{"id":14300,"date":"2023-02-27T14:40:48","date_gmt":"2023-02-27T13:40:48","guid":{"rendered":"https:\/\/www.physiotutors.com\/?post_type=condition&p=14300"},"modified":"2026-08-13T13:21:22","modified_gmt":"2026-08-13T11:21:22","slug":"rotator-cuff-related-shoulder-pain","status":"publish","type":"condition","link":"https:\/\/www.physiotutors.com\/conditions\/rotator-cuff-related-shoulder-pain\/","title":{"rendered":"Rotator Cuff Related Shoulder Pain"},"featured_media":15096,"template":"","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":""},"tracking_tag":[2201,2193,2312],"class_list":["post-14300","condition","type-condition","status-publish","has-post-thumbnail","hentry","tracking_tag-muscle-tendon","tracking_tag-shoulder","tracking_tag-upper-extremity"],"acf":{"free_access":"","app_link":"https:\/\/app.physiotutors.com\/add-ons\/a829b875-9795-41a4-bf2d-f6e71dcc12d8","sections":[{"acf_fc_layout":"page-header-detail-page","background":{"background_image":10851,"background_image_alt_text":"Rotator Cuff Related Shoulder Pain"},"heading":"Rotator Cuff Related Shoulder Pain | Diagnosis & Treatment","subheading":"Shoulder","content_editor":"","button_type":"url","button_label":"","button_style":"button-five","button_internal_link":4646,"button_anchor":"","button_url":"https:\/\/study.physiotutors.com\/course\/rotator-cuff-related-shoulder-pain","button_file":"","label":""},{"acf_fc_layout":"submenu","links":[{"button_type":"anchor","button_label":"Introduction & Pathomechanism","button_internal_link":null,"button_anchor":"section-number-3","button_url":"","button_file":null},{"button_type":"anchor","button_label":"Clinical Picture & Examination","button_internal_link":null,"button_anchor":"section-number-4","button_url":"","button_file":null},{"button_type":"anchor","button_label":"Treatment","button_internal_link":null,"button_anchor":"section-number-5","button_url":"","button_file":null},{"button_type":"anchor","button_label":"Shoulder Online Course","button_internal_link":null,"button_anchor":"section-number-6","button_url":"","button_file":null},{"button_type":"anchor","button_label":"Course Reviews","button_internal_link":null,"button_anchor":"section-number-7","button_url":"","button_file":null}],"dropdown_label":"Go to","button_right":{"button_type":"internal_link","button_label":"Become a member","button_style":"button-three","button_internal_link":22104,"button_anchor":"","button_url":"","button_file":""},"button_description":""},{"acf_fc_layout":"content-with-sidebar","content_editor":"

Rotator Cuff Related Shoulder Pain \/ Subacromial Shoulder Pain | Diagnosis & Treatment<\/h2>\r\nRotator cuff related shoulder pain (RCRSP) is a common condition that affects a large proportion of the population. It is characterized by pain and discomfort in the shoulder region, often accompanied by a limited active range of motion and inability to produce force. The etiology of RCRSP is multifactorial, with several potential contributing factors, including anatomical, mechanical, and biological factors.\r\n\r\nThere are numerous terminology options for this pathology such as subacromial shoulder pain, subacromial impingement syndrome, subacromial bursitis, and subacromial bursopathy. However, \"Rotator cuff related shoulder pain\" or a weak and painful shoulder are preferred and the term \u2018impingement\u2019 should be avoided (Littlewood et al., 2019<\/a>).\r\n\r\n \r\n

Pathomechanism<\/h3>\r\nTendinopathy is a persistent pain and loss of function in tendons due to mechanical loading. It is most commonly seen in the rotator cuff, patellar, and Achilles tendons. The pathogenesis of rotator cuff tendinopathies is still mostly unknown and based on animal studies and surgically removed tendons. Tendinopathy is caused by collagen disruption, inflammation, or tendon cell response and the imbalance of synthesis and degradation may lead to disorganization. There is no direct relationship between structure, pain, and dysfunction, and tendinopathy can result in decreased muscle strength and control.\r\n\r\nTendinopathy may be driven by reduced stimulation of the tendon cell, secondary hyperalgesia, and intrinsic factors such as genetics, age, and loading history. Despite many scientific articles published on this subject, it is still challenging to construct a simple and robust model that accommodates all aspects of the condition (Scott et al. 2015<\/a>).\r\n\r\nThe pain mechanisms in tendinopathy are not clear but are thought to involve local nociception mediated by changes within the tenocytes (Rio et al. 2014<\/a>).\u00a0 The etiology of chronic tendinopathy is complex and multifactorial. The current understanding is the imbalance between the load demands placed on the tendon and its capacity to remodel (Cook et al. 2009<\/a>)."},{"acf_fc_layout":"content-with-sidebar","content_editor":"

Clinical Presentation & Examination<\/strong><\/h3>\r\nMore than 80% of shoulder pain is classified as rotator cuff-related shoulder pain (Ost\u00f6r et al 2005). According to the 2022 clinical guidelines, rotator cuff tendinopathy encompasses subacromial pain syndrome, rotator cuff-related shoulder pain, subacromial impingement syndrome, subacromial bursopathy, long head biceps tendinopathy, and partial thickness rotator cuff tear (Lafrance et al 2022). In this article, RCRSP is seen as an overlapping diagnosis, and synonymous with rotator cuff tendinopathy.\r\n\r\nTo classify as one of these conditions pain should be broadly over the deltoid and upper arm region. The pain will be activity-related and worse with overhead or behind-the-back reaching. Pain in the neck, reproduction of shoulder pain with neck movements, and distal neurovascular symptoms reduce suspicion. Changes in occupation and participation - rather than nature alone - might raise the index of suspicion.\r\n\r\nWhen doing your clinical examination, there should be no significant loss of passive range of movement, particularly in external rotation. Familiar pain should be reproduced with resisted abduction and\/or lateral rotation. Assessment of sleep, nutrition, alcohol, physical activity, and smoking should be done with the promotion of change where relevant (Littlewood et al 2019).\r\n\r\n \r\n

Orthopedic tests<\/strong><\/h3>\r\nMost diagnostic tests for the shoulder are unreliable or not validated and combining provides little use for clinical practice (Hegedus et al 2012<\/a>). However, in the clinical practice guideline by Lafrance and colleagues, there are several recommendations \u2014 although caution is required. These are seen in the bullet points below.\r\n\r\nUse the following tests to confirm or rule out a diagnosis of tendinopathy or full-thickness rotator cuff tear.\r\n\r\nCombinations to confirm a diagnosis:\r\n\r\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Full-thickness supraspinatus tear: Jobe\/Empty Can + Full Can + External Rotation Lag Sign\r\n\r\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Full-thickness infraspinatus tear: External Rotation Lag Sign\r\n\r\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Full-thickness subscapularis tear: Lift-off + Belly Press or Belly Press + Bear Hug\r\n\r\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Rotator cuff tendinopathy\/Partial tear: Painful Arc Test\r\n\r\nTests to rule out a diagnosis:\r\n\r\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Full-thickness supraspinatus, infraspinatus, or subscapularis tear: none\r\n\r\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Rotator cuff tendinopathy\/partial tear: painful arc test or Hawkins-Kennedy test\r\n\r\nTo perform these tests, watch the following videos closely:\r\n\r\nJobe test\/empty can test:<\/strong>\r\n\r\nhttps:\/\/www.youtube.com\/watch?v=DeO50UTxwoo\r\n\r\nFull can test:<\/strong>\r\n\r\nhttps:\/\/www.youtube.com\/watch?v=NuBOHdm20cc\r\n\r\nExternal rotation lag sign:<\/strong>\r\n\r\nhttps:\/\/www.youtube.com\/watch?v=JPsLBYjldGI\r\n\r\nLift off test:<\/strong>\r\n\r\nhttps:\/\/www.youtube.com\/watch?v=AgkTH52_PBI\r\n\r\nBelly press test:<\/strong>\r\n\r\nhttps:\/\/www.youtube.com\/watch?v=RDfStbLsj6Q\r\n\r\nBear hug test:<\/strong>\r\n\r\nhttps:\/\/www.youtube.com\/watch?v=30C3DNq-w4g\r\n\r\nPainful arc test:<\/strong>\r\n\r\nhttps:\/\/www.youtube.com\/watch?v=7-aXHIBRsbU\r\n\r\nHawkins-Kennedy test:<\/strong>\r\n\r\nhttps:\/\/www.youtube.com\/watch?v=X9YiuvQJVJc\r\n\r\nOther orthopedic tests for RCRSP are:\r\n