Nolan Alexander (Host): Meaningful Medicine is a Novant Health podcast bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future.

Today, we'll talk about shoulder surgery, what causes shoulder pain, when to seek care, and what today's treatments and surgeries can really do to help you get back to the life you love.

I'm your host, Nolan Alexander. And with me is Dr. Steven Potter, an orthopedic surgeon from Novant Health. Dr. Potter, thanks for joining us, and how are you today?

Steven Potter, MD: Doing well, Nolan. Thank you for having me.

Host: It's certainly my pleasure. So, let's jump on into it. I'm curious, what are the most common shoulder injuries that you see?

Steven Potter, MD: Rotator cuff injuries are one of the most common I see. And then, we'll see some labral injuries, either whether it's a dislocation or just overuse type injury.

Host: So, I can be a backyard warrior on the weekend, right? Hanging out with my kids, and I've kind of bumped myself a few times. And it's always the question, when should someone consider scheduling an appointment versus taking over-the-counter treatments?

Steven Potter, MD: I think it's certainly reasonable to start most of the time unless you've had some specific incident where you know the shoulder just didn't feel right instantaneously after a particular motion. But for the most part, start with over-the-counter medications, maybe rest for a week or so. But if you're not seeing much improvement at that point, it's worth coming in to have it looked at.

Host: Okay. So, you said about a week or so of trying to manage it on your own and then come in for an appointment?

Steven Potter, MD: I would say that's pretty routine. Or if you notice that you have some major functional deficit, can't lift it at all or anything along that line.

Host: So when I make a visit, what does that first visit look like? And can you outline some of the non-surgical treatment options that you provide?

Steven Potter, MD: Sure. The first visit oftentimes is just figuring out how the injury happened, what you're feeling, what specifically the symptoms are for you. Oftentimes, we'll get an X-ray of the shoulder to get an idea if there's any kind of, you know, long-term abnormality like arthritis or anything that's kind of playing into the pathology in the shoulder.

And then, it's just a matter of figuring out what mechanism may have caused it, and then starting oftentimes with non-operative or conservative management, as we often call it, with things such as anti-inflammatories, maybe a prescription strength versus just over-the-counter, often a home exercise program, and activity modification. Sometimes physical therapy if people prefer that over home exercise.

Host: So, there's a progression leading up to surgery. It's not coming in for one visit and, "Hey, we're going to book you a month out."

Steven Potter, MD: Very rarely. That would be an odd incidence. That would be more like a fracture-type situation versus something like a rotator cuff or a labral injury.

Host: So, what's new in shoulder surgery? I understand there's some more minimally invasive options around today.

Steven Potter, MD: So, you're seeing much more commonly shoulder pathology dealt with using arthroscopic surgery. Historically, they've done some open procedures, but that's becoming less and less common as the visualization with the arthroscope is getting better for us to look through, better quality images, better equipment, better utensils, like our implants, our tools that we use are much more amenable to the arthroscopic surgery.

So, rotator cuff repairs, labral issues, even treating some other type of inflammatory conditions can be dealt with through the scope.

Host: So, it sounds like technology's playing a pretty big role in this.

Steven Potter, MD: Yes. It's been a very beneficial advance for us.

Host: When does someone need a shoulder replacement? And is that as intimidating as it sounds to me?

Steven Potter, MD: Shoulder replacement, we like to leave that for our, you know, last-ditch effort. Usually, it's end-stage arthritis. Somebody's kind of gone through all the non-operative treatment, whether it's injections or activity modification therapy, they just have essentially bone-on-bone wear and tear in the shoulder, and really it's a loss of motion, a loss of function, and severe pain that leads to the option to go with a shoulder replacement.

And yes, initially it can be very intimidating. But the new technology, again, with the quality of the implants, the size of the implants improving, it's become a much more tolerable surgery, to include the aftercare with physical therapy.

Host: I'm sure recovery is a very frequent subject that's brought up in your office. So, what is realistic for patients setting recovery expectations?

Steven Potter, MD: I usually, for most of the procedures that we do, typically tell people around the three-month mark getting back to doing sort of your normal routine, oftentimes getting back into the more aggressive activities. Overhead throwing type activities typically take a little bit longer, somewhere close to the five or six-month mark. But initially, you're in a sling for four to six weeks, really doing therapy starting a week or two after surgery, trying to get that motion and strength back as soon as possible.

Host: All right. So, I got some time before my 50-mile-an-hour fastball can get back to the plate.

Steven Potter, MD: That's right.

Host: Is there anything before or after surgery that a patient can do to speed up their recovery?

Steven Potter, MD: Honestly, generalized health is sort of the best way to do it. Eat a healthy diet, stay active, just take care of yourself really overall, and that's the fastest way to get your body to recover.

Host: So for someone who's joining us in this conversation, they're listening and they've lived with shoulder pain for quite some time, what advice do you have for them?

Steven Potter, MD: If it's been a long time and you've been trying to do it with over-the-counter medications or activity modification, then come on in and we'll take a look at it and see if we can figure out some other options and modalities to get you back to doing the things you want to do, whether that's non-operative or eventually operative.

Host: Dr. Potter, you've given us so many great answers today. Is there anything else that you feel is important related to this topic?

Steven Potter, MD: Really just stay active. Stay active. Take care of yourself. Continue to eat well, sleep well, and don't let yourself just sit around and do nothing.

Host: There we go. I'm going to go hit the weights right after this. Dr. Potter, thank you so much for your time today

Steven Potter, MD: Thank you.

Host: That was Dr. Steven Potter. To find a physician, visit novanthealth.org. For more health and wellness information from our experts, visit healthyheadlines.org.