If so, don't go to the medical literature for guidance on what to do. A new draft review by U.S. government-funded researchers at the University of Alberta in Edmunton found that the 122 studies of invasive and non-invasive techniques for curing a torn rotator cuff offered almost no guidance for knowing what works best.

While a torn rotator cuff is a rare if painful phenomenon among the young (except for the occasional professional athlete or tennis buff), over half of adults over 60 will suffer a serious shoulder injury during their senior years. Virtually all "take it easy" for six weeks to three months. They take steroids and painkillers, take time off work and, for the more adventurous, take up various forms of external therapy such as massage, acupuncture and chiropractor manipulation.

But when those don't work, the next step, as former Washington Post correspondent T.R. Reid learned in his journey into the heart of the U.S. medical system for his book, "The Healing of America," is almost always surgery, which these days comes in a number of flavors. You can have it sliced opened and totally rebuilt; have it sliced open and partially rebuilt, or have it arthroscopically cleaned out and repaired, a minimally invasive procedure. Not only does the patient need guidance on choosing which one of these options works best, they have to decide how long to wait before going under the knife.

The reviewers found that the 122 relevant studies in the medical literature offered inadequate guidance on these questions. Virtually all were "at high risk of bias," the draft report said.

Only 20 were controlled clinical trials. The rest were either ex-post facto cohort studies or reports on outcomes drawn from small groups of patients enrolled in trials without any comparison arm.

More significantly for anyone looking for support for their desire to avoid surgery, only three of the studies compared non-operative approaches to various surgical interventions, and they enrolled a grand total of 167 patients. Those trials provided evidence that was "too limited to make conclusions about the comparative effectiveness of the interventions," the review said.

What the literature did contain was 102 studies looking at or comparing various forms of surgery (get the picture yet on who writes this literature?). And that showed was that the less invasive interventions had more or less the same outcomes of more radical surgery and that those patients generally returned to work a month earlier.

In other words, decades after a surgical intervention became commonplace, the surgical research establishment has told patients what is obvious and best suits the surgeons' economic interests, but not what those patients want and need to know.

The draft review is open for comment until December 7.