Dr. Robert Fullick – Athletic Shoulder

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Dr. Robert Fullick joins Ben Stephenson and Amari Mercadel at the Sports Medicine Update to discuss shoulder evaluations in the athletic shoulder.

Run down of extra tests, such as bear hug.

You learn more as time goes on, good training and fine-tuning over the years. A bear hug assesses a specific part of the subscapular tendon. Other testing may be normal with an upper subscapular tendon injury.  

How can I do all the tests? Do I skip some?

We go from doing all the tests to gaining the confidence to know what the athlete is telling me to help figure out what tests to use. I would recommend doing all the tests until you gain enough knowledge to be able to skip around. You're gonna get better as you go. I used to have doubts about the shoulder early in my career but look at me now. I see every MRI of every patient that I see, and I see every surgical evaluation that might need it. So I would say I'm pretty good at what I do. I’ve gotta be the best I can so that I'm not the guy saying that we’re gonna do physical therapy because I don't know exactly what's wrong, they're gonna go see another guy. 

Tell us more about your background, especially with the shoulder.

My sports background put me in a unique situation where I was comfortable in the locker room. My mentor in Boston worked for pro teams and I got into being on pro sidelines and sitting with different people. Being a young resident covering high-level sports on my own. Foster relationships when I moved to Baltimore got my sports fellowship. 

I don't wanna be wrong, I hate being wrong. When you see someone do an eval, is there something that you are like “Oh, I wouldn't do that”?

I would say the biggest thing that I see missed is not disrobing the shoulder to see the skin, posterior shoulder, etc. Then you're looking at the testing and trying to discern between a cuff strain versus labral. Thats not your fault. Based on the findings, timing, MOI, you can determine whether the patient needs imaging or do they just need physical therapy and some rehab. I would not be hard on yourself. Everyone is going to be in a different spot. 

What are your recs for prehab?

Complex scenario but I tell everyone the stronger the rotator cuff and the more motion going into surgery the better the recovery is going to be. Pre-op motion strongly indicates early post-op motion in my opinion.

Reducing shoulder injuries; how do we know if the humeral head is fractured?

It's an impossibility; I might have the luxury to know what a fractured arm looks like, but you might not. If a bone looks crooked, if a shoulder is out of palace then you try to make it look normal. If you go to reduce and you feel movement of the patient feels pain or a clunk or the humeral head doesn't feel 100% out, then maybe you might think a fracture. You'll never be able to know in that split second. I still see in the ER that they miss posterior dislocations. If you don't get an axillary view, you don't get the full workup. You gotta find a way to get that view, if not, get a CT scan. If you miss a posterior dislocation on the field, that's okay, you're doing the best that you can do with what you have. 

Relocations on the sideline: tips and tricks
Milch maneuver? For the anterior, the external rotation and abduction should be able to relocate. I had a patient just walk his fingers up his head, didn't even have to touch the patient to relocate the shoulder (patient had hsitory of numerous dislocations), just know the basics and principles. You can prevent labral damage by getting the head in quicker

What about those with repeated dislocations?

If you encounter those with dislocations with sneezing and sleeping, typically they need intervention and surgery for the labrum and bone loss. Patients have more motion post-surgery because trust is restored within the joint.