Question: Our daughter, age 33, has developed pain in her shoulder that keeps her from getting a good night's sleep. Her primary care physician says it's her rotator cuff and will require surgery. She has no insurance and also has two elementary children to be cared for. Do you have any suggestions?

Dr. Hibberd's Answer:

Rotator cuff tears come in varying degrees and all cause varying degrees of discomfort. Correction of complete tears almost always requires surgery. An MRI is the usual means for evaluating this condition. Complete disruptions are best corrected surgically, with best results seen when corrected early. If the tissues are torn totally and the opposing ends displaced from each other, surgery to re-oppose the displaced ends is almost always the best option to clear pain and maintain normal shoulder function

Delayed repair is very common, and many minor, incomplete tears heal with the passage of time. Most patients opt for conservative management. Minor tears are usually initially treated by immobilization, then by conservative measures aimed at maintaining shoulder movement and range of motion as tissues heal.

It is very important your daughter maintain full shoulder range of motion, or she will complicate and prolong her treatment after definitive repair has been accomplished.

As regards her financial dilemma, seek a consultation from your local medical assistance office or county health department. Many counties have assistance in the form of a little known "poor fund" that often helps families in times of medical need. She may also consider seeing a social worker with experience in health care issues, and perhaps check at a local hospital to see if she will qualify for aid.