Diagnostic labels for rotator cuff disease can increase people’s perceived need for shoulder surgery: an online randomized controlled experiment

Key Points

1. The diagnostic labels ‘rotator cuff tear’ and ‘subacromial impingement’ result in a small but significant increased perceived need for surgery and imaging in this clinical trial, despite being accompanied by positive and non-threatening clinical messaging.

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BACKGROUND & OBJECTIVE

The clinical presentation of non-traumatic shoulder pain is a diagnostic conundrum. Traditionally, pathoanatomical labels such as subacromial impingement syndrome, rotator cuff tear and tendonitis/tendinopathy have been the preferred diagnostic terms. However, accumulating evidence has challenged the accuracy and utility of these terms (1,2,3). As such, alternative options have been suggested, including rotator cuff-related shoulder pain (RCRSP) (4) and subacromial shoulder pain. To date, there is no consensus diagnostic label across countries and settings.

Diagnostic labels can influence people’s management preferences; however, this has not been experimentally verified for rotator cuff disease. This randomized controlled trial primarily set out to answer the question: “do different diagnostic labels for rotator cuff disease influence peoples perceived need for surgery”?

Diagnostic labels can influence people’s management preferences.

There is no impenetrable barrier to modifying our diagnostic terminology, just tradition and habit.

METHODS

This was a 6-arm online randomized controlled trial. Participants were recruited via an online market research company.

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