Last time we noted that we were going to ask Dr. Ruotolo what he was referring to when he wrote about "nonoperative therapeutic measures." He was on vacation, thus the delay in our following up.

We had hoped he would mention a food or nutrient treatment but alas, he had been referring to physiotherapy. As the Cochrane Report observed, there has been too little data on efficacy for them to come up with sufficient evidence for a recommendation of physiotherapy as a treatment. We continue with our review of the medical literature on shoulder pain.

In Clincial Orthopaedics, vol. 411, 2003*, doctors reported that an M.R.I.** examination showed a lipoma (a benign tumor usually composed of fat cells.) Ordinarily, the patient's pain could have been attributed merely to rotator cuff tear or "nerve entrapment." They both operated on the rotator cuff and removed the lipoma successfully. Thus the value of the M.R.I.

*By Drs. Peter & Leni May, Dept. of Ortho., Mt. Sinai School of Med., N.Y. 10029.
**Magnetic Resonance Imaging.

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