Michael Anderson (Host): Hello everyone, and welcome to this episode of our Fort HealthCare's FortCast vodcast. I'm very excited today. I'm your host, Dr. Michael Anderson, President and CEO of Fort HealthCare. And with me today for this episode, I'm very happy to introduce Dr. Paul Schuppner, one of our wonderful orthopedic surgeons. Dr. Schuppner, welcome to this episode of the FortCast.

Paul Schuppner, DO: Thank you, Dr. Anderson. Appreciate it.

Host: Now, for those that don't know, Dr. Schuppner was voted best in area last year, best physician in area in 2025. Congratulations on that, Dr. Schuppner. But tell us a little bit about yourself. How long you've been with Fort Healthcare?

Paul Schuppner, DO: I started practice in 2013. So, I've been with Fort for the last 13 years.

Host: And we've been very fortunate to have you. You do such a great job with our patients and serving our community. Dr. Schuppner, thank you.

Paul Schuppner, DO: Appreciate it. Yeah, Fort's a great place to live and work. I grew up in a small town, kind of akin to Fort Atkinson, and just really found a home here.

Host: Well, Dr. Schuppner, we're very fortunate to have you. So, thank you for being again on this episode of The FortCast. And today, we're going to talk about shoulder pain. And this is a great topic for me personally, because I have two shoulders, and sometimes they get sore.

And so, this is just a wonderful, opportunity to sit down with Dr. Schuppner and just ask him a little bit about shoulder pain. So, Dr. Schuppner, shoulder pain's got to be fairly common. How often would you say you have somebody come into your office to have shoulder pain evaluated?

Paul Schuppner, DO: Yeah. So, adult shoulder pain, like you pointed out, is very common. It makes up a majority of my practice. So every clinic day, we have multiple patients who present with, you know, a complaint of shoulder pain. Sometimes it's recent shoulder pain, new onset. Sometimes it's been around for years.

Host: Well, Dr. Schuppner, how often do patients come in either referred from their primary care provider or just directly contact you to make an appointment specifically with you? Give us a sense of that.

Paul Schuppner, DO: I would say it's probably half and half. Yes, there's lots of patients referred from their primary care provider or their other subspecialists. I would say a majority of the time or the other half of the time rather, they're self-referred. So, they seek out, you know, care for their shoulder pain. Sometimes also they come from their physical therapist. One great way to start if your shoulder's having pain, it doesn't have to be a physician's visit. It could be a visit to our therapy department because, as we'll probably touch on, you know, therapy is a important component of treatment.

Host: Yeah. No, the physical therapists do a great job, and I'm sure they're very happy to hear that they are a valued member of the care team. So, Dr. Schuppner, when somebody comes in with shoulder pain, what kind are the first questions that you ask, or how do you evaluate the patient initially in order to get an idea of the source of their shoulder pain?

Paul Schuppner, DO: Sure. The first thing to do is you listen. I mean, if you listen to your patient, more or less they will tell you where it hurts location-wise and, you know, how it affects them in terms of their function or dysfunction for that matter. You know, we always ask things like quality, how does the pain feel? You know, does it travel? Because, you know, a shoulder problem can masquerade as pain, you know, traveling down the arm towards your elbow. Sometimes, you know, up through your trapezius, you know, to the base of your neck. So, you know, really though, if you listen to your patient, they'll lead you to the right diagnosis.

Host: So, getting to that right diagnosis, when you have these conversations with your patients and you listen to them, what's kind of the top three or four diagnoses that you see commonly in your office?

Paul Schuppner, DO: Sure. So, you know, at least for adult shoulder pain, there's arthritis-related pain, that would be one. Soft tissue-related pain or tendon issues, if you will. Most people think about their rotator cuff, or at least have heard about it. That would be two. Thirdly, there can be traumatic pain. So, you know, we have a shoulder dislocation. And then, you know, lastly, this condition called frozen shoulder, which is known as adhesive capsulitis, is another common reason for pain and stiffness.

Host: So as you're working through the differential diagnosis, the possibilities of what's causing a patient's shoulder pain, is there anything specifically on physical examination that you look for or other diagnostics such as X-ray or MRIs? Can you take us through that process?

Paul Schuppner, DO: So, you know, for the patient that presents with shoulder pain, for exam-wise, we always check range of motion. That can give us a good indication as to the cause of the pain, whether it's arthritis or this condition I mentioned, frozen shoulder. We'll check strength. You know, strength relates back to your rotator cuff tendon and how that has been affected.

Your biceps tendon is also another common reason why adults can have, you know, shoulder pain. Lots of adults will present with, you know, with their biggest complaint being it hurts when I reach back in my vehicle, and that will cause a lot of pain on my front of my shoulder. And your biceps tendon is a big pain generator also.

From a diagnostic standpoint, we'll do radiographs, which are X-rays of your shoulder. You know, that'll give us a vast wealth of information about what's going on, and that's typically done at, you know, every first visit.

Host: Gotcha. Gotcha. Well, it sounds like, just something in my mind, I was just picturing, uh, a parent or a grandparent reaching back to the car seat in the back of the car helping a little one, and then they get some shoulder pain associated with that. Now, as you're talking to the patient and you're deciding on what further diagnostics to do, at what point would you pursue an MRI?

Paul Schuppner, DO: Yeah. I think a lot of patients come in expecting to have an MRI performed or wanting it performed for different reasons. Sometimes we will order that early on in your care. I think that really dictates based upon your injury or lack thereof, and then, you know, the symptomatology.

The fact of the matter is an MRI, it is the gold standard test or it can help quite a bit with confirming your diagnosis. But most patients can be treated successfully conservatively. You know, even though you're going to see the orthopedic surgeon, surgery's not going to be—at least it shouldn't be the one and only option. You know, different research and studies show that, you know, 80% to 90% of patients can be improved without any sort of surgical intervention. But if patients do fail conservative measures, things like physical therapy, occasionally injections, an MRI is that test in order of us to take the next step, you know, as we're considering does this issue require surgery to achieve our goal of, you know, no pain and a return to full function.

Host: Yeah. And that's a wonderful segue. I'd like to focus a little bit on arthritis because I know we could have a separate vodcast episode on probably rotator cuff and frozen shoulder. But if we just focus on the arthritis, aspect of shoulder pain, Dr. Schuppner, take us through your conservative treatment measures. You mentioned physical therapy. Do you do that initially? Is there a role or other conservative measures such as is there a role for injections? Can you just take us through that process?

Paul Schuppner, DO: Sure. So, you know, for what you had mentioned, for an adult patient with shoulder arthritis, without getting too clinical, you know, the glenohumeral joint, which is your shoulder joint, depending on the severity of the arthritis, that really dictates what the most appropriate first treatment line could be.

For a patient with mild or early shoulder arthritis, physical therapy combined with an injection can really cause a significant amount of improvement. It won't fix the problem per se. But as I tell patients, if we can turn your pain off, it's okay to live with your shoulder arthritis.

You know, we don't take care of pictures on a wall in regards to your X-ray, we take care of people. So again, that I think drives home the message that if we can minimize your pain and you can be functional, it's okay to live with a condition. Just because we see it doesn't mean we have to, we have to treat it. Conversely, if somebody does have very severe shoulder arthritis, you know, bone-on-bone arthritis, you know, sometimes physical therapy and an injection just really is not going to alleviate the pain. Occasionally, we'll trial it, especially if somebody's motivated to try it. Other times, that really lends itself to, you know, a surgical solution, whether it be a shoulder replacement or other procedure.

One caveat would be shoulder arthritis, you know, there's more than just the shoulder joint. There's the AC joint, which I'm pointing to here, your collarbone joint, if you will. You know, that's another common area where arthritis can develop, causing pain related to the rotator cuff. And that's managed differently than what I just talked about, or at least it can be.

Host: So, it sounds like there's—I'm almost thinking about a treatment process like this, starting with conservative measures. If patients get better, wonderful. If they don't get better, you do have other options available, whether it's injections or ultimately it sounds like a total shoulder replacement surgery can be an option for those patients that aren't responding to conservative measures. Does that sound somewhat accurate?

Paul Schuppner, DO: No, that's a good summary and, yeah, that is accurate. And you know, each treatment plan should be individualized to that individual. I think it's important to kind of meet that person where they are. You know, things like age and activity level play a part. You know, their expectation is important. Their, you know, their physical demand, whether they're, you know, a young laborer or an older individual who's in retirement that just wants to golf or to bowl, things like that.

Host: So if somebody's looking at a total shoulder procedure, Dr. Schuppner, what is that like for the patient? Take us through that.

Paul Schuppner, DO: Sure. So if it's okay, I'll even maybe expand on that just a little bit. So if we talk about shoulder surgery, a lot of time, whether it's an open procedure, so a shoulder replacement, or whether it's a more minimally invasive shoulder arthroscopy, from a patient standpoint, the process or the recovery is very similar, believe it or not.

The surgical procedure is very different. But for you as the patient, I think that the timeline and process are similar. So, you know, for somebody undergoing shoulder surgery, you know, in our community, we have you see your family physician for a history and physical. Day of surgery, oftentimes we utilize peripheral nerve blocks from our anesthesia department.

Just as a caveat, you know, nerve blocks have been such a wonderful adjunct. You know, in the old days, which, you know, I'm old enough to remember prior to nerve blocks, shoulder surgery, it was painful, and people and friends and family had horror stories about. In this era with the way that we can manage or prevent pain, maybe not completely, but minimize it, it's made it such an easier experience than what you might talk about at the kitchen table with your grandparents.

But, you know, day of surgery, you know, the procedure is performed, and then patients will go home, and we typically utilize a sling. You know, depending on the work being done, the sling is used for six weeks, and that's a fairly universal period of time. So, you know, I tell my patients, "For six weeks, you'll be a one and a half arm individual."

So, it's not that you're stuck in your sling and you can never use your arm. You know, there's allowances that can be made. You can use that to feed yourself and brush your teeth. You can type and text. I think those are all very reasonable. And then, at six weeks, the sling typically goes away. You know, you'll continue working with your physical therapist.

And for the next six weeks, most of the time, we kind of transition you back, gradually build upon your activities to more normal activities. And by, you know, three months roughly out from surgery, a lot of patients are at a point where it's safe to let them perform the activities that they feel ready for.

Host: In my mind, that's actually a pretty fast recovery. I am surprised it's really that fast. It's got to be wonderful for patients to be able to recover on that sort of timeline.

Paul Schuppner, DO: Yeah, I think some patients are surprised. But our biology and the anatomy, it's been like that, you know, obviously since the beginning of time. So, you know, the healing time is pretty universal. And then, you know, with the help of a good therapist, you know, getting back to your life activities that you love to do is our goal.

Host: Yeah, that's definitely paramount for quality of life, and that's what we're trying to achieve here, right?

Paul Schuppner, DO: Always. Always.

Host: Well, Dr. Schuppner, I cannot thank you enough for being on this episode of The FortCast. Thank you.

Paul Schuppner, DO: I appreciate it. I appreciate your time. Thank you.

Host: And don't hesitate to reach out to Dr. Schuppner if you're having shoulder pain or a loved one's having shoulder pain. I'm sure he'd be happy to see you.

Paul Schuppner, DO: Always. Have a great day.

Host: All right. So, thank you everybody. Please share us on your social media channels. And once again, this is Dr. Michael Anderson signing off. Thank you for joining us this episode of The FortCast.