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I'v been told I'm a "poor risk" for rotator cuff surgery because I'm overweight, a diabetic, and I smoke. But despite all that, I'm fairly active and feel good -- except for the shoulder. Can I beat the odds and have a good result? Surely with all the people running around with this problem, they've come up with a decent solution for people like me.

It does seem like everybody knows someone who has had a rotator cuff problem. With over half a million news rotator cuff injuries or tears each year, it's highly likely you may find yourself in this same group. Older adults (65 years old and older) have the highest incidence of rotator cuff tears. Research shows that more than half of the adults in this age group have a rotator cuff tear -- many without even knowing it! With the aging of the many Baby Boomers (folks born between 1946 and 1964), it's likely that the number of patients with rotator cuff disease showing up in the surgeon's office will continue to increase. Surgeons are anticipating this problem by asking how to optimize treatment? The answer isn't straightforward (do this or do that) because there are so many issues that affect the decision-making process. For example, when should patients receive conservative (nonoperative) care and when should they have the tear repaired surgically? Should treatment vary depending on when the tear occurred (i.e., is the tear acute meaning it happened recently or is it chronic -- it's been there a long time). Should everyone who is recommended to have surgery really go through with it? What if they have known risk factors that predict a poor result (like people who smoke or who have diabetes or other serious health concerns)? And what about surgery? Is there one procedure that works best for each type, size, shape, and location of tears? According to a panel appointed by the American Academy of Orthopaedic Surgeons (AAOS), the evidence to help guide surgeons is fairly limited, weak, or inconclusive. As for negative predictive risk factors (e.g., smoking, diabetes, infection) the panel could not tell surgeons they should or shouldn't advise against surgery unless the MRI showed a significant tear, the patient was elderly, or the patient had a Worker's Compensation claim. And these risk factors did not predict a poor outcome 100 per cent of the time. The panel concluded there is a definite lack of strong evidence to help guide surgeons. The path in choosing the best treatment for optimal outcomes in patients with rotator cuff tears isn't clear. Every patient deserves an individual evaluation with all factors and variables taken into consideration. It's best if you sit down with your surgeon and discuss your goals, health concerns, preferences, and expectations. Only then can you work out a plan of care that is optimized for you and your situation. Don't let all the "naysayers" dictate your choices. It's entirely possible that you could have a very successful outcome. The decision is really up to you and your surgeon working together.

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