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Managing Shoulder Issues After Breast Cancer Treatment
Ashish Khanna, M.D.
March 6, 2020

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Ashish Khanna, M.D., is a physical medicine and rehabilitation specialist at the Kessler Institute for Rehabilitation and part of the ReVital Cancer Rehabilitation Program. Dr. Khanna completed his residency in physical medicine and rehabilitation at the Kingsbrook Jewish Rehabilitation Institute in Brooklyn, NY, where he became interested in cancer rehabilitation early on. He completed his fellowship subspecialization in cancer rehabilitation at Medstar Georgetown University/National Rehabilitation Hospital in Washington, DC. He specializes in the treatment of people who have pain or functional issues as a result of cancer or cancer treatments, including people who have been diagnosed with breast cancer. This includes pain, shoulder issues, fatigue, joint pain from aromatase inhibitors, and other issues. He has lectured at numerous international conferences, has published peer-reviewed research on a variety of related topics, and is the co-author of an upcoming book on cancer rehabilitation.

Listen to the podcast to hear Dr. Khanna talk about:

  • the shoulder problems that can happen as a result of breast cancer treatment
  • links between lymphedema and shoulder problems
  • how shoulder problems can be managed
  • his top three tips for people who are having shoulder issues

Running time: 34:05

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Show Full Transcript

Jamie DePolo: Hello, welcome to the podcast. Our guest today is Dr. Ashish Khanna, a physical medicine and rehabilitation specialist at the Kessler Institute for Rehabilitation and part of the ReVital Cancer Rehabilitation Program. Dr. Khanna completed his residency in physical medicine and rehabilitation at the Kingsbrook Jewish Rehabilitation Institute in Brooklyn, New York, where he became interested in cancer rehabilitation early on. He completed his fellowship sub specialization in cancer rehabilitation at Medstar Georgetown University National Rehabilitation Hospital in Washington, DC.

He specializes in the treatment of people who have pain or functional issues as a result of cancer or cancer treatments, including people who have been diagnosed with breast cancer. This includes pain, shoulder issues, fatigue, joint pain from aromatase inhibitors, and other issues. He has lectured at numerous international conferences, has published peer-reviewed research on a variety of related topics, and is the co-author of an upcoming book on cancer rehabilitation.

Today he joins us to talk about shoulder issues caused by breast cancer treatments and how they can be managed. Dr. Khanna, welcome to the podcast.

Ashish Khanna: Thank you, thank you. I’m happy to be back.

Jamie DePolo: So we’re excited, or I’m excited anyway to talk about this, because shoulder issues are so prevalent among people who’ve been diagnosed with breast cancer. So I’d like to start to talk about the shoulder problems that you see in your practice. I mean, obviously there’s pain, there’s stiffness. Those seem to be the two big ones when I was doing my background research, but are there sort of sub categories within those two areas, and are there other issues that people need to know about?

Ashish Khanna: Yeah. I’m glad you’re bringing some attention to this topic because it’s a big one. It’s also under-recognized as well, which is understandable — most people have a lot going on, a lot to think about when they’re undergoing breast cancer treatments and things like that, so the shoulder kind of takes a back seat, which is fair enough. But eventually those kinds of things kind of... you know, the shoulder issues catch up to you.

But to answer your question, I would say pain and stiffness are probably the two most common things that happen as a result of treatment for breast cancer.

There are some other ones. There are some nerves that travel through the area. Some of them are important nerves, of course, the ones that control your hands and fingers that travel down your arm, and those travel through what’s called the brachial plexus. Those nerves travel through the axilla, the armpit area, down to your arm, and those are the nerves that control the sensation and the muscles of your hand and arm, of course, which are important. There are also some smaller nerves in that area, too, particularly if you have an axillary node dissection as part of your breast cancer treatments or if you had radiation — sometimes people have radiation to the axilla, or to the armpit area, to radiate some nodes.

Those patients are at a higher risk for shoulder issues, whether those are the musculoskeletal issues, meaning the more orthopedic type stuff with the muscles and tendons and bones, which, like you mention, are the stiffness and that kind of pain that we typically think of that goes with that. And then the other kind of pain is the nerve pain aspect of it. And like I said, if you had surgery in the axilla or if you had radiation, then some of those smaller nerves can be damaged. One of them is called the intercostobrachial nerve. You can try and spell that, I would try to, I could spell it for you. I’m sure you can probably Google it, and Google would be, “Did you mean intercostobrachial nerve?”

Jamie DePolo: Yeah, I assume that’s kind of… is that behind the armpit or…?

Ashish Khanna: It’s sort of in the armpit itself, and it runs down the bottom part of your arm.

Jamie DePolo: Okay.

Ashish Khanna: And that nerve is frequently — it’s actually right in the middle of your armpit, right where the lymph nodes are. So if you have a surgery, the node dissection where a lot of the nodes had to be removed, or you required radiation there, then a lot of times there’s no choice but that nerve has to be cut. And as a result, when the nerve gets cut, sometimes the end of it kind of balls up in this little onion-shaped structure, and we call that a neuroma.

And other times after a nerve’s been cut it just kind of sends these weird signals, like tingling and burning, tightness, sometimes on light touch you can feel these funny little things happening. We call that dysesthesias, that’s the medical word for it. But those kinds of things are common, and we call that intercostobrachial neuralgia. That’s one type of shoulder or arm pain.

But far more common than that — I just mentioned that because not a lot of people know about it — but far more common is the stiffness and the pain that you mentioned, particularly as it relates to the rotator cuff and all that kind of stuff, which I’m sure we’re going to get to.

Jamie DePolo: Yes. Yes. And I read that about 60% of people who are diagnosed with breast cancer have shoulder pain, so that’s a lot, that’s more than half.

Now, obviously you talked about surgery, specifically surgery that removes lymph nodes, can cause shoulder issues. I know some of the reconstruction procedures, especially if they’re the type of procedures that move tissue from another area of the body to rebuild the breast, those can cause shoulder issues. Are there others? You know, you mentioned radiation, but does chemotherapy, some of the target therapies, immunotherapies, is it basically all treatment has the potential to cause shoulder issues?

Ashish Khanna: I think the chemotherapy and things like that, those can cause all sorts of issues, so I would say the chemotherapy could possibly make the shoulder pain worse. But a much larger component of that would be what you mentioned first where the surgeries would sort of change the whole kinetic chain, or the way that you move, alter the way that you move. That’s the biggest cause of shoulder pain. So yeah, certain types of surgeries make you more prone to having shoulder problems.

If you think about how the shoulder itself works, you have the humerus, right? The arm bone, and that connects to the glenoid, which is where it meets, and that connection there, that joint there, that’s actually your shoulder joint. That, where your humerus meets your shoulder, is actually part of your scapula — so that bone on the back, on the back of your upper chest, the scapula. So the scapula rotates and it moves. It’s actual only role, really, is just as an attachment point for all sorts of different muscles.

One of the attachments of that is the pectoralis muscle, so we’ll start with that because they’re just — even amongst those common problems it’s probably the most common. And the pectoralis muscle, most people know it as the pec, it’s the muscle when you do a bench press or something like that. It’s a big, flat muscle right underneath the breast that’s adhered to your chest wall, so a lot of patients will have, for example, a tissue expander. The tissue expander is where you take a bag, basically, and you sort of peel the pectoralis off the chest wall and you slide that bag behind it, and then slowly over time you inflate it.

As you know, in most cases you can’t just put an implant where your natural breast once was, you need some sort of muscular pocket to put it in, so this is one of the most common ways, is to use the pectoralis muscle itself. But of course it’s naturally stuck to your chest wall, so we have to stretch that out slowly over time. So you fill that bag, and patients who’ve had this done already know this. You go back to the plastic surgeon after they have implanted that bag behind the pectoralis, and they slowly fill it with saline, water, and it gets bigger and bigger.

And then whenever you achieve the size of the implant that you want, you go back to surgery, they remove the tissue expander, that bag — they deflate it, remove it, and then they slide the implant in, in its place. And then the pectoralis muscle, that was the one attached to your chest, is now holding that implant in.

Jamie DePolo: Got it. I’m sorry to interrupt, I do have one question. I have read about a procedure where the implant is actually on top of the pectoralis muscle.

Ashish Khanna: Yeah.

Jamie DePolo: Is that any less likely to cause pain or shoulder issues, or is it just going to cause different kinds of shoulder issues?

Ashish Khanna: I would say it would certainly be less likely to cause a shoulder issue. Now the implant you’re talking about if people want to look it up, it’s called a prepectoral implant. Pre, like before or ahead of. It’s the prepectoral implant. You can certainly discuss that with the plastic surgeon. That’s a discussion you probably need to have with him or her, because not everybody… it’s not always a choice for everyone.

Jamie DePolo: Okay, so there are some other criteria that need to be considered.

Ashish Khanna: Yeah, for sure. Yeah. The size of the breast before the breast cancer surgery; if you had a lumpectomy, the size of the remaining breast tissues; and the size that you want your reconstructed breast to be, all those kind of things factor in whether a prepectoral implant would work for you or not.

Yeah. But they would have less. So the thing, I guess what I’m getting at, is that if you have the tissue expander, what that does is it stretches your pectoralis muscle, and the pectoralis muscle is attached to a couple different places on your chest. One is on your sternum in the center of the chest. The other one is it attaches to your clavicle, or the shoulder bone. Yeah, the clavicle there. And then the last place where it attaches is actually onto your arm. So if you lift your elbow up in the air and you grab that front part of your armpit, that’s actually the pectoralis muscle on its way traveling over and attaching to your arm. A lot of people don’t realize that.

So if you imagine that you take that flat muscle that’s attached to all those places and you pull it forward and you keep it pulled forward for weeks, what’s going to happen is it’s going to start tugging at those places where the muscle attaches. So up here on your collarbone it’s going to pull your collarbone down, and it has that attachment onto the humerus there, so you’re going to hold your arm down to your side, and basically, essentially you’re going to protract the shoulder, or you’re going to be hunched forward. It’s essentially what happens to a lot of people. As you stretch that pectoralis muscle, it causes the whole shoulder to kind of hunch down.

A couple problems with that. One is that your rotator cuff has to travel between your collarbone and the top of your humerus. There’s a particular rotator cuff muscle there called the supraspinatus, and it commonly gets squeezed. And we call that a subacromial impingement, or basically a rotator cuff tear.

So this kind of thing frequently causes rotator cuff problems, including rotator cuff tears and rotator cuff tendinopathies and things like that, because of the shoulder just being kind of hunched forward. The space where your rotator cuff usually exists between your collarbone and your arm becomes a lot more narrow once you’re hunched forward, and that can cause a whole bunch of different problems.

Another surgery that you mentioned would be the latissimus flap. That’s where you take the… instead of expanding the pectoralis, in this case you take a strip of the latissimus off your back, and it’s tunneled around forward and creates a little pocket and then you can place the implant behind that. So that causes perhaps less shoulder problems, but definitely creates shoulder problems in a lot of people, too, as a tradeoff of course. And the reason for that is the latissimus is a huge, powerful muscle of your back. It actually controls the scapula and stabilizes your scapula quite a bit, so you’ve got a loss of kind of scapular stabilization, your scapula kind of swings out, up and out, and that can also kind of squeeze the shoulder joint and cause rotator cuff problems. Not rotator cuff, tendinitis.

Jamie DePolo: Okay.

Ashish Khanna: And rotator cuff tears. Yeah.

Jamie DePolo: But it does sound like pretty much any type of breast cancer surgery or any type of reconstruction surgery has the potential to lead to a shoulder problem.

Ashish Khanna: Yup, I would definitely agree with that. Some more than others.

Jamie DePolo: Okay.

Ashish Khanna: Some almost all the time. With a tissue expander and those types of things, yeah.

Jamie DePolo: Okay. And I’m wondering, too, does the… after someone has surgery, the requirement is you can’t really use that arm much. So you’re not supposed to lift things, you’re not really supposed to move it around much. I know there are exercises that are given, very gentle stretching exercises to start with, but I’m wondering, does that lack of activity or lack of movement, does that contribute as well to any sort of shoulder issues?

Ashish Khanna: Yeah. Yeah, it definitely does. So basically what you’re talking about there is frozen shoulder, or the medical term for that is adhesive capsulitis. So basically we have the shoulder capsule, and the rotator cuff or tendons sort of get adhesed to each other, that’s why it’s called adhesive capsulitis, and the shoulder can freeze up.

I mean, basically the principle is that, you know, use-it-or-lose-it kind of thing. If you hold your arm down at your side all of the time for days, weeks, months, it’s going to be very difficult for you to move the arm above your head again, and that’s because the rotator cuff, if you don’t stretch out all of those muscles and don’t stretch your shoulder capsule, it starts to shrink down on you and you have a limited shoulder range of motion, and it will be painful to try to move it beyond a certain point.

A lot of times that’s reversible, so yeah, it’s better to address it early and doing those exercises to prevent frozen shoulder is definitely important. And there are a couple ways that you can do that and even know how to tell if you’re developing a frozen shoulder. A lot of people don’t realize that they might be developing one. One way I say is if you take your arms and you put them on your hips, you should be able to have your elbows where they’re totally out to your side. So if you put your hands on your hips and you find that your elbows are kind of pointing backwards and you have a tough time swinging your elbows forward, then that means that your shoulder capsule may be getting tight on you.

The other way to do it is to take your hands and kind of put it behind your head like you’re shampooing the back of your head, that kind of motion. You should be able to reach the back of your head. A lot of people can’t even do that, but if you can that’s good. A lot of people are going to swing their elbows forward when they… if they’re able to touch the back of their head they’ll do that. Really, you want to be able to touch the back of your head and you want to swing your elbows all the way back as far as you can, and that would be one type of stretch that you can do. If you have trouble doing those motions, then I would say almost certainly that you’re developing a bit of frozen shoulder.

Jamie DePolo: Okay. Now is lymphedema linked at all to shoulder problems, or is that sort of a separate issue in and of itself?

Ashish Khanna: Yeah, it is. Yeah, so shoulder pain, a lot of people with lymphedema, between half and maybe 70% of people with lymphedema report some sort of shoulder pain also. Part of the reason… there’s a couple different reasons. One is that if you have lymphedema, your arm is going to be heavy, so you have a lot of extra weight that’s kind of stressing the shoulder joint. Also, if your arm is heavy you tend not to use it as much. Of course if you have one arm that’s, you know, if you’re trying to reach something out of a cupboard, you’re more likely to use your other arm, so people end up using their lymphedematous arm a little bit less.

Also, with lymphedema, you have something that we call cording, or axillary web syndrome. I’m sure you probably talked about this in a previous podcast at least once or twice.

Jamie DePolo: Yeah, but just in case, could you explain what it is?

Ashish Khanna: Yeah, sure.

Jamie DePolo: Okay.

Ashish Khanna: Well actually, we don’t truly understand what it is. But we call it cording. What causes it or who gets it and why some people do and why some people don’t is, from my understanding, not totally clear. But you can correct me, maybe, I’m happy for somebody to educate me on that.

But it’s cording, it’s also known as axillary web syndrome, but basically, the understanding is that some of the vessels, perhaps some lymphatic vessels themselves, they start to sclerose, or they get hard. And then you don’t have to have lymphedema to have this, we think it is associated with lymphedema to some extent, but if you take your arm and you stretch it out above your head and you kind of feel under our arm in the armpit, sometimes some people can feel like a tight sort of cord or like a rubber band there, and that can sometimes be painful. It’s usually not really, really painful, but it’s like a rubber band that’s kind of keeping you from moving your arm all the way up above your head.

And that’s kind of a self limited problem, meaning it usually goes away on its own. You can massage it and actually, if you go to a lymphedema therapist they can help you. They kind of massage that cord out, and it can disappear over time, like I said, even if you do nothing.

And then another thing I’ll mention about that is a lot of people get nervous because they can hear it pop. So if you’re massaging it, and you have a cord and you kind of massage it a little bit for a few minutes every day, which is totally fine, and you hear that popping noise, or a popping sensation, then it’s important to know that that’s totally normal and you don’t have to worry about that. The cords do sometimes just kind of pop or rip, and that’s totally fine.

Jamie DePolo: Okay, that’s good to know. Now before we get to some treatments or stretches, or ways to maybe hopefully ease or prevent some of these shoulder issues, I’m curious: are shoulder issues more likely to happen pretty close to the treatment, so are they more likely to happen say in the couple months right after surgery, or can somebody go along and then all of a sudden maybe 2, 3, 4 years later develop some shoulder issues?

Ashish Khanna: Yeah. Yeah, that’s a good question. I would say both. In the acute, sort of postoperative period, there are going to be the instructions for a lot of patients to not move the arm. You’ve got to baby the arm in the beginning, and like I said, it’s one of those use it or lose it kind of things. You know, most people will start developing some degree of frozen shoulder by simply just always having the arm down at their side. So yeah, you definitely see it frequently after surgery.

If you’re talking years out, that’s also possible. One reason definitely would be radiation, so that makes me think of a lot of times when I see somebody who has shoulder problems that they had surgery years or even decades ago. If you have radiation, then you get what we call radiation fibrosis syndrome. And that’s after you have radiation to a tissue, slowly over time, meaning months to years, the tissue just sort of starts to harden over time, and that can cause a slow, sort of progressive tightening of the shoulder.

If you had the radiation to the chest wall, like a lot of people do, then your pectoralis muscle is under there, and the pectoralis muscle is, of course, going to receive some degree of radiation being right behind your breast after all. And it can start to sclerose and tighten up, and over the years people will start to have this stooped posture a little bit. Again, that can kind of cause rotator cuff problems and create a shoulder impingement that way.

Jamie DePolo: Well, and I think, too, as we all age, there’s the potential for arthritis just as the space, or the... what do I want to call it, the fluid in between the bones and the joints sort of goes away. And the covering of the bones wears away, so then you get kind of that bone-on-bone friction, too, which may have nothing to do with the surgery but I guess is a risk of aging.

Ashish Khanna: Yeah. No, that’s definitely true. Yeah, some people — and it depends. You know, they say a lot of times if you do a lot of overhead work or you use the shoulder a lot, you lift things for your entire career, then you take a lot of wear and tear on the shoulder regardless of breast cancer surgeries or regardless of what you had. Yeah, for sure.

Jamie DePolo: So, given all these various sort of concerning, and, to me, somewhat depressing things that we’ve talked about, how can we manage these shoulder issues, and is there a way to even prevent them, or if someone has to get them, can they be as minimal as possible? What can people do?

Ashish Khanna: Yeah, so the optimistic side of this is it is relatively easy to treat and prevent, so that’s the good news. So you mean like what kind of exercises can you do to stave off having some shoulder problems?

Jamie DePolo: I guess, yeah, like are there things that if somebody knows they’re going to have breast cancer surgery — say they’re going to have a mastectomy and implant construction, so the person knows they’re getting a tissue expander and then it’s going to be swapped out for the implant — are there things that could be done ahead of time to maybe make that area, the pectoral muscle in particular, as stretched out and as loose as possible? You know, is that a good idea, I guess that’s what I’m wondering?

Ashish Khanna: No, no, no, you’re right. That’s a great idea, because studies show that people who had shoulder problems going into the surgery are going to have worse shoulder problems when you come out on the other side. That’s definitely the case. So yeah, what you’re talking about now is something that we call prehabilitation, and that’s basically where you can optimize the shoulder prior to going into breast cancer surgery, and there are studies showing that that does make a big difference.

Where I work at Kessler in New Jersey, we have a program to do that, and there are a lot of other programs around the country to do that kind of prehabilitation. So you should ask your physicians about that for sure, and see what kind of… especially if you have shoulder problems already, it’s definitely worth bringing up, I would say for sure.

Jamie DePolo: Okay. And then if somebody, say they’ve already had surgeries and didn’t think about that, didn’t know about it, are there things they can do now? Is it, and I guess I should ask, too, is it really best to see a physical therapist or rehabilitation specialist to deal with some of these issues, or can someone start on their own?

Ashish Khanna: In most cases you can start on your own. I mean, I would recommend definitely to see a rehabilitation specialist such as myself or a physical therapist if you have a lot of shoulder problems.

As you mentioned, we don’t have time to cover all the different types of shoulder problems. There are many of them, so seeing someone who has knowledge of it is worth it particularly if your shoulder is really bothering you, then that’s something you need to probably get somebody with some knowledge to look at and make sure that the exercises that you’re doing at home are the best and the safest and are the most appropriate ones for your particular type of problem.

But that being said, there are general sorts of exercises that you can do to prevent getting a frozen shoulder. One of the most common ones you see is kind of like a wall-climbing exercise, and that’s where you face the wall about arm’s length distance, and then you use your fingers… put your arm out in front of you and you touch the wall and then you slowly use your fingers to walk up the wall. And then as your arm goes up, you kind of take a step towards the wall, and things like that.

You should be able to walk your hands all the way up so that your arm is completely all the way up in the air almost to the point where your nose or your armpit is completely flat against the wall, or your nose is touching the wall and your arm is completely above you.

Most people who are going to have tight shoulder capsules or have adhesive capsulitis or frozen shoulder, or your surgeon just let you know that now it’s safe for you to start moving the arm, it’s going to be very tough for you to go all the way up. But that’s a good exercise to do, that wall-climbing exercise. So try to get as high as you can and then hold it there and get a good stretch out of it for 30 seconds or so, and try and do that a couple times throughout the day.

The other one that’s actually a little bit tougher would be to do it out to the side. It’s the same thing, so now your arm is completely out to the side and you’re touching the wall with your fingers and you’re going to try to climb up, up, up with your fingers and try to get in… and a lot of people are going to cheat, they’re going to swing their arm a little bit more in front of you, like 45 degrees, because that hurts less and it’s easier. But the idea is that you want to stretch it, so make sure you keep your arm completely out to the side, sort of parallel to the chest. Don’t cheat and bring your arm forward. That’s going to be a tougher one, I guarantee, and a lot of people are going to have much tougher time doing it out to the side than they are out to the front, but it’s important to do both of those.

The other one, like I mentioned, like I said in the beginning, putting your hands on your hips. If you have a tight shoulder, your elbows are going to be pointing backwards. So really try to bring those elbows forward and hold it there, and just kind of swing your elbows forward and point them forward as much as you can, and hold that. That’s a great stretch for the shoulder capsule.

And then the other one was where you touch the back of your head, bring your arms up and touch the back of your head, and then swing your elbows all the way back, as far back as you can, and try and hold that. That one also will be a little bit tougher for most people, that particular shoulder motion, with a frozen shoulder.

Jamie DePolo: Okay, and I should point out — because I have shoulder issues, not due to breast cancer surgery but just because of arthritis — that it’s not a competition. Because I feel like I have done all these stretches and exercises, or I continue to do them, and as you said, it’s important to do them as you talked about them, correctly, especially the one out to the side. And even if you can only get your arm up an inch or two, that’s where you start and then you will get it higher after time. But don’t, as you said, don’t cheat, because you’re really not helping the rehabilitation process. And I speak from experience here.

Ashish Khanna: As a cheater, you speak from experience, right? No, I know, I know it is tough, I can’t imagine. I’m sorry to hear that you have that problem. Yeah, like you said, it is just a game of inches. It’s going to be tough in the beginning, definitely, but a little bit at a time. And then I also want to mention, when you have the pain, this is not a time to try to power through the pain, that kind of thing, unless some people kind of have that personality.

You know, you want to do it to the point where you start feeling a little bit of discomfort and then kind of back down from that and just hold it there for 30 seconds or a minute or something. This is not the time to try to be a superhero and power through the pain or anything like that.

Jamie DePolo: Okay, very good to know. So to kind of wrap up, could you give us your top three tips for, say, somebody who is listening to this right now, they’re holding their shoulder, they’re rubbing the front of their shoulder going oh, yeah, that sounds like me. What would be your top three suggestions for somebody who is feeling shoulder pain right now?

Ashish Khanna: I guess the top three things I would do, I would try to see… top three, hm.

Jamie DePolo: Or you can give top two, whatever works best.

Ashish Khanna: I was going to say, how about top 10?

Jamie DePolo: Oh! Well, you could do the top 10, too!

Ashish Khanna: I mean, the most important thing I think would be to try to do the stretches.

I think the number one thing, if you’re having a lot of shoulder problems, would be to reach out to make an appointment with a rehabilitation physician who can really diagnose what type of shoulder problem you’re having. Shoulder problems are fairly straightforward and easy for a physician or physical therapist or occupational therapist, too, by the way, to diagnose. I mean, there’s the rotator cuff and then on top of that, the shoulder joint itself can be a problem. But you can kind of discern between those two.

Otherwise you can get an MRI, and a physician can order and interpret those MRIs and get some imaging to kind of see what’s going on with the rotator cuff. The adhesive capsulitis, the frozen shoulder, you can see that on MRI as well. So I think it’s worth seeking some professional help, particularly if the arm is causing a problem, it’s interfering with your daily life. If it’s interfering with your daily life that would be something I would definitely do.

The next one would be to do the exercises on your own if you can, but of course you’re going to need clearance from your surgeon. You need to check with them and make sure that it’s safe to do that. You don’t want to mess up the surgery or anything, with all you’ve been through, by exercising the shoulder, so you need to make sure that it’s safe to do that.

But after that, online there are a lot of places that show you different shoulder stretches and things like that. A lot of the stretches I just described to you I know for a fact are on YouTube, so find a reputable video on YouTube, and they’ll demonstrate the wall-climbing exercises and things for you, too. That’s a way that you can kind of take control of your own healthcare there and do it on your own.

Jamie DePolo: Well, and I think your institution even maybe has, if I’m remembering correctly, has some YouTube videos about exercises, don’t you?

Ashish Khanna: Yeah, a lot of places do. Yeah, if you find a reputable place you can see some different shoulder exercises. A lot of the videos are great on there to show you what to do and things like that. And like I said, if you’re not sure, if your shoulder is getting kind of tight and you don’t always have pain all the time — it can be painless, particularly in the early stages — but if you’re not able to put your hands on your hips and kind of swing your elbows to the side or put your hands behind your head and do that comfortably, then I would say for sure, you’re starting to tighten up there. Time to maybe look into it.

Jamie DePolo: Yeah. Well, and definitely as you said, if somebody is going to go online definitely look for a source like a rehabilitation institution or a doctor’s office.

Ashish Khanna: Right.

Jamie DePolo: Don’t just look for somebody else who’s showing what he or she happens to do. Definitely look for a medical site.

Ashish Khanna: Yeah, right. Look for reputable hospital videos or something like that. And again, if you have questions, you don’t have to go it on your own. I would definitely suggest, if your arm is bothering you, it’s interfering with your life, definitely reach out to somebody that you think can help you, either a physical or occupational therapist or a rehabilitation physician.

Jamie DePolo: Well, great. Thank you so much, Dr. Khanna, this has been really helpful.

Ashish Khanna: My pleasure.

[Editor's Note: Watch this video to learn more about frozen shoulder. Dr. Khanna recommends this video and this video as good places to start to learn some stretches and exercises.]

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