those spurs, which can be small, which can be big. It depends on every case. And so when we do these mathematical accounts with the spurs, ultimately we can have a tear, a rupture of the tendon.
OK, so this is a rotator cuff tear, a rupture in the tendon, which is caused by weakness, because of aging, together with all of this spur, that is impinging and acting, let me use the word, as a knife, cutting the tendon. It's not the best way to explain, but it's very easy for general population to understand. So again, here I see. A normal tendon on the left and a tendon with a rupture on the right side. So how can the problem present in a clinical point of view?
Well, see. Uh, as I always say to my friends, doctors, medicine is not black and white, medicine is Fifty Shades of gray. Like the book? Ok? it's a funny way, but it's a very serious way of making doctors understand. So we have the black, we have white, and we have many scenarios in between.
So things start with inflammation of the tendon, and after that, we can have very small tears that can become big tears. So the thing is, see, there are different kind of tears. But this is something that I don't think is needed to explain, in very technical terms, what is a small tear, a bursal tear, a pasta lesion and an intrasubstantial tear.
This is something for the doctor to understand until you have a big tear. And what does the patient feels? This is important for the general population to figure. So the clinical scenario is very typical. OK, so we have some symptoms that are very typical. So first of all, rotator cuff tear leads to a pain in the lateral side of the shoulder, and a pain in the anterior part of the shoulder, in front of the shoulder, as we elevate.
In the middle of the movement of elevation, we have a lot of pain. This is a tendency, this is what we call the Neer's ARCH, but this is very technical. What I want people to understand is that in this space, 3 dimensionally, is where we will classically have pain. This is not mandatory, but is a huge tendency. And this is another important thing. When we look at the arm from the shoulder to the elbow, we always divide the arm in three pieces, in three parts, that we call thirds.
This is the proximal third. This is the middle third, and this is the distal third. So as a rule, rotator cuff pain will happen in the proximal third and in the middle third, in a way that, in the proximal and middle third, the patient will have pain, and, in the distal third, close to the elbow, rotator cuff pain usually doesn't happen. I'm not saying that this happens all of the time, but it happens in the vast majority of the cases.
And still, night pain is very common. So I have pain in my shoulder, I have difficulty to sleep. I need to find a position, and, until I do not find a position, it bothers me too much, and I wake up in the middle of the night. This is very common. So how do we do a diagnosis of rotator cuff tears and inflammation? Well, the diagnosis is super clinical.
A good doctor must have all of the understanding of how the disease work, in his mind, and then, depending on a very well-done consultation and medical history, and then the doctor will start to understand what the patient has. And then he must do a very physical examination and, see, this is not done in five minutes. This is done in never less than 15, 20 minutes and I take sometimes 25 minutes.
I know that we are having less time to talk to our But Doctor Sergio, we would. I would definitely want to say that your slides are really so self, so easy to understand. And the way you're going up, despite the fact that you're from Brazil, it's really, really good to know. And I think the viewers are already finding it very nice. So we are looking forward to more from your.
But I can I continue? Of course, you can. OK, I still have 20 minutes to talk. OK, something like that. So see. So the diagnosis is clinical and the doctor must do a well-done medical history and a well-done physical examination. People need to understand the diagnosis is never in
the MRI, is in the doctor's mind. Once the doctor understand the problem in his mind, once he does a well done medical consultation and a physical examination. And when he will ask for an MRI ? It depends on the clinical picture. This is a decision done in the office. So whenever we think I have a clinical suspicion of a rotator cuff tear, then I will ask for an MRI very rapidly for people to understand.
I have a 42-year-old man, and, in the physical examination, it's very clear that there is only inflammation, and not a cuff tear. I do a clinical diagnosis, and I'm not going to ask for an MRI. Whenever I have a 70- 80-year-old lady, who, for six months, she cannot elevate the shoulder. Very typical physical examination. I'm going to ask for an MRI, and it depends on case by case. How do we treat these cases?
The answer is, well, it depends. If I have only inflammation, if I have a small tear or if I have a big tear. Whenever I have only inflammation, the extreme majority of the cases will not need surgery, I repeat, non operative management is the super rule. I do this for 16 years. Surgery is a super exception, super exception.
We do a lot of things, physiotherapy, injections in the shoulder, strengthening. And so on. We can treat these cases for about two to three months. And they get really better. The extreme minority of such cases are to be operated. I operate one case of inflammation, I would say in a year max, sometimes zero, and I see a lot.
So the extreme majority will not need surgery. But I have small tears. Many of such tears will heal without surgery, but some, in many I will do physiotherapy, injections, strengthening, but some I will have to operate. I operated in 15 January, January this year, a 35-year-old lady with a small tear. She was unable to do anything, for five years, and I operated her, and she she's already in the gym, four months post-op.
So we have indications for partial cuff tears. But this is not for us to discuss here. This is something very technical to be discussed case by case in the office with a very good specialist. And big tears, I would say in theory, all of them need surgery. They cannot heal without surgery, and the vast majority of them will have lovely outcomes. The only thing is that I could spend 10 hours talking about this, but let me talk two minutes.
The thing is, many times you cannot operate big, big tears because the patient has a lot of co-morbidities. She's 80 years old. She has Alzheimer. She has not balance, She follows a lot, she had She already had two heart attacks, She had a stent in the heart. She has uncontrolled diabetes, so it's all a clinical scenario.
And what we call the personality of the lesion. I never see a knee in my office. I see a patient who has clinical comorbidities. He has a heart. His emotions, his family, his fears and his expectations. So we must put all of this together to take a decision whenever to operate or not. How is the surgery? This is a photo of myself.
11 years ago I was quite younger, but and with many less wrinkles in my face, by the way. This is a right shoulder. The surgery happens when we are looking to a monitor, so take a look. The shoulder is here, but my face is looking to the monitor and this is what we call arthroscopy. Very small incisions in the shoulder. Take a look.
The shoulder is here, But my eyes are in the monitor, so my hands are in the shoulder and my eyes are in the monitor. On the camera, and you'll see I am discussing with the other surgeons what to do and this is how we do the surgery. So my friends, I hope you like it and please don't forget, subscribe. Leave your comment.
Give us your thumbs up. Feel free to use all of these ideas and images you have just seen to explain this problem to your patients in your office, and we see each other in the next video. As Dr. Sergio always says, and we always keep saying, never stop flying. See you, my good friends, folks.
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