The major pain source of rotator cuff‐related shoulder pain: a narrative review on current evidence

Review written by Dr Angela Cadogan info

Key Points

  1. The reviewed evidence doesn’t appear to support a conclusive, clinically significant relationship between mechanical factors and rotator cuff-related shoulder pain (RCRSP).
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Rotator cuff-related shoulder pain (RCRSP) is a description of a large number of different pathologies, both traumatic and atraumatic in nature, that present with similar symptoms, including bursitis, rotator cuff tendinopathy, rotator cuff tears and calcific tendinopathy.

In earlier years, atraumatic rotator cuff pain was thought to be caused by either a primary (acromial morphology) or secondary (scapula dyskinesis) reduction in the subacromial space and acromioplasty surgery was widely performed for ‘impingement’ symptoms. While this was successful in relieving symptoms for some, it was not effective for everyone. This has led others to take up the challenge to further examine other causes of rotator cuff-related pain.

The aim of this narrative review was to discuss possible sources of pain contributing to RCRSP according to the mechanisms-based pain classifications.

Rotator cuff-related shoulder pain is a description of a large number of different pathologies.
There does not appear to be a clear clinical association between acromiohumeral distance and critical shoulder angle and atraumatic rotator cuff-related shoulder pain.


The authors conducted a narrative review of the literature to review mechanism-based classifications of RCRSP. Mechanism-based pain classifications were introduced in the 1990s and most of the articles reviewed were published after this time. ‘Nociplastic’ pain was only recognized in

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