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This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations.
A 63-year-old woman presents with a 2-year history of progressive weakness and discomfort in her right shoulder, especially when she puts dishes on the top shelf in her kitchen. She is otherwise healthy and has had no injuries. Her physician diagnosed "bursitis" and gave her four subacromial corticosteroid injections; the first two seemed to relieve her symptoms temporarily, but the last two
The Clinical Problem
Strategies and Evidence
Evaluation
Imaging
Treatment
Acute Complete Tears
Partial-Thickness Rotator-Cuff Tendon Defects
Chronic, Full-Thickness, Degenerative Tendon Defects
Areas of Uncertainty
Guidelines
Conclusions and Recommendations
Source Information
From the Department of Orthopaedics and Sports Medicine, University of Washington, Seattle.
An audio version of this article is available at www.nejm.org.
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