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

Review written by Jared Powell info

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.
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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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