24/05/2025
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Just published 🔥
What’s in a name? The case for using “rotator cuff related shoulder pain” in clinical practice
🙋♂️ Shoulder pain is a prevalent musculoskeletal complaint, affecting millions globally and posing significant challenges in clinical diagnosis and management. Historically, terms like "subacromial impingement syndrome," "rotator cuff tear," or "non-specific shoulder pain" have been used to describe shoulder pain, often implying a specific structural pathology. However, emerging evidence questions the diagnostic accuracy of these terms, as imaging and clinical tests frequently fail to pinpoint a definitive pain source. Misleading diagnoses can lead to unnecessary treatments, including costly surgical interventions, which may not outperform conservative management.
✅ Recent research, including systematic reviews and clinical trials, highlights the need for a more accurate and patient-centered diagnostic nomenclature to improve clinical outcomes and reduce healthcare waste (Lewis, 2016; Ketola et al., 2017).
📘 A brand-new study by Lewis, Mintken, and McDevitt (2025), published in the Journal of Orthopaedic & Sports Physical Therapy, advocates for the adoption of the term "Rotator Cuff Related Shoulder Pain" (RCRSP) to describe non-traumatic shoulder pain in clinical practice. (https://www.jospt.org/doi/10.2519/jospt.2025.13405)
💡 The authors argue that current diagnostic labels, such as subacromial impingement syndrome, rotator cuff tendinopathy, or non-specific shoulder pain, are either misleading or unhelpful, failing to meet patients' needs for understandable and meaningful diagnoses. The paper synthesizes evidence from clinical research, patient perspectives, and a global clinician survey to support RCRSP as a scientifically grounded and patient-centered term.
🔑 Key Arguments
❎ Limitations of Current Diagnostic Labels
Lack of Diagnostic Specificity: The paper highlights that no imaging modality (MRI, ultrasound, radiographs) or clinical test can definitively identify the source of shoulder pain. Structural changes, such as tendon tears or acromial variations, are often present in asymptomatic individuals, undermining their diagnostic value (Ibounig et al., 2024).
❎ Misleading Terminology: Terms like "subacromial impingement syndrome" are criticized as vague and clinically unhelpful, akin to "suprahumeral pain syndrome." Similarly, terms like "tendinopathy" or "tendinitis" imply a specific tendon pathology that cannot be confirmed as the sole pain source (Lewis, 2016).
❎ Patient Perspective: Drawing on Hilary Mantel’s insight that "the worst pain is unexplained pain" and that treatments must "make sense" to patients, the authors argue that "non-specific shoulder pain" fails to provide clarity or guide meaningful treatment, leaving patients dissatisfied (Mintken et al., 2025).
❎ Evidence Against Structural Diagnoses
🩸 Biochemical Mechanisms: The presence of biochemical imbalances (e.g., elevated Substance P, TNF-α, and IL-6 in bursal and capsular tissues) suggests that shoulder pain may arise from mechanisms not detectable by imaging, challenging the notion of pain without nociception (Sahemey et al., 2016).
😷 Failure of Surgical Interventions: Studies, including a 10-year follow-up, show that acromioplasty and other surgeries (e.g., labral repairs, biceps tenodesis) do not outperform placebo surgery or conservative rehabilitation, indicating that structural "fixes" may function as placebos (Ketola et al., 2017; Schroder et al., 2017).
💰 Healthcare Costs: A Freedom of Information request revealed that 5,709 acromioplasties performed in the UK in 2023-24 cost £24,600,954 (USD$30,955,215), highlighting significant healthcare waste due to ineffective procedures.
✅ Case for Rotator Cuff Related Shoulder Pain (RCRSP)
✅ Clinical Relevance: RCRSP focuses on the muscle-tendon unit and surrounding structures (e.g., bursae, muscles) without implying a specific pathology. It aligns with evidence that exercise is beneficial when pain is associated with increased load relative to capacity (Burne et al., 2022).
✅ Patient-Centered Approach: RCRSP provides a meaningful framework for patients, explaining pain in terms of load and capacity without necessitating surgical intervention. It supports shared decision-making by discussing treatment options, including rehabilitation, lifestyle factors, and the risks and benefits of surgery or injections.
✅ Clinician Support: A 2022 survey of 480 clinicians showed strong preference for RCRSP, with over 250 respondents favoring it over alternatives like subacromial pain syndrome (13%), tendinopathy (10%), non-specific shoulder pain (8%), or impingement syndrome (5%) (Powell et al., 2022).
💡 Recommendations
The authors propose three key actions:
1️⃣ Adopt RCRSP: Clinicians, educators, and journal editors should use RCRSP in clinical communication and academic writing to provide diagnostic clarity.
2️⃣ Phase Out Misleading Terms: Terms like "impingement syndrome" and "non-specific shoulder pain" should be abandoned due to their lack of precision and failure to meet patient needs.
3️⃣ Acknowledge Patient Needs: Recognizing that unexplained pain is distressing, clinicians should use RCRSP to empower patients and align diagnoses with evidence-based practice.
📣 Conclusion
The adoption of RCRSP represents a paradigm shift in diagnosing non-traumatic shoulder pain, moving away from pathoanatomical assumptions toward a more accurate, patient-centered, and evidence-based approach. By unifying clinical language, RCRSP supports shared decision-making, reduces reliance on ineffective surgeries, and aligns with patients’ needs for meaningful explanations and treatments. The authors urge the global healthcare community to embrace this term to enhance care quality and sustainability.
📒 References
Burne G, et al. (2022). The Shoulder: Theory and Practice. Handspring Publishing.
Ibounig T, et al. (2024). Osteoarthritis and Cartilage.
Ketola S, et al. (2017). Bone Joint J. DOI: 10.1302/0301-620X.99B6.BJJ-2016-0569.RI
Lewis J. (2016). Man Ther. DOI: 10.1016/j.math.2016.03.009
Mintken PE, et al. (2025). J Orthop Sports Phys Ther. DOI: 10.2519/jospt.2025.13405
Powell JK, et al. (2022). Musculoskeletal Care.
Sahemey R, et al. (2016). J Biol Regul Homeost Agents.
Schroder CP, et al. (2017). Br J Sports Med. DOI: 10.1136/bjsports-2016-097098
