Dr. Mehul Shah and Dr. Joseph Zuckerman delve into the intricate world of shoulder surgery, exploring innovative techniques, patient stories, and expert insights on common procedures.
Dr. Mehul Shah and Dr. Joseph Zuckerman delve into the intricate world of shoulder surgery, exploring innovative techniques, patient stories, and expert insights on common procedures. From non-operative approaches to groundbreaking advancements in surgical therapies, it's the latest on shoulder replacement options.
Narrator: SiriusXM presents an NYU Langone Orthopedics podcast. Orthopedics is just very important to the population in this country. Its ability to restore patient function. Problems related to cartilage, to someone who has more advanced forms of arthritis. Getting people back to their activities and the things that they like to do. Featuring NYU's experts in the field of Orthopedics trying to figure out that problem before it even is a problem. Problems with solutions. Well beyond physical therapy, to conservative pain management, to surgery. The best medical minds now come together. Applying all of our minds to solve these problems. We're here to get people feeling better so they can get back to their lives. And that's really what we try and accomplish. These are the Bone Whisperers.
Dr. Mehul Shah: Hi, I'm Dr. Mehul Shah, and you are listening to the Bone Whisperer podcast, brought to you by NYU Langone Orthopedics and SiriusXM radio. Today's episode is titled advancements in shoulder replacement surgery, getting you back on the court faster than ever. And we were talking with Dr. Joseph Zuckerman, the Walter A.L. Thompson Professor and Chairman of the Department of Orthopedic Surgery at NYU Langone Health. Dr. Zuckerman is a world renowned shoulder surgeon and specialist in shoulder replacements. Among his many accolades, he is past president of the American Shoulder and Elbow Society and past president of the American Academy of Orthopedic Surgeons. Dr. Zuckerman, a man we affectionately call the boss. Welcome to the podcast.
Dr. Joseph Zuckerman: Thank you, Dr. Shah. It's a pleasure to be here.
Dr. Mehul Shah: The pleasure is all mine, for sure. Dr. Zuckerman, before we get into the topic of shoulder replacements, can we briefly go over the anatomy and structures of shoulders and what exactly shoulder arthritis is?
Dr. Joseph Zuckerman: Well, what people affectionately refer to as the shoulder joint is really a region of your body. The shoulder region. The joint itself is a joint between your upper arm bone, or the humerus, and the socket, which is formed from the scapula. So the socket is called the glenoid. The upper end of your, uh, arm bone is called the humerus. So it's really the glenohumeral joint. That's what most of us refer to as the shoulder. And when we talk about shoulder arthritis, that's the joint that's affected by shoulder arthritis. Now, that joint is oftentimes referred to as a ball and socket joint, but in reality it's a ball on a dish, because the socket or the glenoid is flat and the humeral head is a ball is very round. So in order to maintain the stability of the joint and have it function very well, it has to be surrounded by important muscles and tendons, soft tissue structures, and that really represents the rotator cuff. The rotator cuff is a group of muscles and tendons that surround the glenohumeral joint and allow it not only to move in all different directions, but also to maintain the ball in the socket where it should be. So like any other joint in the body, the humeral head, the ball, and the socket, the glenoid, is covered by a smooth, glistening surface of articular cartilage. That's what allows all of our joints to function normally. When you have arthritis, it means that there's been a deterioration of that articular cartilage. You lose it. It could be just from an aging process, it could be from another condition in the body that causes the articulate cartilage to deteriorate, it could be from trauma or injury. But the common pathway is the loss of that articular cartilage. That is the arthritis that you develop.
Dr. Mehul Shah: So why does that loss of articulate cartilage, why does that cause pain?
Dr. Joseph Zuckerman: Well, once you wear through the articulate cartilage, you get down to the bony surface, and the bone has important nerve endings in it. So once you have bone rubbing on the bone, or even articulate cartilage rubbing on bone, that's painful, and that's what produces the pain. Now, oftentimes with the different types of arthritis you have, there's inflammation associated with it. And the inflammation itself causes pain because it's the body's reaction to injury. That's how we protect ourselves. If there's a problem, the body responds to it with inflammation. That helps protect it and also initiates a healing process. Although when it comes to arthritis, the body really is unable to heal it to the extent that it cannot reform the articulate cartilage that's been lost.
Dr. Mehul Shah: So we've all heard of knee and shoulder replacements and knee and hip arthritis. It is my understanding that shoulder replacements are not as common as knee and hip replacements? And is there a reason why?
Dr. Joseph Zuckerman: You're absolutely right. There are many more hip and knee replacement performed in the United States each year than shoulder replacements. I would say there are about 650,000 knee replacements performed each year, about 350 to 400,000 hip replacements, and probably on the order of 150 to 200,000 shoulder replacements. Now, the reasons for that are not necessarily well known, except one important reason is the shoulder is not a weight bearing joint like a hip and knee. If you have a bad knee, a very arthritic knee, you're going to find it very hard to get around. Same thing if you have an arthritic hip. However, shoulders are much more forgiving because we're not walking on our arms. And if you've got a bad shoulder on one side, you can usually compensate for it by using the shoulder on the other side. So it's a more forgiving joint when it comes to arthritis.
Dr. Mehul Shah: Right. I also think maybe the dominance of someone's arm may play a role, right? Because if it's your non dominant arm, you may not be using it as much as your dominant arm.
Dr. Joseph Zuckerman: Right. So if you develop arthritis in your left shoulder and you're a right handed person, you may not notice the disability as much. You can work around it. Now, so that begs the question, why don't patients preferentially develop arthritis in their dominant side - the side that they're using for most things? I don't have an answer to that, but we see it to varying degrees. It could be on the dominant side or the non-dominant side, and we really don't understand why.
Dr. Mehul Shah: Now, when someone is diagnosed with shoulder arthritis, are they destined to need a shoulder replacement, or are there any non-operative treatments? What's your sort of algorithm on how you treat patients who are newly diagnosed?
Dr. Joseph Zuckerman: So shoulder arthritis is like arthritis in any other area of the body. It has to follow a continuum of treatment based upon the degree of symptoms. So the treatment, first and foremost, is non operative. Sometimes it may be something as simple as limiting your activities, avoiding certain activities that cause pain. Sometimes simple medications like Tylenol or over the counter anti inflammatory medications can be very effective in relieving the discomfort. Sometimes it may progress, in more significant cases, to injections of different materials, like steroids, which is a strong anti inflammatory medication. Injection of what we refer to as viscosupplementation, which is basically joint lubricants to help lubricate the joint. And there are other injections that are used now - something called platelet rich plasma has been used, or even stem cells. And although there's not a significant amount of evidence that either one of those injections are effective. Nonetheless, they are used by some physicians, uh, for patients, but the results are really, really uncertain.
Dr. Mehul Shah: What about the efficacy of those H.A. injections or hyaluronic acid viscose supplementation? I use it commonly in the knee. I don't believe insurance companies cover it much for the shoulder. Is there less evidence for it in the shoulder? Has it been shown to be helpful?
Dr. Joseph Zuckerman: The data for the shoulder is much less robust than it is for the knee. And personally, I think the data for the knee is not that robust. Suspect, and it has not been studied near as much in the shoulder. So it's not surprising to me if some insurance companies won't cover it, because the evidence is not there that it's particularly effective.
Dr. Mehul Shah: And also recently we've come to really appreciate that corticosteroid injections, especially in the hip and the knee, aren't as benign as we think when it comes to future joint replacements. There's some evidence to suggest that these injections can increase the risk of infection, though it still remains very small, in the hip and the knee. Has that also been shown in the shoulder?
Dr. Joseph Zuckerman: So it's important to respect the fact that anytime you put a needle into a joint, you have the risk of introducing infection. Now, that risk is very small. I would, some people have estimated to be one in 10,000. And when we frequently inject joints, let's say a arthritic glenohumeral joint with steroids. And steroids can be very effective, but they do carry a risk. Now, one thing that's been pointed out recently is that injections of steroids within three months of a planned shoulder replacement can increase the risk of infection following the shoulder replacement. So right now, if we're considering a shoulder replacement in any of my patients or in patients in general, I think it's pretty well understood that you want to wait at least three months between any type of injection into the joint. Although steroids is the most important one, I like to use that rule of thumb for any injection into the joint.
Dr. Mehul Shah: Interesting. I think, uh, that's obviously probably the safest way to approach this.
Dr. Joseph Zuckerman: So the other aspects of steroid injections that I think is sometimes overemphasized is some people think that steroid injections into the joint can cause a deterioration of the joint. Now, I think that's not the case if steroid injections are used sparingly. I've seen patients in my office that have had 15 or 20 steroid injections into their shoulder, and they have a very degenerated arthritic joint. It may have been that way to begin with. But the thing about steroid injections is the first one is usually most effective, the second one will usually be effective, it may be for a shorter duration. And, uh, by the time you get to a third of fourth well-spaced injection, it's not really helping anymore. So there's no reason to consider more than three or four injections in any patient. So if you follow that rule, you'll never be in a situation where you get many injections which can cause deterioration of a joint.
Dr. Mehul Shah: You know, in my practice, I also try to use age as a determining factor of whether I'm going to use steroids or not. A younger patient with arthritis, we know it's not a long term play. Someone who's in their 8th or 9th decade where they're not really considering surgery, they have multiple medical comorbidities, if they get one steroid injection a year, so be it. You know, maybe not the best thing to do, but it may make them more functional when they can't be otherwise.
Dr. Joseph Zuckerman: I think if you follow that rule of one injection a year, I think you're being very careful and thoughtful about this, and I'd have no problem with that at all. But again, sometimes I see it abused to the extent that it's people are getting injections every three months, regardless of their effectiveness.
Dr. Mehul Shah: Absolutely. So if someone has failed non-operative treatment, who would you consider good candidates for shoulder replacement? Who would you consider a poor candidate and that you would still try to avoid surgery on?
Dr. Joseph Zuckerman: Well, you make a very good point, Dr. Shah, that patients get to the point of considering a shoulder replacement, they have to progress through a series of non operative management. And I've been surprised, pleasantly surprised, that sometimes I see a patient in my office with an x ray that looks quite frankly terrible, but they've not had any treatment thus far. Their symptoms are moderate and we wind up starting from the beginning, putting them on medication, considering injections, and they can do reasonably well for quite some period of time. So you don't want to consider surgery until you've finished, you know, and convinced yourself and the patient that simpler measures, non operative measures, are not going to be effective. So then when you get to the point of considering a patient as a candidate for shoulder replacement, I think in 2024, any patient with a degenerative condition of the glenoumeral joint, I would consider a candidate for shoulder replacement, probably with the exception of somebody that has an underlying infection in the shoulder or a previous infection. And that's what you have to really be very careful in considering. Any active infection, absolutely not a candidate. But if they had a previous infection in the shoulder, you have to be very careful in evaluating that patient. So that's from a pathologic point of view when they present to us with different types of degenerative conditions. Now, there are also some patients that are good candidates and some patients that are bad candidates based upon how they're going to conduct themselves following the surgery. Because this surgery, shoulder replacement can be very successful. But it can be very unsuccessful if patients don't adhere to the post operative regimen that allows them to heal and regain function.
Dr. Mehul Shah: Does age play a role in this day and age? Is there a certain age in which you don't want to consider because you don't want to consider shoulder placement surgery? My understanding is that these don't last a lifetime. There's a time limit where they're going to eventually loosen and may need to be redone again.
Dr. Joseph Zuckerman: Well, I found myself having a differing view on age when it comes to patients requiring shoulder replacement. As I get older, I think anybody's a candidate for this. But that’d be my personal perspective. Uh, I think that through the years, there's been a thinking about joint replacements in general, that you don't want to do it in younger patients because it's not going to last a lifetime, and then you'll have to redo it. But technology has changed, and the success of the shoulder replacement, just like the success of hip and knee replacements, has changed. So, frankly, in my own practice, if somebody came to me at the age of 25 with severe post traumatic arthritis that was severely disabled, couldn't work, couldn't do what they needed to do to have a quality of life, I would not hesitate to do a shoulder replacement because I know they're going to get 10, 15, 20 years of function out of that, or maybe even more, and they're going to function well. So I'm not going to tell that patient that you need to wait until you're older. So the short answer to your question is, I consider shoulder replacement in patients of any age if they've got the proper pathology that I think we can treat.
Dr. Mehul Shah: Right. I mean, definitely you need to have consideration of restoring someone's function in their productive years of life. There's a certain period of time when people aren't productive, but young people can't work, so on and so forth, can really affect their livelihood. So we alluded to earlier, there's different types of shoulder arthritis. Can we get into what the different types of shoulder arthritis are and what factors may affect the type of shoulder replacement you pick?
Dr. Joseph Zuckerman: Yeah, there are different types of arthritis that affects the shoulder, just like arthritis that affects the hip and knee. So the most common one we see is what most people would call osteoarthritis, which most of the public would refer to as wear and tear arthritis - arthritis that tends to be associated with older age and the wear and tear that you subject your body to for the decades of life. That's usually an arthritis that affects one or two joints in your body, more commonly in the hip and knee than the shoulder. And those patients usually have a good rotator cuff, in other words, good muscles around the shoulder, which is important because that will help direct what type of replacement they get. And then there's the rheumatoid arthritis, which is an inflammatory arthritis. That doesn't just affect the joint surfaces, but it affects the connective tissue around the shoulder. So those patients will have arthritis and usually deterioration of the rotator cuff, which is an important consideration in considering the type of shoulder replacement you do. People that have had previous fractures or significant injuries have what we refer to as post traumatic arthritis - arthritis that develops as a result of a previous trauma. That can result in severe deformity of the bones. You know, the bone could heal in an abnormal, or what we call a malaligned position, and also have associated with it, changes to the rotator cuff and the soft tissues. And there's not one type of post traumatic arthritis, but that can run a whole spectrum from mild arthritis to severe arthritic changes. And then there are other less common arthritis, uh, types around the shoulder. One that we see more and more is something called rotator cuff arthropathy, or rotator cuff arthritis. As patients get older, the rotator cuff deteriorates just as a product of age. And when that happens, it can initiate an inflammatory process, which can result in changes in the glenohumeral joint, loss of articular cartilage, that can result in significant deformity around the shoulder. So those patients now have a specific type of arthritis that results in loss of the joint surfaces and severe deterioration of the rotator cuff.
Dr. Mehul Shah: So along with different types of arthritis, there are many different types of shoulder replacements, and I'm sure many in our audience have heard of shoulder replacements, and then also something called a reverse shoulder replacement, which can sound kind of scary. Can you explain the differences of the different types of shoulder replacements that are available?
Dr. Joseph Zuckerman: So when you think about shoulder replacement, there are two general categories that are out there now. What's referred to as an anatomic shoulder replacement, in which you replaced the humeral head, the ball, with a round surface, and you replaced the socket, which is flat, with a flat surface. That's an anatomic replacement because you've replaced it with the usual anatomy that's there. Then there's the reverse shoulder replacement, which has really come into play over the last 20 or 25 years. It's been developed and now has really become much more commonly performed. It's called reverse, because you wind up putting a circular or a round structure on the socket side and a not flat, but a cupped, uh, surface on the humeral side, the ball side. So it's reversed. It's just the opposite of an anatomic replacement. And that's designed that way to compensate for patients who do not have a good rotator cuff. Now, within the category of shoulder replacements, there are things you can do that are partial replacements. So, for instance, some surgeons may decide that doing just a partial replacement is necessary rather than a complete replacement, so they may only replace the humeral head. There are certain conditions where you may consider that, and that really comes down to the type of arthritis that somebody has, or the type of condition and the surgeon's preference. And when you look at the different components, in other words, the pieces we put in, it comes in different shapes and forms, different lengths and such. But those are all variations on a theme. Right now, the decision for patients who have a degenerative condition of the glenohumeral joint, in other words, shoulder arthritis, is, are they best as a candidate for an anatomic replacement, or are they best as a candidate for a reverse replacement?
Dr. Mehul Shah: Now, what can people expect after shoulder replacement in terms of, is their range of motion going to be the same? Is their strength going to be the same? Can they reach up to the cupboard as they did before surgery? How do you educate your patients on what they can expect?
Dr. Joseph Zuckerman: Well, patient expectations after shoulder replacement is very important. So we try and have a detailed discussion with the patient ahead of time as to what they can expect. First and foremost, the result of any shoulder replacement should be pain relief. Patients after surgery be relieved of the pain that they had almost completely. Now, therefore, that begs the question, how much pain did I have beforehand? And that's important. I don't do a shoulder replacement on anybody that doesn't have significant disabling pain in their shoulder, because if they didn't have that, then chances are simpler methods, like non operative methods we talked about before, could be effective. So pain relief is first and foremost important. Regaining range of motion, which relates to regaining function, can become, uh, a little less predictable. But I would say the vast majority of patients undergoing shoulder replacement of either type will have improved range of motion afterwards. In other words, reaching above the shoulder level to do things for their daily activities that's necessary for their, basically to live their lives.
Dr. Mehul Shah: Now, to address the title of this podcast, what have been some recent advancements in shoulder replacements that have evolved over the past 30 or so years. When I was a resident, it was a pretty standard procedure for an anatomic shoulder placement. We would do an incision in the front of the shoulder, we resect the humeral head, we would remount the glenoid, we would cement the components in place and put in the plastic and the metal head and close up. And the patient stayed in the hospital for about four days after surgery, went home. Um, I don't think they went to rehab for shoulder replacements back then. But what has changed since I was your resident?
Dr. Joseph Zuckerman: Just as most of orthopedic surgery and medicine has changed, so has shoulder replacement. Most patients have shoulder replacement either go home the same day or the day after surgery. It's a well-tolerated procedure, and patients can be comfortable within 24 hours after the procedure and do very well afterwards. Now, how they're handled after surgery is dependent in large measure on the type of surgery they have. So, for instance, and every surgeon has their own protocol. When I do an anatomic replacement in patients, they're immediately started on therapy the day of surgery, and the therapist sees them while they're still in the hospital and instructs them in their exercise program that they do for the first five weeks after surgery. Again, that's my protocol. They're in a sling for five weeks, except when they do their exercises. And these exercises are passive exercises. In other words, helping with the other arm, because I want that portion of the rotator cuff that I had to repair and, ah, sew together afterwards to heal. Because I know an anatomic replacement requires a good, functioning, intact rotator cuff to be successful. Now, you contrast that with a reverse replacement. When I do a reverse replacement, they may have a rotator cuff or they may not, but the function of the replacement doesn't rely on the rotator cuff. So those patients also start their therapy the same way, the same day of surgery, but they're in a sling only for two weeks afterwards. And I encourage them to use their arm, even in the sling, for more active range of motion. Now, by the time either patient gets to about three months after surgery, I tell them they're going to have 70% to 80% of their overall recovery in terms of pain relief, which is excellent by that time, but regaining range of motion and function, but that patients after a shoulder replacement will continue to improve on a gradual basis up to a year after surgery.
Dr. Mehul Shah: People now have been using navigation or robots to do shoulder replacement. Can you explain to our audience what role the robot have in the shoulder surgery?
Dr. Joseph Zuckerman: So just like hip and knee replacement has progressed in terms of the technology, shoulder replacement has also. Now there's two aspects of progression of the technology. One has to do with the implants that we use. As I said, we use different shapes, sizes, we uncommonly use cement to hold these in place. Uh, usually they're coated with different materials that allow the body to attach to it. So all those things have occurred as well. How we put the shoulder replacement in has also followed the progression of other areas of orthopedics. We like to use as minimally invasive processes as possible so the incisions are shorter. Uh, it's also possible to do this operation through a smaller approach that spares the rotator cuff, which is usually has to be divided and repaired for exposure. So, uh, those opportunities are available. Most shoulder systems that are out there today allow you to preoperatively plan the operation by using x rays and a CT scan, you can plan the operation on your computer and decide what size implant you use, where you want to put it, what angle, all the details that are necessary during the operation. So you can plan it beforehand, and then you can, during the surgery, enact that plan. There is a system out there that allows you to plan it preoperatively, but also allows you to use what we refer to as intraoperative computer guided navigation to put the pieces in place exactly where you plan to do it preoperatively. We think that's been very beneficial.
Dr. Mehul Shah: When you talk about this, navigation sounds like a very complex thing. Is this to be used only for the most expert surgeons as yourself or the orthopedic surgeon in the community? What role does navigation play? Is it only in the most complex situations?
Dr. Joseph Zuckerman: Well, there's no doubt that the ability to intraoperatively navigate or use navigation during the operation is very helpful. It's helpful in the complex cases and it's helpful in the simple cases. So even though I've done thousands of shoulder replacements, I find that the use of preoperative planning and intraoperative navigation has made me a much better shoulder replacement surgeon. And that's with all my years of experience. So I would say the orthopedic surgeon who doesn't do it as frequently, but has a good number of cases, 20 or 30 a year, I think things like preoperative planning and intraoperative navigation can be very helpful for any surgeon who does this operation. Really what it helps us do is make sure we can do the operation the way that we think is going to give the patients the best result.
Dr. Mehul Shah: Now, when I was a resident also, we saw that most of the shoulder replacements that were being done were the anatomic type. Just from perusing the or schedule these days, I see most of the shoulder surgeons on the schedule are doing, it looks to me even as many reverses as they are doing anatomics. Is that because we're seeing more of those types of arthritis, or are we expanding the indications of the reverses?
Dr. Joseph Zuckerman: Dr. Shah, you're absolutely right. In 2024, there are many more reverse shoulder replacements done than anatomic replacements. Some people would say it's 70% of all shoulder replacements are now reversed, compared with 30% anatomic. Some people would say it's maybe even greater, some people would say it's a little less. But in a relatively short period of time, 25 years, reverse shoulder replacement now dominates the whole spectrum of shoulder replacement surgeries that are performed. And the reason for that is a few. First and foremost, reverse shoulder replacement now allows us to more effectively treat certain degenerative conditions around the shoulder that we couldn't treat with anatomic replacement because it just didn't work. Any patient with a compromised rotator cuff wouldn't do well after an anatomic replacement, they will do well after a reverse replacement. So that opens up a number of different indications, or reasons for patients to have shoulder replacement. So that's one important factor. The other thing is that we have expanded the indications. We know that as patients get older, the rotator cuff doesn't function as well. So if I have patients in their mid seventies, eighties or even nineties, even if the rotator cuff appears to be intact, I'm going to do a reverse replacement, because I have concerns about the function of the rotator cuff after surgery. So we've expanded the indications, and also reverse replacements allows us to treat indications or reasons for surgery that we did not have before.
Dr. Mehul Shah: So, addressing the question at hand, when would you allow a shoulder replacement, either anatomic or reverse, to attempt to get back to sport?
Dr. Joseph Zuckerman: Return to sport is an important consideration, because even though we operate on patients in their sixties, seventies and eighties, patients want to be active. I'm going to see patients after this podcast. And if the word pickleball doesn't come up four or five times, I'll be shocked, right? Because the older population particularly is playing it to a great extent. So, recognizing that anatomic replacement has a little longer period of immobilization afterwards in the sling than a reverse replacement, so let's look at the three month time after either operation. At three months, I expect patients to have regained very good range of motion. Not full, but a very good range of motion. They're very functional for their everyday activities. Their strength is returning. So at that point, I let them start to do certain exercises or athletic activity. So, for instance, if they're golfers, I let them start chipping and putting. Over that next month, they go to the driving range to start hitting off at tee - irons and then drivers. And then usually at the four to five month point, I let them go out and play golf again with a few limitations. Number one, every time they hit, it needs to be off a tee. And that includes on the fairways. If they're in the rough, they get relief - it goes out in the fairway because I don't want them to swing hard and have the head of the club hit some kind of obstacle, like a root or something, because that rapid deceleration, I think, can injure the soft tissues around the shoulder. And I tell them, no sand traps - you get relief. And if they need a note from me so their friends believe it, then I give them a note.
Dr. Mehul Shah: Sounds like my kind of games. Sounds like my kind of game.
Dr. Joseph Zuckerman: So, and I usually they do that for the next three months, until six months, and then I let them go back. And I also tell golfers that they're going to thank me after these operations, because when they start playing again, they're going to hit straighter than they ever hit before, but they're going to lose about 20 or 30 yards. But then after three or four months, they'll go back to their old bad habits, right? And the slice comes back and the hook comes back. So let's get to the issue about racquet sports. Generally at four months or so, I will let them start hitting a tennis ball or start swinging to play pickleball. And I'm no expert in pickleball, but I used a period of from four to six months to let them progress, to get used to hitting on a gradual basis, and then they can return to competition at six months. Now keep in mind, this is just my protocol. If you ask ten orthopedic surgeons who do shoulder replacement what their protocol is, you're probably going to get some variations on a theme. Another question patients ask is, what about weightlifting? Again, I have my own protocol. Patients like to go to the gym exercise. So my rule of thumb is I let them lift weights as long as it's below the shoulder level, in other words, shoulder height and below. Any exercise they do, they need to comfortably do ten or twelve repetitions to. In other words, I don't want them straining to do four or five repetitions. So it's really based upon increasing the number of reps rather than a higher weights with smaller reps. And I try to avoid them doing things overhead.
Dr. Mehul Shah: As you alluded to, different surgeons may have different expectations or limitations to place on patients, and I think it's very important that a patient address their concerns and their goals after surgery and find an orthopedic surgeon who does enough shoulder placements whose limitations align with their expectations.
Dr. Joseph Zuckerman: Patient expectations, as you pointed out, is very important. These are discussions I like to have ahead of time. I like to know what their expectations are, what they want to be able to do after surgery. For some people, they're expecting a grandchild, they want to be able to hold the grandchild safely and help their daughter or daughter in law or son or son in law take care of the baby. Other people want to go back to competitive pickleball or tennis or golf, right, activities like that. So you have to make sure they understand what they'll be able to do after surgery so they don't have unrealistic expectations.
Dr. Mehul Shah: Well, Dr. Zuckman, thank you for coming to the podcast. As always, it was enjoyable talking to you and a very informative and educational experience.
Dr. Joseph Zuckerman: Dr. Shah, it's a pleasure for me to be here, and I hope the audience who listens to this finds it helpful. Thank you very much.
Narrator: The Bone Whisperers is a co production of NYU Langone Health and SiriusXM. The podcast is produced by Scott Uhing, sound design by Sam Doyle. SiriusXM's executive producer is Beth Ameen and senior operations manager is Emily Anton. Narration and additional sound design by Michael Luce. Don't miss a single episode of the Bone Whisperers and subscribe for free wherever you listen to podcasts. To hear more from the world renowned doctors at NYU Langone Health, tune into Doctor radio on SiriusXM Channel 110 or listen anytime on the SiriusXM app. For the Bone Whisperers podcast, I'm Michael Luce. Join us next time for the latest advances in orthopedics on the Bone Whisperers.