S02_E18 - Shoulders, Elbows, Knees, and the "Funny Bone"...

Speaker 1: 0:00

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Speaker 2: 0:04

Welcome to the Healthy Matters podcast with Dr. David Hilden , primary care physician and acute care hospitalist at Hennepin Healthcare in downtown Minneapolis, where we cover the latest in health healthcare and what matters to you. And now here's our host, Dr. David Hilden .

Speaker 3: 0:21

Hey everybody, it's Dr. David Hilden, your host of the Healthy Matters podcast. Welcome to episode 18. Here in Minnesota, most of us are soaking up every last little bit of our most precious summer. And for many of us, this is the most active time of the year. And while that's almost always a good thing, it does open us up to the possibility of injury. But what exactly is, say golfer's elbow, what's tennis elbow and why do so many people end up with shoulder injuries? Well, today we're gonna get to the bottom of some of these more common injuries that interrupt our summer fun. Hopefully come up with some options for ways to prevent them altogether. Joining me today are orthopedic surgeons, Dr. Jackie Geisler, who specializes in hands, and Dr. Nancy Luger, who specializes in sports injuries. So one we hear about all the time, Dr. Geisler is tennis elbow, what is it?

Speaker 4: 1:12

Yes. Tennis elbow goes by two names. It goes by tennis elbow and it goes by lateral epicondylitis. So it's a common disorder on the outside of your elbow. It's pretty painful. It's a tendonitis or a tendinopathy, sometimes considered a degenerative condition, often seen for overuse and sometimes athletics as well. A misnomer, you do not need to be a tennis player to suffer from tennis elbow. So

Speaker 3: 1:37

Why is it called that?

Speaker 4: 1:38

Uh , 'cause it's common in tennis players with the overhead serves, they're doing that repetitive, actually wrist motion as well as the elbow motion that will really aggravate that the tennis elbow is a problem with actually the wrist extensors where they originate in the elbow. And so anything with that wrist extension can really aggravate that condition.

Speaker 3: 1:56

Is it common? I mean, even in non chemist players ,

Speaker 4: 1:59

It's so common. I , it's probably the number one condition I get stopped in the hallway for my colleagues to ask me about. Everybody has it. It doesn't matter if you're doing stuff for hobbies on the weekends, if you're an athlete, if it's part of your job. We see it a lot in manual laborers. We see it in people doing their everyday activities, cleaning their house, things like that.

Speaker 3: 2:17

And so, I know a guy works in the hospital with us. He swears he doesn't play tennis. His outside of his elbow has been hurting him for weeks, maybe even a month or two, and he doesn't know how he got it. So in addition to tennis and those things that you've mentioned, you can get it just from your normal life or from sports, totally normal. But what , what are you feeling? What does it feel like?

Speaker 4: 2:34

People complain that it feels like hot or even burning there. It's extremely , um, not only point tender, but almost burning when they move their wrist or do their elbow activities. And it's, it's right adjacent to that point of the elbow on the outside there.

Speaker 3: 2:49

So other than not doing the things that led to it mm-hmm. <affirmative> , is there anything people can do for it?

Speaker 4: 2:55

Yeah, there's lots of things you can do from it. So , uh, I will say you're onto something if it, if it hurts, don't do it is totally a treatment. We even put a name on it, it's called activity modification. It sounds super fancy, but the idea is , is you wanna pull back from your activities a little bit so that you can allow that area to rest and to heal. And then the treatment is, is, has so many options in part because they all work a little, but none of them will reliably cure your symptoms necessarily on their own. I

Speaker 3: 3:24

Love that activity modification, Jackie . That pretty much just means when it hurts when you do this, stop doing that. Yeah. You got it. So quit doing what you're doing. What makes it hurts? When do they need to see you? You're a surgeon. Yeah.

Speaker 4: 3:35

So I would say if it continues to get worse, instead of continuing to get better, despite the obvious home re remedies. So, you know, the first thing to do is to pull back on your activities. Usually people say like, when I do these three things, it's really painful. So scale back on that, do some rest. Ibuprofen, Tylenol over the counter , both help with pain and inflammation. Um, so those can be really helpful. You can even go on, this sounds ridiculous, but like, you can buy over the counter like armbands, you can like Google tennis elbow and they'll show you an armband that you can buy. You wanna be careful not to apply those two tightly to solve one problem and make a new problem. But if those things are really not serving to make you better, that's a great time to schedule an appointment with with a provider.

Speaker 3: 4:14

How long does it last? And , and , and let's say you don't do anything. I I'm just, okay. I stopped playing tennis, I stopped doing work at a jackhammer or whatever it was that caught brought it on. Mm-hmm . <affirmative> , how long can you expect it to still bother you?

Speaker 4: 4:26

Uh, in good news, 80% of people have their symptoms resolved by a year. But

Speaker 3: 4:31

That's the good news. That's

Speaker 4: 4:33

A long, I know I was blasted

Speaker 3: 4:34

Time.

Speaker 4: 4:35

I was being a little facetious. Yeah, it's, it's a difficult, difficult condition. Most people don't have their conditions last that soon. I think if you get on it right away and try to intervene and interrupt that cycle, you can shorten the course of it. But some people just have a really difficult time with it. It doesn't mean that it's not going to get better. It's just really difficult in the interim. Is

Speaker 3: 4:55

There a surgery that's helpful?

Speaker 4: 4:57

There is, but the good news is most people don't need the surgery. So just because you see a surgeon, don't be surprised if they have a whole menu of options that they offer to you before surgery. Surgery's really a last resort.

Speaker 3: 5:10

So maybe I'm not gonna make it as a Wimbledon champion , uh, with my tennis elbow, but I want to golf. I'm gonna win the US open golf tournament. What is golfer's elbow?

Speaker 4: 5:20

Yeah, good question. So that's basically a very similar condition on the inside of the elbow. So on the side of your elbow next to your body. And it's the same kind of idea, but using different muscles that aggravate the condition. And so that side , um, can feel like very similar, can be aggravated by similar but slightly different activities. Treatments are very similar. The one thing that's a little bit different is there's a nerve, your funny bone nerve is sitting right next to there , also known as your ulnar nerve. And that can be associated with the condition sometimes and that can cause numbness and tingling in your fingers. And so some people have those two conditions together.

Speaker 3: 5:56

Okay , so I can't let that one go. People do talk about the funny bone. Mm-hmm. <affirmative>, you called it a nerve. Tell us

Speaker 4: 6:02

About that . Oh yeah. So the funny bone, when you bang your elbow, you get that electrical shock

Speaker 3: 6:06

Hurts like a big dog hurt .

Speaker 4: 6:08

Yeah. We call it the funny bone. The bone it actually runs next to is called the humerus, which in my head the humorous is funny. And so I think that's probably how it got its name, but there's really nothing that that laughable about it. It really is sore.

Speaker 3: 6:22

Oh, it just like d when you get that dinger on the inside of your elbow, it's the worst

Speaker 4: 6:26

And it is the nerve that causes that problem that is really painful. So the,

Speaker 3: 6:30

The golfer's elbow, the tennis elbow or the medial and lateral epicondilitis, they're treated roughly the same, right?

Speaker 4: 6:38

Yeah, very similar treatments. So for example, we talked a little bit about some things you can do at home. So you can scale back on some of the activities that you enjoy. You can or that aggravate your symptom. You can take ibuprofen, take tenol, both two really great medications that you can get without a prescription over the counter . You can get what's called a counterforce band and that can help with uh, redistributing the stress that's on the area that hurts, which can be really helpful. A lot of people do benefit from an occupational or physical therapy course. It's conflicting whether that actually changes things. But what I find most helpful about that is they can serve as a bit of a coach to help you identify the activities that are aggravating your condition and help you understand where to scale back. They can continue helping you be active while also avoiding the things that are giving you trouble. And then there's more invasive treatment options as well. So injections can be very helpful and there's a variety of injections that can be useful. So steroids are pretty common. They seem to help in the short term , maybe not as much in the long term . There's some other options like you can inject some blood or you can use some p r p, platelet rich plasma has a little bit of evidence for it still sometimes in the experimental phase. But those are all things that can be helpful. And then of course if those things fail and your symptoms are really limiting, it could be that you need to see a surgeon and we could help you with that

Speaker 3: 8:00

Heat or ice, what should you use? Good

Speaker 4: 8:03

Question. So that's a pretty dynamic area right now. So I would say in general, ice is good when there's a component of inflammation and with the, the conditions that we're talking about, there's an understanding that they might actually be more degenerative than they are actually inflammatory. And so I would, this is the way I recommend it. I say try the ice and if it helps you feel better than that's what you're gonna use to help the pain. It may not overall help your condition necessarily get better faster or shorten your course reliably, but it's gonna help you feel better and tolerate those symptoms better. I like heat in the morning when you're a little bit stiff, warm it up a little bit just like a professional athlete, they're gonna warm up in the beginning and then they're gonna cool down at the end. But you wanna be careful that you don't, you know, immobilize or hold things still too long. 'cause that'll solve one problem and make a new problem. And we know that movement is important for healing.

Speaker 3: 8:56

Motion is the lotion, somebody is the lotion . Have you ever heard that one before?

Speaker 4: 9:00

Yes. Motion is the lotion. So

Speaker 3: 9:02

Why does it last so long? Well, you set up to a year. People with tennis elbow or golfer's elbow can be in pain. You don't wanna take like ibuprofen for a whole year, right? Yeah,

Speaker 4: 9:12

You don't. You don't. So I would say like if you're taking it more than on an occasional basis or if you're taking it around the clock, you know, three times a day, that's probably time for more focused treatment. So that's when I would see a medical professional. See if you're a candidate for an injection, that'll give you more localized anti-inflammatory and medical treatment to that area. And whether it's the anti-inflammatories that work or something else that can be really helpful. And then those treatments are more focal instead of being systemic or in your whole body. And that can make them safer.

Speaker 3: 9:43

Good tips about keeping your elbows , uh, healthy or what to do about 'em when you do have an injury to your elbows. That was Dr. Jackie Geiser. When we come back from a short break, I'm gonna shift to your shoulders and we're gonna talk about injuries to the rotator cuff and surrounding structures in your shoulder. That will be with Dr. Nancy Luger . We'll be right back.

Speaker 2: 10:05

You are listening to the Healthy Matters podcast with Dr. David Hilden. Got a question or comment for the doc, email us at Healthy matters@hcme.org or give us a call at six one two eight seven three talk. That's 6 1 2 8 7 3 8 2 5 5. And now let's get back to more healthy conversation.

Speaker 3: 10:27

And we're back and we're going to shift gears to the shoulder. Dr. Nancy Luger, another orthopedic surgeon colleague of mine in Hennepin Healthcare, does a lot of work with sports injuries and shoulders . So Nancy, first of all, what are the common shoulder injuries? And specifically, I guess on what I'm talking about is your rotator cuff .

Speaker 4: 10:44

So there are many injuries about the shoulder, but most people talk about the rotator cuff. And the rotator cuff is actually four tendons that are making up the rotator cuff. So collectively we call it the rotator cuff, but there are four tendons and there are different actions in the shoulder. And the shoulder is the most mobile joint in the body. So rotator cuff responsible for the movement of that shoulder. And

Speaker 3: 11:06

It's really, I've often found it a remarkable joint. And I'm not just saying that 'cause I'm talking to a shoulder surgeon, but you know, a lot of the, a lot of the joints kind of go in one direction, but this allows a baseball player to throw a , a , a ball a hundred miles an hour and allows us to do our shoulders and all these different directions. It's actually quite a remarkable structure, but it also means stuff can go wrong. So how do people injure their rotator cuff commonly?

Speaker 4: 11:32

So I'd say there's a couple ways. One, you can just have an acute trauma. You could , um, be riding on your bike real fast, hit a pothole, fall with your outstretched arm and have an acute event of your rotator cuff tearing a rotator cuff. I'd say most commonly we see as people age, their tendon qualities kind of change over time. The composition of the tendon changes over time and the more you recreate and do golf, tennis, upper extremity sports like swimming, volleyball, et cetera , you can injure or cause inflammation or damage to the rotator cuff. That way

Speaker 3: 12:06

Maybe you should just stop doing all those things and become a couch potato

Speaker 4: 12:10

That has consequences of its own. Dr. Den

Speaker 3: 12:12

<laugh> . I love that you gave that a little bit of thought before you answered that <laugh> . Okay, so I've had some injury or I'm a pitcher for the twins or whatever it is. Uh, what classic symptoms might I have? Uh, in a rotator cuff injury? In

Speaker 4: 12:25

A rotator cuff tear, it's often pain that radiates down kind of the outside of the arm, the upper arm , um, pain at night, very difficult times . Sleeping, sleeping on that side. Uh, pain with overhead, motion lifting overhead, so putting things in cupboards or um, if you work overhead like an electrician or something like that. Um, those are the most common things people complain about.

Speaker 3: 12:47

Just like one of our producers has a a tennis elbow. You are describing my daily life right now. So do you have any appointments coming up? I'm gonna come see you. I have exactly what you've just described. Pain overhead , um, especially at night. And how do I know? And I'm serious. I have all that right now. How do I know, how do I know if it's serious?

Speaker 4: 13:08

Um, I'd say, you know, the common things that you do for , uh, pain in your any joint is you rest it. You can , um, avoid things that really bother it or fancy term activity modification. You guys

Speaker 3: 13:21

Are buzz kills <laugh> , you know, you just, you have to stop doing all the stuff,

Speaker 4: 13:26

Take some anti-inflammatories, ice it, et cetera. But if it's unrelenting and doesn't resolve after your , uh, week or so of , um, trying to modify it, then we're always happy to see you in our clinic.

Speaker 3: 13:37

When do you need to get images and , and you know , or in non-medical terms, X-rays and the like. So

Speaker 4: 13:43

Usually when someone comes into our office we can see some things on x-rays. So we do a screening X-ray, it's bad enough to come see us in the office. So I'd say x-rays are usually a , a good initial assessment and then it's our physical exam or have you lost motion? Have you lost strength and did you have a real significant accident or something like that. That makes me concerned that you actually tore all the way through the tendon and now have a, a large rotator cuff tendon tear versus just irritation of the tendon. And then I would order an m r i .

Speaker 3: 14:12

Okay. So you've talked about tears and irritation , um, and there's four of 'em you said, I think you said there's four structures in there . Uh, can you tell if they're partially torn or they're ripped or they're completely disconnected? Um , can you , can the patient tell that? I know you can tell that with some of some

Speaker 4: 14:30

Procedures. Um , I think, you know, they can be equally as painful if there's a full tear or just irritation. So from a patient perspective, probably can't tell as much on physical exam if there is genuine weakness , um, that would make me highly suspicious that someone has a full tendon tear and that that tendon is no longer working

Speaker 3: 14:48

And they might not know they have that no , it would, would just hurt.

Speaker 4: 14:51

No . Correct.

Speaker 3: 14:52

So there's options for treatments, I take it there's non-surgical ones and probably surgical ones start with a non-surgical. What, what would you do to somebody once you've diagnosed this

Speaker 4: 15:01

Generally? Um, I think the vast majority of people get better with some form of physical therapy. And I think as Dr. Geisler said, I think of them as your coach. So some people need more coaching than others. So as far as how many visits you're gonna need, it's gonna be dependent on how much instruction you need. But they can teach you how to do , um, motion appropriately, make sure you maintain your range of motion and then show you how to like gradually strengthen all the muscles that are involved in the rotator cuff and the surrounding structures that can support the shoulder joint as well.

Speaker 3: 15:33

Can you hurt it or make it worse by doing that?

Speaker 4: 15:36

Generally you don't make it worse. People tend to stop if it's very painful and that's where your therapist can help you and get back to you and say, listen, this patient isn't doing very well, can you reassess? And that's when you would maybe lean towards imaging if they're not improving with therapy.

Speaker 3: 15:51

So when do you have to do surgery? Or I shouldn't maybe put it that way. When is surgery a good idea?

Speaker 4: 15:56

So again, when we think of um , rotator cuff tears, I'd say if there's a tear all the way through the tendon and you head a acute trauma, we often recommend surgery. That is a acute change in your rotator cuff tendon. If you have a kind of more of degenerative tear over time, you've gone through the full course of physical therapy, you've tried to ice it, rest it , et cetera , and you're still not getting to the point where you're back to the activities that you enjoy, that's when I would maybe have a discussion about the benefits of a surgery.

Speaker 3: 16:26

Okay. Now Dr. Geisler talked about a fairly long recovery course for some of the elbow tendinopathies. How long of a situation are we talking about with most rotator cuff problems?

Speaker 4: 16:38

I'd say it's pretty similar. I'd say most orthopedic injuries in general are 12 months. Um, I, I think everyone gets a little scared when they hear that, but when you think of how long you've been suffering and then you modify your activities kind of rest it , you get weak over time. So it just takes a lot to get your motion back. Then you have to get your strength back and you don't get strong overnight. It takes many weeks to get strong and then you haven't been in your sport or activities and then you have to go through your preconditioning of your sport back to your full competition.

Speaker 3: 17:12

Yeah, it is a long time, but that seems to be a consistent theme. You'd almost rather just like break a bone in half half and have you put some hardware in there and it'd fix it.

Speaker 4: 17:19

Still long recovery with that Dr.

Speaker 3: 17:21

Hilman . I know, I know <laugh> , but you can , you both orthopedic surgeons admit it. You like to put in hardware, don't you ?

Speaker 4: 17:28

Yes.

Speaker 3: 17:28

Yeah, they both said yes immediately. <laugh> <laugh> . Okay. Um , Dr. Luger, you do , uh, um, other sports injuries as well and I hear a lot, I hear about soccer players and in my age group I hear a lot about pickleball players and they're all coming up with a c l injuries. What's that?

Speaker 4: 17:46

An A C L injury is an injury to the ligament in the center of the knee. There is a couple ligaments in the center of the knee. Most people have heard of the A C L, which is the anterior cruciate ligament. There's also a P C L or posterior cruciate ligament. But the most common injury in soccer players, basketball players, cutting, pivoting, twisting sports is the a c l.

Speaker 3: 18:07

You know, I'm an , I'm an internal medicine guy, I'm like terrified of anatomy and scalpels and all that. But I do remember when and when we had to do , uh, an anatomy lab and the a c L is a thick short short but thick little ligament. How the heck can that thing pop or or break? I don't even get it. There

Speaker 4: 18:25

Are many ways you can do it, direct trauma, contact injury, but also it's a common non-contact injury where you just twist funny and you're, you're going in one direction, you twist, pivot, and your momentum's carrying you in one direction and you're trying to go another direction in it

Speaker 3: 18:40

And that one hurts and your knee maybe isn't stable. Um, what do you do about it?

Speaker 4: 18:44

What I think that most people should know is the classic presentation for an A C L is they twisted her to pop, they couldn't put any weight on it and their knee swelled up. You definitely wanna go see a , a physician at that point to have an evaluation after you see the physician, more than likely will get an M R I to confirm what that a c L looks like and then see if there's any other structural injuries to the knee.

Speaker 3: 19:07

Are you able to then surgically repair most of them?

Speaker 4: 19:10

So there's different treatments now , uh, historically there was a c l repair. Um, there is some traction on repairing acls, but they're very specific new literature on that. So that is kind of old school

Speaker 3: 19:25

Repairing them?

Speaker 4: 19:26

Correct. The gold standard is and still is reconstruction, remaking that ligament taking tissue from your body usually and putting in place where your ligament has been torn. Okay,

Speaker 3: 19:38

Where, where do you take it from in the body to reconstruct it?

Speaker 4: 19:42

You can take it from multiple places. You can take part of the quad tendon on the same knee, you can take part of the patellar tendon and you can take hamstringing tendons

Speaker 3: 19:51

And you can do without these

Speaker 4: 19:53

And you can do without these.

Speaker 3: 19:54

I always wonder who's the first first person that ever said, let's take a little bit out of a different tendon and like reconstruct and then you just sew it in place

Speaker 4: 20:02

And you sew it in place. There are some devices to use to hold it little

Speaker 3: 20:06

Well, you guys do cool stuff . Little fancy .

Speaker 4: 20:07

It's a little fancy <laugh> .

Speaker 3: 20:09

You know , you don't just like take a staple gun <laugh> and you do it that way. So those are a c l injuries and um , we've talked about your elbows and your shoulders. I'm gonna ask each of you in turn to tell me what else you are seeing in your practices. You're both or orthopedic surgeons at a big downtown hospital in Minneapolis and it's summertime. Jackie, what else are you seeing ? So

Speaker 4: 20:32

In the summer, anytime people in Minnesota are out active pickle balling, bicycling, whatever it is, they're vulnerable to both the sports injuries and the other injuries that you get from just like being active. So, you know, we do see a lot of fractures, wrist fractures, ankle fractures, those are pretty common. Um, tendonitis is pretty common. Carpal tunnel, everybody always seems to have that trigger. Fingers are also other things that are really common. There's a tendonitis called day cor veins tendonitis.

Speaker 3: 21:01

Can I ask you to say more about trigger finger? Because in my primary care clinic I see loads of people with this and it could be any one of these fingers where their fingers all kind of stuck

Speaker 4: 21:10

Bent. Yeah, it's very common and no one has ever heard of it until it happens to them. And then it's like common for us to see. But a new experience for the patient, it's where there is a little bit of a mismatch between your tendon and the , and the pulley system that it runs through, through the tunnel that it runs through and either the tendon gets a little big or that tunnel gets a little thickened and then the tendon wants to sort of not slide through that tunnel very easily. Kind of like a knot on your shoelace sliding through the eyelet. It'll go through, but it kind of pops back and forth as it does that.

Speaker 3: 21:42

That's a great way to put it. Can I ask you, Dr . Geister, how'd you get into hand surgery? Because you are specifically a surgeon of the upper body, the arms and the hands. Mm-hmm. <affirmative> , what drew you to that?

Speaker 4: 21:53

I just think it's super interesting. The anatomy is super complex. The breadth of what we do. There's so many conditions that affect the hand, and the hand is a little bit like the face, like it's very socially interactive and I just really love the interplay of the complex and the way we use our hands. And I just think it's a great specialty.

Speaker 3: 22:13

A pro tip to listeners, if you have a hand injury, you want to see a surgeon who specializes in hands. And I often recommend Dr. Jackie Geiser for just that purpose. Dr. Luga , you do a lot of sports injuries. How'd you get into that?

Speaker 4: 22:26

I love sports. I love talking about sports. I like watching sports, I like participating in sports and there's lots of cool tools and instruments in surgery for sports. Okay.

Speaker 3: 22:36

You said cool tools. Uh, do you get 'em at Home Depot or what are the coolest tools? <laugh>,

Speaker 4: 22:41

We do not get 'em at you .

Speaker 3: 22:42

Do . I bet you do. You go down to Home Depot and

Speaker 4: 22:45

We , we , I love Home Depot <laugh> . I know we do not get 'em at Home Depot. However, I will say that putting in traction pins, you do use the A drill Yeah . From Home Depot.

Speaker 3: 22:55

Yeah . So you guys break out the power tools in the , in the, in the surgery suite and you're putting in all this cool metal and stuff like that. Yes. Yep . Unbelievable. So let's talk about what people can do to avoid all these injuries. Dr. Luger, you start. So

Speaker 4: 23:07

I'd say it's very important that you have a proper warmup , uh, so that you get warm before you go to your , uh, extreme competition competition . Secondly, I think that it's important to recognize when you have some fatigue and that you take appropriate breaks so that you don't injure yourself because your form suffers or you can no longer do your amazing competition. Um, and then also a proper cool down . Make sure you that you stretch and maintain your nutrition and hydration and proper equipment. Make sure you're wearing proper footwear, et cetera , depending on what you're doing.

Speaker 3: 23:43

So after hearing all this, Dr. Jackie Geisler, maybe you can help me out with this one. Is exercise still a good idea?

Speaker 4: 23:48

Oh, it's fabulous. Yeah. I mean the , the benefits of exercise are never contested, but I do think, I spend a lot of time talking to patients about setting expectations for what kind of sporting is appropriate in their life. And so I think one of the things to just sort of pay attention to is make sure that you have appropriate expectations. If you're gonna pick up a new sport, say running, you don't wanna sign yourself up for a marathon in six weeks. You wanna start with something like a couch to five K program where you can really get your body in, in the movements, in the exercise, build up that strength, build up that endurance, try to listen to your body, respond to any new injuries or sore spots, and modify your techniques.

Speaker 3: 24:25

That's a great tip. I love the couch to five K. It probably doesn't happen over one weekend.

Speaker 4: 24:29

No, sure doesn't. It takes a lot of effort.

Speaker 3: 24:31

We have been talking about summertime injuries , sports injuries of the elbows and the hands and the knees and the shoulders with Dr. Jackie Geisler and Dr. Nancy Luger . They are colleagues of mine here at Hennepin Healthcare in downtown Minneapolis and a key part of our orthopedic surgery department. I do often tell people, if you need an orthopedic surgeon, you come to Hennepin Healthcare. If you happen to be in the upper Midwest, that's where you wanna go. Not only these two, but their whole team is simply the best in orthopedic surgery anywhere. So Jackie , Nancy, thanks for being on the show with me today. Thank

Speaker 4: 25:05

You Dave. Happy to be here. It's a pleasure.

Speaker 3: 25:06

Thank you both for lots of great information. Listeners. I hope you've picked up a thing or two and I hope you'll join us for the next episode. And in the meantime, be healthy and be well.

Speaker 2: 25:17

Thanks for listening to the Healthy Matters podcast with Dr. David Hilden . To find out more about the Healthy Matters podcast or browse the archive, visit healthy matters.org. You got a question or a comment for the show? Email us at Healthy matters@hcme.org or call 6 1 2 8 7 3 talk. There's also a link in the show notes. And finally, if you enjoy the show, please leave us a review and share the show with others. The Healthy Matters Podcast is made possible by Hennepin Healthcare in Minneapolis, Minnesota, and engineered and produced by John Lucas At Highball Executive Producers are Jonathan, CTO and Christine Hill . Please remember, we can only give general medical advice during this program, and every case is unique. We urge you to consult with your physician if you have a more serious or pressing health concern. Until next time, be healthy and be well.