This episode of the OrthoInfo podcast is brought to you by the American Academy of Orthopaedic Surgeons (AAOS) and American Shoulder and Elbow Surgeons (ASES). 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
