DEAR DR. GOTT: I have not seen anything in your column about a torn rotator cuff. I have one in my right shoulder. I am a 79-year-old male and wonder if an operation would help me in any way. I had a triple bypass in 1977 and implants placed in my prostate. Other than that, I'm in good health.

DEAR READER: The muscles and tendons that connect the upper arm bone to the shoulder blade and hold the ball of the bone firmly into the shoulder socket are known as the rotator cuff. Injuries result primarily from a fall with impact to the arm, the aging process, poor posture and from repetitive activity — specifically, that which is done overhead. Symptoms include loss of motion because of pain and shoulder weakness.

A torn rotator cuff can occur because of bursitis, tendonitis or a tear or strain. Bursitis is irritation and/or inflammation of the bursa located between the shoulder joint and tendons of the rotator cuff. Tendonitis is essentially inflammation of the tendons caused by excessive use, such as is seen in tennis players or carpenters. This excessive use can lead to tears or strains of the area.

Diagnosis is commonly made by physical exam. When questions remain, your physician might choose to order an X-ray, ultrasound or MRI.

Temporarily discontinuing the irritating activity, applying cold packs, which can be purchased at your local pharmacy or improvised with a bag of frozen peas from your refrigerator, gentle daily exercise and over-the-counter nonsteroidal anti-inflammatory drugs, such as ibuprofen or acetaminophen, can ease the pain. If these conservative measures fail to provide relief, visit your physician to determine the next step that might be physical therapy, a steroid injection or surgery. If surgery is recommend, obtain a referral to an orthopedic specialist for confirmation. He or she will be able to repair any tears or remove any bone spurs or calcium deposits.

I do not believe your age or medical history should prevent you from having surgery; however, I recommend you consider conservative measures first.

To provide related information, I am sending you copies of my Health Reports "Managing Chronic Pain" and "An Informed Approach to Surgery." Other readers who would like copies should send a self-addressed stamped No. 10 envelope and a $2 check or money order for each report to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title(s) or print an order form off my website at www.AskDrGottMD.com. Good luck.

DEAR DR. GOTT: Since last June, I have experienced tight neck muscles that make it a problem to sleep and drive my car. I've tried everything except acupuncture. My doctor is unconcerned. I'm 70 and in good health. I exercise three or four times a week on a stationary bike, garden and walk. Can you help me?

DEAR READER: There are 33 vertebrae in the spine, seven of which are in the neck. The neck holds up your head, which, on average, weighs about 10 pounds. With poor posture, even a few centimeters of poorly distributed weight can place an enormous burden on the neck muscles. So muscles tighten up as a defense mechanism and cause pain. Other than posture, other possible causes are osteoarthritis of the neck, fibromyalgia, polymyalgia rheumatica and hypothyroidism.

I recommend you see a sports therapist or request a referral to the physical-therapy department of your local hospital. You can be taught proper exercises that will strengthen the neck and, I hope, eliminate pain and stiffness.