04/21/2025
What rotator cuff-related shoulder pain is and why it is superior to other outdated diagnoses?
Rotator cuff–related shoulder pain (RCRSP) is a term used to describe a spectrum of shoulder pain conditions involving the rotator cuff tendons.
It acknowledges a spectrum of pathology:
Instead of pinning the issue on a single diagnosis like "impingement" or "bursitis," RCRSP reflects the clinical reality that symptoms often arise from multiple overlapping issues (e.g., tendinopathy, bursitis, and mechanical dysfunction).
It avoids outdated or misleading terms:
Terms like subacromial impingement suggest a structural compression as the main issue, which modern research has shown is not always the case. Surgical decompression based on this model has not shown superior outcomes to conservative management in many studies.
“Impingement” also suggests a need for surgery to “make space,” which may lead to unnecessary procedures.
It supports evidence-based treatment:
RCRSP encourages a focus on conservative management (exercise therapy, education, and gradual load management) as first-line treatment.
This matches current best evidence, which shows many patients improve without the need for imaging or surgery.
It reduces over-reliance on imaging findings:
Imaging often reveals asymptomatic rotator cuff tears in people with no shoulder pain.
RCRSP promotes clinical diagnosis based on history and physical exam, avoiding overdiagnosis and overtreatment.
It promotes a biopsychosocial approach:
The term invites consideration of pain as a multifactorial experience, involving physical, psychological, and social contributors.
This is more aligned with modern pain science and patient-centered care.
Bottom line
"Rotator cuff–related shoulder pain" is a more inclusive, precise, and evidence-aligned diagnosis than older, more pathoanatomical terms. It helps clinicians avoid over-medicalizing benign findings, tailors treatment to what actually works, and better supports patients in understanding and managing their condition.