Drs. Olinger and Erickson discuss when back pain warrants a trip to the doctor and which symptoms are true red flags requiring emergency care, as well as the important distinction between acute and chronic pain. They explain the "ladder of invasiveness" approach to treatment, why they typically recommend conservative treatments like physical therapy and injections before surgery is ever considered, and how to set realistic expectations if surgery does become necessary. They also emphasize that it’s essential to tailor surgical treatment to each patient’s unique needs: Not every procedure is right for every patient, and taking the wrong approach can do more harm than good. 

This episode is a must-listen for anyone who is experiencing back pain and wondering whether they should try managing it at home or see a doctor. Oh — and if you should see a doctor, should it be an orthopaedic spine surgeon or a neurosurgeon? What’s the difference? Listen to find out.

Host: Catherine R. Olinger, MD, MS, FAAOS, Assistant Professor, Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics; OrthoInfo Spine Section Editor

Guest: Melissa M. Erickson, MD, MBA, FAAOS, Associate Professor of Orthopaedic Surgery and Associate Professor of Neurosurgery, Duke University School of Medicine; Medical Director, Duke University Hospital Perioperative Services; Co-Director, Combined Complex Spine Fellowship

In the episode, host Shariff K. Bishai, DO, FAAOS, sits down with shoulder and elbow surgeon Daniel Acevedo, MD, FAAOS, to help listeners understand when a torn rotator cuff might – and might not – need surgery.

From understanding the difference between partial- and full-thickness rotator cuff tears to navigating the full spectrum of nonsurgical treatments, including physical therapy, corticosteroid injections, platelet-rich plasma (PRP), and biologic implants, Drs. Bishai and Acevedo break down how surgeons evaluate each patient's unique situation and why shared decision-making is at the heart of choosing the right path forward when you have a rotator cuff injury.

Key Topics Covered in this Episode:

• Types of Rotator Cuff Tears: The differences between degenerative, overuse, and traumatic tears, as well as partial-thickness vs. full-thickness tears — and why understanding which type a patient has matters for treatment planning.

• Symptomatic vs. Asymptomatic Tears: Why some patients can live with a rotator cuff tear without knowing it, and what changes when a tear becomes painful.

• The Natural History of Untreated Tears: Why roughly 50% of full-thickness tears increase in size over two to five years — and what that means for long-term outcomes.

• When To See a Doctor for Shoulder Pain: Which symptoms are concerning, why it’s a good idea to initially try home remedies like rest and ice to see if the pain goes away, and at what point you should be evaluated by a doctor.

• Conservative Treatment First: The role of physical therapy, anti-inflammatory medications, and the "one-and-done" approach to corticosteroid injections in managing rotator cuff symptoms.

• Biologic Therapies and PRP: How platelet-rich plasma and collagen implants are changing the way partial thickness tears are managed — and why Dr. Bishai has a collagen implant in his own shoulder.

• When It's Time for Surgery: The clinical indicators — including persistent pain, failed conservative management, and tear progression — that signal it's time to have the surgical conversation.

• Using Ultrasound in the Clinic: How in-office ultrasound can provide quick, valuable information without immediately ordering an MRI.

• Pain Patterns That Point to Diagnosis: Why shoulder pain that stays above the elbow points to the rotator cuff, and what it means when symptoms travel further down the arm, plus how to know if the symptoms are due to a shoulder or neck issue.

About Our Guest:

Daniel Acevedo, MD, FAAOS, is a shoulder and elbow surgeon with Los Angeles Orthopaedic Surgery Specialists in Tarzana, Calif. He is a member of the American Shoulder & Elbow Surgeons (ASES) who has authored numerous peer-reviewed articles, book chapters, and surgical training videos focused on shoulder and elbow surgery. His special interests include biologic augmentation for rotator cuff repair and treating both competitive and recreational athletes.

The OrthoInfo podcast is part of the BoneBeat Orthopaedic podcast channel, with production and editing provided by MK Quinn Media. For more conversations on orthopaedic health and patient care, please visit aaos.org/thebonebeat.

Host: Shariff K. Bishai, DO, FAAOS, Shoulder & Sports Medicine Surgeon, Detroit Orthopaedic Institute; member, American Shoulder & Elbow Surgeons (ASES); member, OrthoInfo Editorial Board

Jocelyn Ross Wittstein, MD, FAAOS, a nationally recognized expert and sports medicine surgeon at Duke University Medical Center, provides her clinical insights and key research findings. The discussion highlights the importance of collaboration between orthopedic surgeons and women’s health professionals; proactive strategies for osteoporosis prevention (yes, you can prevent it!), including specific dietary changes and exercises; and how women can self-advocate to ensure that their symptoms are treated holistically rather than being written off as normal aging or treated as isolated structural issues. 

Host: Mary K. Mulcahey, MD, FAAOS, 

Guest: Jocelyn Ross Wittstein, MD, FAAOS, 

Drs. Gianakos and Hamid also explain when to seek professional help for foot issues, including red-flag symptoms that require urgent care, and the difference between foot and ankle surgeons and podiatrists. They offer advice about how to navigate health information on the Internet and why it’s important for patients to do their research rather than relying solely on AI summaries for answers. And they highlight some of the exciting advances in foot and ankle surgery that are helping more patients get back on their feet.

Host: Arianna Gianakos, DO

Guest: Kamran Hamid, MD, MPH, FAAOS

Mary K. Mulcahey, MD, FAAOS, Editor-in-Chief of OrthoInfo, is joined by Neil Sheth, MD, FAAOS, Chief of Orthopedic Surgery at Pennsylvania Hospital. Together, they answer frequently asked questions about hip replacement: who is an appropriate candidate, how technology and materials have advanced, presurgical preparation, what the surgery entails, how long it takes, and what patients can expect in terms of recovery, rehabilitation and return to activity. The discussion touches on important considerations such as post-surgery pain management (including opioids), potential complications, metal allergies, and implant failure.

Dr. Sheth also talks about when to see a doctor for hip pain and where to start, given that there are different types of doctors who treat hip pain and patients may not know who to see initially. He explains what an Adult Reconstruction surgeon is and clarifies which symptoms and conditions he and his colleagues do and do not address.

Host: Mary K. Mulcahey, MD, FAAOS
Guest: Neil Sheth, MD, FAAOS

The trio covers what biologics truly are, dispelling misconceptions about “stem cells” and highlighting the importance of evidence-based approaches over marketing hype. They walk through the latest science behind various biologic treatments, discuss the regulatory landscape, offer practical guidance for patients navigating treatment options, and share insights into the future of regenerative medicine in orthopedics.

Host: Shariff K. Bishai, DO, FAAOS
Guests: Don Buford, MD, FAAOS, and Scott A. Sigman, MD, FAAOS

The discussion delves into what it means to be an orthopedic surgeon — including the significance of board certification, fellowship training, and being a member of the American Academy of Orthopaedic Surgeons (AAOS). Drs. Bishai and Mulcahey help listeners understand the difference between orthopaedic surgeons and other specialists who treat the same conditions, such as podiatrists, plastic surgeons, and neurologists. And they explain the difference between general orthopaedic surgeons and subspecialists.

The conversation emphasizes the importance of seeking care from properly trained specialists. It encourages patients to be self-advocates, to ask questions or even seek second opinions if they don’t feel comfortable with both their care plan and their doctor.

Drs. Bishai and Mulcahey also reflect on the value of the physician–patient relationship, underscoring the collaborative and ongoing nature of orthopedic care, including the critical role of physical therapy. They talk about what being an orthopaedic surgeon means and why caring for patients is a 24/7 job for them.

Co-hosts: Shariff K. Bishai, DO, FAAOS, and Mary K. Mulcahey, MD, FAAOS