Scott Webb (Host): Though rotator cuff injuries are common for athletes, we can all injure our rotator cuffs by falling, being in a car accident, and unfortunately, in lots of other ways. My guest is here to tell us how the rotator cuff works and how we can help folks nonsurgically when they're injured.

I'm joined today by Dr. Thomas Schmittdiel. He's a board-certified physician in Family Medicine and Sports Medicine, practicing at Franciscan Health. This is the Franciscan Health Doc Pod. I'm Scott Webb

Doctor, it's nice to have you here today. We're going to talk rotator cuff. But before we get to that, I want to have you explain your specialties and background, how that informs your patient care, especially we're talking about these common sort of orthopedic injuries.

Dr. Thomas Schmittdiel: I am a Primary Care Sports Medicine physician. And so, what that means is I did my background training in Family Medicine, so a primary care specialty. So, I learned the general ins and outs of almost all different parts of medicine. And then, I got to take an extra year and focus on muskuloskeletal and ultrasound medicine. So, it kind of is one of my favorite things to learn about, is the human body and how it moves. Because if you understand how you move, you can understand what's hurting you, and that usually gives you a pretty good idea on how to fix it. That always made sense to me. And so, I've been really happy.

Plus, I get to work with athletes. I get to help people get back to their activities they like to do, whether it's gardening, whether it's stuff around the house, whether it's playing with the grandkids or trying to get to that next level in competitive sports. So, I get to see a wide variety of people. And the rotator cuff plays a big role in almost everything we do. 

Host: Yeah. That's the thing about the rotator cuff. I've learned, in speaking with other providers at Franciscan Health, is that, you know, yeah, it might be somebody on the field of play. You know, a baseball pitcher might injure their rotator cuff, but it also might be somebody around the house, you know, suffers a fall, something like that. So, tell us, what is the rotator cuff exactly? Like, what does it do, what's its role, what's its function?

Dr. Thomas Schmittdiel: Yeah. That's a great place to start. So, the rotator cuff is basically the fine motor movement muscles of your shoulder. You have four rotator cuff muscles. Everyone learns this in medical school. This is called your superspinatus, your infraspinatus, your teres minor, and your subscapularis.

And the important part about these muscles is that they allow your arm to move up, move to the side, and moves your arm in what we call internal, external rotation. And essentially, what that aims is you are able to do the fine important movements that you need to do, whether you're playing sports or working around the house. So, anytime you're reaching for something above your head, like out a cabinet or you're doing your hair, putting your belt on, or you're throwing a ball, all that requires a lot of movement in the shoulder, and that's what your rotator cuff is for.

Host: Wondering, what are some of the most common injuries that you're seeing and how do they occur, just generally speaking?

Dr. Thomas Schmittdiel: Yeah. So, we see all different types of rotator cuff injuries. I will say the two most common ways people injure the rotator cuff are what we divide in what we call acute or chronic injuries. What we mean by acute injury means injuries happen that occur right away. So if you fall, you're in a car accident, you throw something really hard and you feel something tear, that's what we consider acute injuries versus a chronic injury is something that takes a long time to build up.

So, let's say you use your arms a lot when you work. You're a mechanic, you work in a factory, or you do a lot of fine motor overhead stuff like maintenance or woodworking. And you just continually use that arm in the same way for years and years and years. And it's important to know how you injure your arm, and that's usually the first thing your doctor's going to ask you when you go in to see them about shoulder pain because that starts to help us figure out what type of injury you have and then where we go from there.

Host: Yeah, I'm sure patient history is a big part of this. Wondering, what the signs and symptoms are? Like, how do we know, what would get us to come see you or speak with a provider about our shoulder? How do we know we've injured it?

Dr. Thomas Schmittdiel: That's a great question, and I use this line all the time in my clinic. I say, "You'll know when your shoulder hurts," you know?

Host: Right. Yeah.

Dr. Thomas Schmittdiel: So, my advice always is, and this is with most things in type of Sports Medicine, is when it starts to affect your daily function. If you feel like it's stopping you from doing the things you like to do, you feel like you can't do the things you like to do at a certain level, or you're avoiding activities because your shoulder hurts, then I think that's a time to go talk to your primary care provider, talk to a specialist, and get your shoulder checked out.

Host: Yeah. I know that, pickleball is really popular now. I have some friends in my age bracket, let's say over 50, you know, that are suffering and are having some trouble playing pickleball because of shoulder pain, soreness, whatever it is. I'm like, "You know, you should probably speak to your doctor, speak to a provider." As you say, when we can no longer do the things we enjoy doing, things we love doing, that's probably a good time to reach out, right?

Dr. Thomas Schmittdiel: Oh yeah. No, I have patients come in. Pickleball is the hot new thing and it's definitely been coming up with shoulder and elbow injuries, which, you know, I always give my patients credit because they are competitive when it comes to pickleball. So, they want to get back out there. I see a lot of rotator cuff injuries.

Also, a lot of swimmers will come in with rotator cuff injuries from all the overhead movement. I see a lot of guys who like to have a hobby shop and they'll be working on cars, bikes, you know, anything that's kind of mechanical. They'll get themselves in those weird positions and just that kind of small movement. And then, you know, after we get their shoulder fixed, they always show me, you know, what they're working on. So, I've seen a lot of the cool cars that are driving around Northwest Indiana.

Host: Yeah. Yeah. They used to call it tennis elbow, right? Now they're calling it, is it pickleball elbow? is that what we call it now?

Dr. Thomas Schmittdiel: Something like that, you know?

Host: Wondering, are there some non-surgical ways that you can treat rotator cuff injuries or anything that like we can do at home to kind of heal and recover from injuries?

Dr. Thomas Schmittdiel: Yeah. And that's actually kind of where my niche in the medical world is. So, I'm a non-operative Sports Medicine doctor. So, I don't do the surgeries. My partners at Franciscan, we have some really good sports docs and some good upper extremity docs who are happy to see you, but I always tell the patients, my job is to make you not go see them. Because if I can fix you, everyone's happy.

And the way you kind of approach surgical versus non-surgical decision-making, it really comes down to the level of your injury and the way you can tell injuries. You can always go through the history and physical exam, which to me is the most important thing. Learning about what you're limited in and then seeing how you can function in clinic.

And then if we want to get more information, we can always order an MRI. And what you look for in an MRI is the level of tearing because I hate to say it, but anyone over the age of 50, 60 years old, you're going to have some partial tearing in the rotator cuff. It's just one of those privileges of getting older. It's going to be on the MRI. But I try to always tell my patients, even if we see it, if you're functioning well and, you know, you're able to move your arm in almost the directions, we don't have to immediate to surgery.

Host: So, let's talk like recovery time, the sort of standard rotator cuff injuries, if you will, in terms of the treatment that you offer, physical therapy and otherwise, what's the recovery time?

Dr. Thomas Schmittdiel: Again, no patient is typical, but the textbooks are going to tell you. It's usually like, you know, anywhere from six to 12 weeks, depending on the severity of the injury. And I always try to tell patients, you know, if this problem has been bugging you for years and years, it's also not going to go away overnight. You know, it takes a while to have a chronic injury. And most of the time, it takes a while to fix a chronic injury. But the best thing you can do for fixing any of these long-term rotator cuff injuries that have been nagging you, you got to start.

And so, I usually start with two things. Number one, in my opinion, the most important part of rotator cuff repair and treatment is physical therapy. Getting into the physical therapist, and even if you don't go for a long time, but going to learn the proper exercises because the stronger you get your rotator cuff muscles, the more properly your shoulder's going to move. And then, that gives the tendon time to heal, and it also will help alleviate pain. So to me, the physical therapy is kind of our cornerstone. It's the most important thing we can get you to do your partial or your more chronic rotator cuff inuuries.

Host: Is there anything else we can do besides, I don't know, not playing pickleball or you swimming or falling off ladders? How could we prevent rotator cuff injuries?

Dr. Thomas Schmittdiel: Prevention really, it's all on a spectrum with the treatment. It's the stronger you keep your shoulder and the better biomechanics or the better way you move your shoulder, then the less likely you're going to get an injury. And the most common ways I see people having pretty severe rotator cuff injuries, if it's not from a fall or an accident or something you can't avoid, but the stuff that we can avoid is just ignoring your own body. So, playing through pain and really doing things even though you know they're uncomfortable. And a lot of that comes down to people love what they do. People love to play pickleball, people love to go swimming, people love to go rock climbing, all these things.

That's one of the hardest part of my job is to have these conversations that, "Hey, if you want to keep doing this for the next 20, 40 years, you know, we may have to take a few weeks off right now." And usually, when I phrase it like that, most people come around.

Scott Webb: Yeah. You know, it's been great to have you on. I know we're going to speak again soon. We're going to talk strains, sprains, fractures, you know, all that good stuff. I'll just give you a chance here. Final thoughts, takeaways when you think about the rotator cuff and the folks that you see in the office, what's your best advice?

Dr. Thomas Schmittdiel: My best advice is to do your homework. And what I mean by that is when the physical therapist asks you to work a little bit outside of their sessions, it's the best thing you can do for yourself, a little bit every day goes a lot further than doing a lot once or twice a week.

Host: Yeah. Yeah.

Dr. Thomas Schmittdiel: And another thing that I really try to help people with, and this can come off a little scary at first, is the best physical therapy you can do is therapy when you're not in pain, because pain seems to be a big kind of barrier I see a lot of people going to. And one way we can deal with pain outside of the physical therapy is I can give you a little boost with either a steroid injection or with some medicines. So if pain is your issue, let your doctor know because usually there are some things we can do to help. And then, we'll get you into some good physical therapy.

Host: Well, that's perfect. Like I said, we're going to talk again soon. Pick your brain some more. Thank you so much.

Dr. Thomas Schmittdiel: Oh, thank you for having me. I appreciate it.

Host: And for more information, visit franciscanhealth.org and search orthopedics. And if you found this podcast helpful, please share it on your social channels, and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.