The experiments creating the biggest buzz among spinal cord researchers are those involving fetal cell, stem cell or embryonic stem cell transplants. So far, most of the research is in animals, though some studies are beginning in people.

In all three methods, the idea is essentially the same: To implant in the damaged spinal cord immature cells that can be nudged to grow into many, perhaps all, of the thousands of different types of nerve cells in the body. The immature cells can also be genetically engineered to produce large quantities of the chemical messengers believed to stimulate new nerve growth.

Ideally, the cells would be transplanted into a patient within a week or two of injury, but the ultimate goal is to use them months or even years later to stimulate nerve growth.

In embryonic stem cell transplantation, cells are taken from embryos at the 8- to 12 cell-stage, says Dr. John W. McDonald, director of the spinal cord injury program at Washington University in St. Louis. These cells, isolated for the first time only a year ago, then differentiate into every type of cell in the body, including spinal nerve cells.

In fetal cell transplants, tissue is taken from the spinal cords of aborted fetuses. Researchers at the University of Florida are already trying this method in a few patients to see if it yields new nerve growth.

At Cedars-Sinai Medical Center in Los Angeles, researchers are gearing up for a study in which they would take nerve stem cells from the brains of patients with spinal cord injuries, grow them in large numbers in the lab, and re-inject them to trigger new nerve growth. Once thought non-existent in adults and still tough to identify in the lab, neural stem cells – presumably left over from fetal development – have been shown to exist in the brain in the lining of spaces called ventricles, in the hippocampus, a memory center, and in the spinal cord.

If the basic cell transplant strategy works in humans – and researchers should know in two to five years – it could eclipse everything else now in testing.

Already, researchers have been able to insert into neural stem cells “marker” genes that show where the cells migrate after being injected into animals and what kinds of nerve cells they become, says Dr. Evan Snyder, a neuroscientist at Children’s Hospital in Boston.

In fact, preliminary research shows that if human neural stem cells are injected into mice three or four days after a spinal cord injury, the cells move to exactly where they’re needed and start replacing the cells that were damaged, Snyder notes.

At a neuroscience meeting next month, McDonald’s team will present data showing that embryonic stem cells can restore function by replacing cells lost after spinal cord injury in rats, even if they’re transplanted as long as nine days later.

Ten years ago scientists scoffed at the thought that a paralyzed person could walk again; today they’re counting on it.

Four years after being paralyzed from the neck down in a riding accident, Christopher Reeve is preparing to walk again, a feat long assumed to be impossible for any quadriplegic, even Superman.

As scientists work to develop drugs to minimize acute spinal cord damage and hunt for new ways to spur regeneration even long afterwards, Reeve is trying to “meet the scientists halfway. . .”

Speaking openly, often eloquently, by phone from his Bedford, New York home, despite his reliance on a respirator to breathe, Reeve believes that, ultimately, “recovery will go to the fittest.”

So every day, he has an electrical device attached to his muscles to stimulate contractions. “I have no loss of tone whatsoever,” he says, adding that his calf muscles “are the exact same size as when I was injured.”

To prevent osteoporosis, which can be caused by a lack of weight-bearing exercise, he is strapped to a “tilt table” and raised to a vertical position to force his weight onto his feet.

He also “walks” on a treadmill — his weight suspended in a harness, his feet propelled by the moving belt. The theory is that spinal nerves can be retrained to make the legs move in a coordinated way, even though the messages that control voluntary leg movements can’t get from the brain down to the legs across the damaged area of the spinal cord.

Ten years ago, if anyone as badly injured as Reeve even dreamed of walking again, scientists would have scoffed. Reeve’s injury is not only high on his spinal cord, it’s “complete,” which means the nerve fibers are cut all the way across, not just partway, as in some cases.

Indeed, the dogma has long been that, while nerves in the arms and legs regenerate, those in the central nervous system do not — a grim fact of life for 10,000 Americans a year whose spinal cords are injured as a result of car crashes, sports accidents and violence, and for the quarter million more living with their injuries, most of whom with fewer resources than Reeve.

But thanks to an explosion of new research — some to be presented next month at a major neuroscience conference in Miami — that pessimism is cracking.

“It will be a long, arduous path, but I no longer think it’s impossible for people with severe, even high, spinal cord injuries, to walk again,” says Dr. Evan Snyder a neuroscientist at Children’s Hospital in Boston and one of the leaders in spinal cord regeneration research.

“There is tremendous new hope. The neat thing is that the central nervous system does have the capacity to regenerate — we just need to harness it. And we’re also getting better at using advances in electronics and surgery to maximize a person’s independence,” says Dr. John W. McDonald, director of the spinal cord injury program at Washington University in St. Louis.

Electronic devices can help paralyzed patients gain control over their bladders; a drug called NT-3 seems to help the bowel work on command; and early data suggest another drug called inosine helps healthy nerves grow toward the damaged area.

Surgeons can also do “tendon transfers” to restore limited movement to paralyzed muscles by hooking them to still-functioning tendons. Many primary care doctors don’t think to recommend this, McDonald says, but by re-jigging tendons so a patient can grasp things between the thumb and forefinger, a person may be able to feed himself.

Indeed, a half-dozen new therapies to repair damaged spinal cords, including cell transplants, are or soon will be in human trials, says Dr. Wise Young, a neuroscientist at Rutgers University in New Jersey. “The hope is that if we can get 10 to 15 therapies going in parallel, at least one of them will hit.”

None of the new approaches was “dreamt of 10 to 15 years ago,” adds Arlene Chiu, who runs the spinal cord injury program at the National Institute of Neurological Disorders and Stroke. “So on that basis, I’d say things are very promising,” even though, so far, most research is in animals, not people.

Still, the challenges are daunting, almost as if evolution had “decided” that a spinal cord injury was so devastating, it was not worth investing the resources it would take to heal it.

The spinal cord, which runs inside the backbone, is only as thick as a thumb, but it’s through this channel that the brain sends signals through descending nerves onward to muscles and organs and carries messages, such as pain signals, up through ascending, sensory nerves.

Deep in the center of the cord lie the nerve cell bodies called “gray matter;” branching out from these are tendrils called dendrites, which catch incoming electrical signals; also projecting out are filaments called axons through which nerves send outgoing signals.

Some axons are long, running the entire length of the cord. Because they are coated with a white insulating material called myelin, bundles of axons are called “white matter.” Both white and gray matter also contain supporting cells called glia, and oligodendrocytes, which make the myelin.

The organization of the cord means that below an injury, nerves (and the muscles and organs they control) don’t work well or at all, while above it they do. It also means that below certain injuries, a person can feel nothing — neither pain nor pleasure.

If you injure your cord in the neck region, you may not be able to breathe without a respirator because the nerves that control the diaphragm won’t work; if you injure your cord farther down, you may have control over breathing and arm movements, but not over your legs, bladder and bowel. If the cord is not severed all the way across, there may be some function below the injury because some nerves still work.

When the cord is injured, there is instant damage to the immediate area: the bony vertebrae crush axons, rendering them useless. But for days, weeks, even months later, the damage spreads up and down the cord.

Ruptured blood vessels no longer deliver oxygen, causing waves of cell death. Damaged cells pump out glutamate, which triggers a cascade of chemical events that is fatal to nerve cells, including the release of destructive oxygen molecules called free radicals.

The injured cord also pumps out chemical signals such as IN-1 that inhibit regeneration of nerves. Axons that survive the initial injury may also lose their myelin coating, without which they can’t transmit signals. Glial cells clump into scar tissue, making it even harder for nerves on both sides of an injury to hook up. And inflammation, including the influx of immune cells that destroy nerve cells, further fans the flames of destruction.

But in 1990, the picture began to brighten when Dr. Michael Bracken and his team from Yale University showed that a drug called methylprednisolone, injected in huge doses in the first eight hours after injury, prevented some of this damage by blocking free radicals.

“This was the first time anything had been shown to work in spinal cord injury,” says Bracken, a neurologist. To this day, methylprednisolone is the only drug approved to treat either acute or chronic spinal cord injury.

But other ways to treat the cord in the immediate aftermath of injury are in the pipeline, including a drug called an AMPA antagonist that blocks glutamate receptors, likely to be studied in humans soon, and another called interleukin-10 that blocks inflammation, at least in rats.

Cooling the body after injury also slows damage in rats, says Naomi Kleitman, a neuroscientist at the Miami Project to Cure Paralysis.

The implications are compelling. The more doctors can limit the immediate injury, the more they can focus on the really tough part: restoring nerve function in people whose spinal cords were injured months or years earlier.

It’s a tall order, but Christopher Reeve is ready: “I expect full recovery — up to and including walking.” SIDEBAR 1: Getting a lift from new devices, wheelchairs

The holy grail of spinal cord research is to restore some or all nerve function, but even in the most optimistic scenarios, that’s still five years away. In the meantime, however, new devices and better medical care can improve the quality of life for the estimated 230,000 Americans living with spinal cord injuries, and for many others with mobility disorders as well.

Two years ago, the US Food and Drug Administration approved an electronic signalling device that allows some quadriplegics — people whose arms and legs are paralyzed — to regain partial use of one hand. In January, the agency approved another electronic device that restores some control over bladder, bowel and penile function.

And three months ago, Johnson & Johnson began human testing of a fancy, $20,000 wheelchair that can operate on two wheels or four and can climb stairs, go up hills and maneuver over curbs.

To be sure, even with better devices, learning to live with a spinal injury is a task that takes time “and a lot of work,” says Michael Ferriter, 47, a carpenter who was injured in a work accident 20 years ago.

But with every new device and improvement in basic care, the lives of paralyzed people get a bit better, though the amount of care necessary — and the cost, estimated to be $1.4 million over the life of a spinal injury patient — are huge.

That’s because a spinal cord injury can affect every organ and body function below the level of injury: muscles, bones, skin, blood vessels, internal organs and breathing, notes Dr. Daniel Lyons,, medical director of the spinal cord injury program at Health South/New England Rehabilitation Hospital in Woburn.

Without skin sensation, for instance, a person can’t tell when he’s getting sore from sitting too long in one position. This can lead to pressure sores and ulcers, which can lead to infections. The solution here is low tech: having someone monitor the skin, helping the patient change position often, and developing better cushions for wheelchairs.

Blood clots are another challenge. Because a paralyzed person can’t move, blood can pool in the legs and form clots that travel to the lungs. One solution is to take a blood thinner such as Lovenox.

Heart arrhythmias are a problem, too. In a healthy person, signals from the parasympathetic nerves, which tend to slow down heart rate, are coordinated with signals from the sympathetic nerves, which tend to speed it up.

But in many people with spinal injuries, this balance is thrown off. The parasympathetic nerves remain intact because they branch off high on the spinal cord, while the sympathetic nerves, which branch off lower, are damaged. The result is that the heart beats erratically because slow-down messages are not coordinated with speed-up ones. The body can compensate but if it can’t, implantable pacemakers can help.

Breathing, even just coughing, can be another huge problem. The solution is often to use a respirator, which literally pushes air into the lungs, though rehabilitation specialists try to wean people with some remaining nerve function off respirators and teach them to strengthen muscles in the diaphragm and neck to assist with breathing.

Depression is also a threat. Though many patients regain significant quality of life, says Lyons, getting to that point is difficult. “Everyone does it differently,” he says. “Well-educated business executives are often very devastated early on, then do very well as time goes by,” he says.

“Younger people who don’t have a lot of plans for their lives sometimes do well early on, then have more difficulty later as they realize that things will be tough.”

Mobility is an obvious challenge, too. At UCLA and the Miami Project to Cure Paralysis, researchers are trying to retrain damaged spinal cords by suspending a patient over a moving treadmill.

In some patients, the legs move involuntarily, and even do so in a coordinated — left foot, right foot — manner. Researchers theorize that even below the level of injury, there may be a neural “pattern generator” and “memory” in the cord that — without messages from the brain — may make walking possible.

German researchers have demonstrated improvements in mobility by putting such patients on a treadmill, says Reggie Edgerton, a UCLA physiologist pioneering the method. But so far, no one with a “complete” cord injury (one that cuts across the entire cord) has been able to regain the ability to walk.

Of more immediate benefit to many is the Freehand device, made by the NeuroControl Corp., to regain use of a hand.

The Freehand system uses a sensing device taped to the skin on the shoulder. Wires from the sensor run to an external control box and from there to a transmitting coil taped to the chest. Just under that coil is a stimulating device that is implanted surgically under the skin.

Leads from the implanted device run down the arm to electrodes on the fingers and thumb. When the shoulder is moved, signals travel down to the hand. So far, about 150 people worldwide are using the device.

The VOCARE system, distributed by NeuroControl and made in England, is similar. In this case, the implantable part of the system is surgically placed under the skin on the abdomen, with electrodes on nerves to the bladder, bowel and in men, the penis. The transmitter coil is held or taped to the skin over the implant and the unit is controlled externally by the patient if he has sufficient hand control, or by a helper. The device, which allows patients to urinate, defecate or get an erection, is now used by 1,500 people worldwide, most of them in Europe.

Michael Ferriter, the carpenter injured in a work accident, welcomes the new options for treatment of injuries like his. But he also has hard-won advice: “Live healthy — mentally, physically and spiritually until there’s a cure. Don’t wait for it. Live it now. . .You’ve got to do it. That’s what life is about.”

Among ancient peoples, it is said, this precious bodily fluid was used as the basis of a primitive lie detector test. The accused would be given a handful of rice and told to swallow it; if he couldn’t, it meant he was nervous – and guilty.

This slippery stuff also helps moisten and digest food, and has healing powers as well – proteins that fight bacteria, fungi and viruses and others that speed tissue healing, says Dr. Irwin Mandel, professor emeritus at Columbia University. In fact, animals that lick their wounds heal faster than those who don’t.

The fluid in question, of course, is saliva, or actually, spit – a combination of the saliva pumped out by salivary glands and all the other effluvia floating around in our drool: drugs (licit and otherwise), bugs (viruses, fungi, bacteria), hormones, antibodies and anything else small enough to seep out through tiny blood vessels into the mouth.

As unpleasant as it all sounds, spit is in. In fact, it could be the diagnostic fluid of the future, according to scientists who plan to gather next week at the National Institute of Dental and Craniofacial Research to explore spit’s many wonders – and economic potential.

Already, a number of companies are using the Internet to tout spit test kits, some of which have not been approved by the US Food and Drug Administration, which acknowledged last week it’s scrambling to keep up.

With the kits, consumers muster a little spittle, fork over $60 or so and send the sample to a lab to find out whether, say, their testosterone is tanking, their estrogen slipping, or their stress hormones soaring.

Spit, or more elegantly, oral fluid, is almost identical to the clear part of blood, but with everything – including infectious organisms – present in weaker concentrations. In the past, diagnostic tests were not sensitive enough to detect these low concentrations, but now they are.

That means that almost anything that can be detected in blood can theoretically be found in spit, too – with less pain, risk of infection and expense.

Spit testing is cheap because it’s so safe – neither patient nor health care worker can get stuck with a needle. “You don’t need a technician to get the sample,” says Dr. Stephen Sonis , chief of oral medicine at Boston’s Brigham and Women’s Hospital.

So far, spit tests have only been FDA-approved for a few limited uses – to detect the AIDS virus, illegal drugs, alcohol, a hormone that signals premature labor, and periodontal disease. There are no tests that allow a person to both collect and analyze spit at home – yet.

With the OraSure kit made by the Epitope Corporation of Beaverton, Ore., for instance, you have to go to a health care professional, who puts a toothbrush-like swab between your cheek and gums for a few minutes, then sends the sample to a lab to be tested for HIV. Insurers also use the OraSure kit to test for marijuana, cocaine, opiates or methamphetamines.

In other countries, the kit is used to collect spit for testing for hepatitis B and other diseases. And soon, this kit and others like it could be used to get DNA for testing from prisoners on parole or people at risk for genetic diseases. (It’s unlikely, by the way, that spit samples could be collected surreptitiously from, say, a coffee cup or eating utensil, because the sample would be too small and would degrade quickly without preservation.)

But as spit collecting and preservation techniques evolve, do-it-yourself spit tests could be commonplace.

Already, doctors use spit tests to monitor hormonal changes in infertile women, says Dr. Philip Fox, former clinical director at the National Institute of Dental and Craniofacial Research at NIH and now research and development director at Amarillo Biosciences Inc., in Amarillo, Tex.

Similarly, SalEst , made by Biex, Inc. in Dublin, Ca. allows women at risk of premature labor to have their spit tested by a doctor for the hormone estriol. If estriol rises before 36 weeks of pregnancy, it’s a signal the woman may go into labor prematurely.

But it is the gray area of spit testing through companies on the Web that concerns the FDA, which worries about consumers putting their trust in diagnostic tests that have not been approved.

The Great Smokies Diagnostic Laboratory in Ashville, N.C., for instance, offers spit tests for a number of hormones through its website (www.bodybalance.com). You pick the test – StressCheck, MaleCheck or FemaleCheck – pay $60 and send in your sample to see if your hormones are in the normal range. No doctors are involved.

The company claims the tests are “screening” tools, not true diagnostic tests, and admits its tests are not approved by the FDA. After inquiries from the Globe, the FDA said it is “concerned about the Great Smokies advertising and promotion as well as about other firms that advertise and promote lab tests on the web.”

While it is not illegal for labs to set up an in-house testing service and offer it through health care professionals, it is illegal is to offer this service directly to consumers, says Dr. Steven Gutman , director of the FDA’s division of clinical laboratory devices.

But “the beauty of the test” for consumers, argues Dr. Alison Levitt, a physician at Great Smokies, is precisely that “you don’t need to go to the doctor. . .People are interested in their hormone levels. People want numbers.”

Aeron LifeCycles Clinical Laboratory in San Leandro, California used to offer spit tests directly to consumers, too.

But last year, after federal and state regulators reviewed the lab’s practices, the company decided to put doctors in the loop, though you still don’t need to actually talk to a doctor to be tested, notes George Romero, customer service manager.

You simply send in your spit and $44, pick a name off a company-supplied list of doctors and that doctor signs the test order. For an additional fee, that doctor will help interpret the results, which you also get sent directly.

But how useful is it to send off some spit and get a few numbers that you try to interpret? Probably not very – in part because some hormone levels fluctuate wildly.

To test for stress, for instance, the Great Smokies lab checks levels of two hormones, DHEA (dehydroepiandrosterone) and cortisol. But cortisol levels vary over a 24-hour cycle, so if you send in only two samples a day, as the company website suggests, the potential for misinterpretation would appear to be high. In the version of the stress test sold to doctors, hormones are measured four times a day, says Great Smokies physician Levitt.

For researchers, however, it is precisely this variability in hormone levels that makes spit-tests a gold mine because they can track physiological changes almost in real time.

“When cortisol goes up in the blood, we find it in saliva within 20 minutes,” says Douglas Granger, a Pennsylvania State University behavioral endocrinologist. In studies of people before and after roller coaster rides, cortisol in saliva shoots up within 15 minutes, then returns to normal in an hour.

In other work, Granger has found similar cortisol spikes in kids experiencing family stress.

In one test, he asked mothers and kids to discuss a topic about which they disagreed, then had the kids spit into little cups. The kids judged the most anxious by other tests showed the highest rises in cortisol levels, says Granger, who has formed a research company to study spit for a number of hormones..

Ultimately, with more sophisticated spit kits, consumers could test their oral fluids at home. What spit testing offers, says, Dr. Irwin Mandel, affectionately known among researchers as “the grandfather of spit,” is “a lick and a promise” – a simple, reliable way of monitoring health.

Take care in getting tested

If you decide to have your oral fluids tested, especially by one of the services offered on line, be wary:

• When collecting the spit sample, follow package directions carefully. Typically, spit samples must be preserved quickly to remain useful. (For instance, if you’ve just eaten or drunk something, rinse your mouth and wait a few minutes before collecting spit.)
• Think about potential confidentiality problems. Anytime you reveal medical information on the Internet or send bodily fluids through the mail, your confidentiality may be at risk.
• Remember that a number of medical treatments and conditions, including drugs, radiation therapy, autoimmune problems such as Sjogren’s syndrome, can affect saliva. This could influence the accuracy of your tests.
• Most important, if you bypass a doctor and use the Internet to find a spit test service on your own, you could be jeopardizing your health. If you’re sick – or worried that you might be – call a doctor.

Problems with the shoulder, the second most unruly joint in the body after the knee, send 4 million Americans to their doctors each year.

With young people – and active older folks as well – it’s usually a sports injury. But aging, along with plain old wear-and-tear, also wreak havoc on this flexible yet delicate joint.

“The shoulder is the most mobile joint in the body, but it’s the most unstable, too. What we gain in motion, we lose in stability,” says Dr. Jeffrey L. Zilberfarb, a shoulder surgeon at Beth Israel Deaconess Medical Center in Boston.

Indeed, the shoulder is the only place where tendons pass through a tight space between bones, making it a “set-up” for trouble, says Dr. Michael Wirth, an orthopedic surgeon at the University of Texas Southwest Medical Center in San Antonio.

And trouble comes in various forms. Tendons and muscles can shred as a result of wear and tear, making arm movement agonizing or impossible. Ligaments can be so loose congenitally or become that way from trauma or over-stretching that the arm slips out of the socket, a problem called instability or dislocation, depending on the severity. The opposite can happen, too – a shoulder joint can become so stiff from scar tissue that it becomes “frozen.”

Two summers ago, Carol Furneaux, a 55-year-old musical conductor from Carlisle, tripped over her 100-pound black lab as she got out of bed one night. The dog barely noticed.

But as she landed on her outstretched right arm, she felt a searing pain through her shoulder. By morning, the acute pain had subsided, but she couldn’t lift her arm.

Dr. Alan Curtis , an orthopedic surgeon at New England Baptist Hospital, gave her the diagnosis: a torn rotator cuff, the group of muscles and tendons that stabilizes the shoulder. He stitched it up surgically through a tiny incision and Furneaux was fine.

Until last summer, that is. She’d just had knee surgery (it has not been a good couple of years, she says) and was dutifully soaking her leg in a Jacuzzi. But as she hoisted herself out with her arms, she ripped her other rotator cuff. The verdict: another surgery.

Shoulders are particularly vulnerable to problems because a lot can go wrong in a relatively compact area. For one, spurs, or small protrusions, can develop on the acromion, a bone that sits on top of muscles and tendons, which connect the muscles to bone. The spurs rub against soft tissue, resulting in irritation and pain.

“Every time you reach forward, if the acromion has spurs on it, it rubs on top of the cuff, causing impingement, ” notes Curtis of the Baptist.

Sometimes, impingement of soft tissue is simply the result of poor anatomy – the acromion angles too far down. In other cases, the space is cramped because the bursa, a sac of fluid that lubricates the shoulder, becomes inflamed. Impingement can also occur if the rotator cuff muscles are weaker than the deltoid muscles in the arm – when the arm is raised, the cuff gets pinched.

Impingement often leads to tendonitis, an inflammation of the tendons. For reasons that are unclear, tendonitis may also cause calcium deposits in the cuff, which further irritates tissues, causing acute pain.

In 95 percent of cases, tendonitis gets better with simple remedies like rest, ice, and anti-inflammatory drugs. In severe cases, an injection of cortisone into the space beneath the acromion may be needed.

But with enough wear and tear – or with a sudden, acute injury like Furneaux’s – shoulder muscles and tendons can literally tear away from the bone. Tears that only go partway through the thickness of the rotator cuff often heal without surgery, says Curtis. But tears that go all the way through or that cause persistent pain or weakness demand surgery.

Historically, this meant a four- or five-inch incision to peel the deltoid off the acromion to gain access to the rotator cuff and stitch up the tear. The deltoid is then reattached and must heal, which takes six weeks or more. If the deltoid fails to re-attach properly after surgery, it can be irreparable.

“The worst case scenario,” says Curtis, “is a failed cuff repair and a failed deltoid repair. Then you have no cuff, no deltoid. You lose the ability to raise your arm, and there’s no good answer for that.”

In recent years, doctors have increasingly turned to less invasive, arthroscopic surgery. This involves making three quarter-inch incisions through which tiny cameras and instruments are inserted to enable doctors to sew up small tears as they monitor the procedure on a screen. For medium-size tears, doctors use a “mini-open” surgical technique, in which the deltoid is split, but not detached from the bone.

Although athrosocopy makes for speedier healing – it’s day surgery versus a night or two in the hospital for the larger incision – it’s still technically difficult enough that many surgeons haven’t yet learned to do it.

Meanwhile, surgeons are turning to a growing number of high-tech approaches for other shoulder problems.

Robert Colman is a 32-year-old Brookline man who works as a “grip,” or TV and film lighting specialist. That means he’s constantly lifting and holding lights over his head. Gradually, he says, pain from his shoulder instability became intolerable.

But instead of repairing Colman’s overstretched ligaments the old way – removing pieces of the ligaments and sewing the ends together through an open incision – his surgeon, Zilberfarb, repaired it with a new technique called thermal capsular shift.

This involves inserting lasers or radiofrequency probes through tiny incisions and heating ligaments to 152.6 degrees Fahrenheit, under anesthesia. The heat shrinks the collagen in ligaments, which causes scar tissue, which in turn tightens up the ligaments.

Potentially, ligaments could stiffen up too much or stretch out again over time. So far, though, Colman’s had no problems – he’s lifting weights and says he’s “glad I had the surgery.”

Many surgeons also now shave bone spurs off the acromion (a procedure called acromioplasty or subacromial decompression) during an arthoscopic procedure. This widens the space between the acromion and the soft tissues.

Wirth and others are also testing new ways to strengthen shoulder tendons with grafts of a material called SIS (made from the lining of the small intestine in pigs).

“It’s remarkable stuff,” he says. The material, which triggers the re-growth of tendons that have become too thin, is only done experimentally at this point.

As for “frozen” shoulders, the solution is more low-tech: stretching and physical therapy. It can take a year or more to “thaw” a frozen shoulder, with exercises to increase range of motion and break up scar tissue. In really stubborn cases, it may take surgery to remove excess scar tissue.

Many people simply live with their shoulder problems, hoping they’ll go away. And often they do. But others – especially men and older people – tend to wait too long to seek help, giving up one activity after another and putting up with considerable pain.

“What brings many men into the office is wives who can’t sleep because their husbands toss and turn because of shoulder pain,” Zilberfarb says. “Guys are in denial. We’d wait until an arm falls off to come in.”

Older people, too, often wait until the torn cuff atrophies and retracts into the socket.So the moral, as Furneaux puts it, is simple: “Don’t put it off.” With her first shoulder injury, she waited almost six months to see a doctor. “I was almost at the point where they couldn’t repair it,” she says.

Now, thanks to two athroscopic surgeries, she says, “I can lift both my arms over my head. It’s like it never happened.”

Divining and treating shoulder problems

The rotator cuff is a group of four muscles and tendons that hold the shoulder together and give it strength and flexibility. Together, these tissues hold the upper arm bone (humerus) in the shoulder socket (glenoid).

Problems can be diagnosed by X-rays (including an arthrogram, in which dye is injected into the shoulder to highlight the rotator cuff) and tests like CT scans, EMGs (electromyelograms, which assess the ability of nerves to stimulate muscle contractions), MRIs, and ultrasound, says Dr. Jeffrey L. Zilberfarb, an orthopedic surgeon at Beth Israel Deaconess Medical Center in Boston.

But you may be able to figure things out more simply. Sit on a chair with your arm held horizontally in front of you, elbow bent. Have a doctor or a friend push down lightly on the top of your hand as you pretend to pour water out of a glass. If it hurts as you “pour,” your rotator cuff may be irritated and you should see a doctor, says Zilberfarb.

Most shoulder problems can be treated without surgery. Try the following:

• Rest. In bed, lie on your good side and put a pillow between your injured arm and your side to take the pressure off the shoulder. When you’re not in bed, if your shoulder is very painful, keep your arm in a sling for a few days. (But if you have a fever, get to an emergency room – you may have a “septic shoulder,” a serious infection.) Never rest so much that your shoulder gets stiff – alternate rest with gentle exercise. – Cold. If you have tendonitis, put ice on your shoulder for 20 minutes 3 times a day. Cold helps by reducing inflammation.
• Heat. If your shoulder is stiff, try heating pads and gentle exercises like standing in a hot shower with your shoulder against a wall and “walking” your fingers up the wall. Heat helps by increasing blood flow to injuried tissues.
• Medications. Over the counter anti-inflammatory drugs like ibuprofen often help. For severe cases, you may need cortisone injections or cortisone cream applied to the skin.
• Ultrasound. Like heat, ultrasound waves can warm tissues in the shoulder, improving blood flow and speeding the healing process.
• Electrical stimulation. TENS, or transcutaneous electrical nerve stimulation, can ease pain by sending electrical signals through the skin to your shoulder to block pain signals.
• Exercises – done gently – can also help heal injured shoulders and prevent further injury. Here are some:

1. Take a towel and drape it over your good shoulder. Hold the front end with your good hand. Put your bad arm behind your back and grab the dangling end of the towel. Pull gently with your good arm to raise your injured arm. Hold for a few seconds then repeat five to 10 times.
2. Rest the hand of your bad arm on the shoulder of your good arm. Take your free hand and pull the elbow of your bad arm toward your good side to stretch your bad shoulder. Hold the stretch for 10 seconds, then repeat. You can also do this lying down.
3. Take an inner tube from a bicycle tire or color-coded rubber tubing from a physical therapist. Tie it to a doorknob. Stand with your injured shoulder toward the doorknob. With your bad elbow pressed against your side, hold the end of the band and pull it toward your good side. Repeat 10 times. Then turn so that your good shoulder is toward the doorknob. Grab the tubing with your bad arm, and move it away from your body, again keeping your elbow tucked in.