Dear Dr. Roach: I had an MRI that showed three of my four rotator cuff tendons have complete tears. I can only lift my right arm midway. I cannot comb my hair, and I’m right-handed. I cannot lift a glass or coffee cup to put on a shelf in kitchen cabinets. I have some pain if I move my arm too much, but Advil helps. Can you tell me what to expect after surgical repair? — V.K.
Answer: The rotator cuff is a group of four muscles (subscapularis, supraspinatus, infraspinatus and teres minor) that attach the arm to the torso. The bony joint does not really do that the way the hip does, for example. Any movement of the arm or shoulder needs to be balanced by the rotator cuff for the shoulder to work properly.
Shoulder cuff issues are the most common cause of shoulder pain. But the most common rotator cuff problem is not a tear, but damage to the tendons without a complete tear. This is usually treated by physical therapy and sometimes joint injection.
An acute, full-thickness tear in a person with an otherwise normal shoulder is usually treated with immediate surgery to prevent muscle atrophy and further joint degeneration. Full-thickness tears in a person with existing rotator cuff disease and who have new limitations in shoulder movement are also usually treated surgically.
The goal of surgery is to restore as much function to the shoulder as possible and my experience with my own patients who undergo shoulder surgery is that most function can be restored. However, it can be a long road to get there, with physical and sometimes occupational therapy after surgery.
Some older patients with full-thickness tears nonetheless have pretty good function of the shoulder. Conservative therapy (with the very same experts in physical and occupational therapies) can be effective. Surgery should be considered only in those who don’t respond to therapy and medication.
Dear Dr. Roach: A friend of my 31-year-old daughter has just been diagnosed with visual snow syndrome. He is devastated, since his profession depends heavily on being able to see clearly. I understand that the disease is not physiological, but rather neurological. Is this disease incurable? Is there a genetic link? Do you know of any studies underway? — C.S.
Answer: Visual snow syndrome is new to me. It is a rare disorder where people notice snowlike dots throughout the visual field. It can sometimes begin in childhood, and apparently there are adults who can never recall having vision without those kinds of dots, which can cause significant loss of visual acuity (and psychological consequences, as you might well imagine).
A 2017 review of the condition identified this as related to, but distinct from, migraine with aura. They proposed two treatments: one medicine normally used for seizures, lamotrigine, and another used for migraine (among other conditions), verapamil. The authors noted that this does not cure the disease, but can improve vision significantly enough to make a real impact on people’s lives.
A second review from 2020 suggested medication therapy is unfortunately not effective much of the time, and suggested the wearing of colored glasses (blue-yellow) as being helpful in some people with this condition.
I did find a trial in Colorado recruiting patients for transcranial magnetic stimulation for this condition. You can find it at clinicaltrials.gov.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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