Two torn shoulders, one sore one

THE 30-SECOND VERSION

A torn rotator cuff on a scan is common after 60. In one village study, two out of three tears in people over 60 caused no pain at all. A tear on a report is a clue, not a verdict.

THE MYTH

Torn is not the same as broken

The myth goes like this. If a scan shows a torn rotator cuff, the tear must be what hurts, and a torn thing has to be sewn back together. It sounds like common sense. It is how most of us think about a ripped coat or a split fence board.

But a group of doctors in Japan went and checked. They offered a joint checkup to everyone in one village, and 664 people came, about a fifth of the whole town. Every one of them had both shoulders scanned, pain or no pain. More than one in five had a full-thickness tear, which means a tear that goes all the way through the tendon.

Nobody in their 20s, 30s, or 40s had one. About 1 in 10 people in their 50s did, and by the 80s it was more than 1 in 3. Here is the part I read to Frank. Over the age of 60, two out of every three tears caused no symptoms at all. In other words, his right shoulder is not strange. It is normal. A worn tendon is a bit like the thin spot on an old pair of boots. It shows the miles, and the boots still keep your feet dry.

Surgery, or the slow way

So what about the tears that do hurt? A team in Finland took 180 painful shoulders in people over 55. Each had a small tear that came on slowly, with no fall or injury behind it. They split them three ways. One group got physical therapy alone. One got therapy plus an operation to shave bone from the roof of the shoulder. The third got therapy, the shaving, and a full repair of the tendon.

They followed people for about six years, by which point the average patient was 71. There was no real difference in pain, in how well the shoulder worked, or in how pleased people were. Only 8 shoulders in the therapy group went on to have the repair. Or put another way, for this kind of tear, the slow way held its own against the operating room.

Honesty about all this

I should be straight with you. Not every trial agrees. A Norwegian study found that repair did better than therapy at ten years for small and medium tears. And a tear that arrives with a fall, or an arm you suddenly cannot lift, is a different animal, and surgeons often move faster on those. So I did not tell Frank to cancel anything. I told him the tear on his report is a clue, not a verdict, and that a good program of therapy is a fair first try for the worn kind. His doctor gets the final word. We’ll see.

A small win of my own

Since the day of the four grocery bags, I have made two trips from the car every time. Carol has not said a word, which is how I know she noticed. My right shoulder, the one that ached before the milk was in the fridge, has been much quieter for two weeks now. That is not a study. It is one man and a few bags. But it cost me nothing, and I will take it.

Now I would like to hear yours. If something small has made your shoulder, back, or knees a little easier, hit reply and tell me what it was. The best ones may end up in a future Friday issue, with your first name only, and only if you say yes.

What to keep from shoulder week

Three things, if you keep nothing else. Remember Tuesday: the shoulder blade has to glide freely for the arm to work, so a hunched, clenched shoulder is working against itself. Remember Thursday: your shoulder is charged by the inch, so carry things close and split the load. And remember today: a scan can show wear that has nothing to do with your pain. Move the arm, strengthen it, and let your doctor weigh the pictures against how you feel.