Introduction to RCRSP

Shoulder pain is one of the most common musculoskeletal complaints, and at the heart of it for many lies the rotator cuff—a group of four muscles and tendons that stabilize and are involved in moving the shoulder. An overarching term for conditions such as subacromial shoulder pain (or, impingement) syndrome, rotator cuff tears (partial or full thickness tears) or rotator cuff tendinopathy; is what clinicians broadly refer to as Rotator Cuff Related Shoulder Pain (RCRSP).

What’s Happening Under the Surface?

RCRSP isn’t a single diagnosis but a spectrum of conditions that involve the rotator cuff and surrounding structures. Pathophysiologically (i.e. the changes that accompany shoulder pain in this instance), it’s not just about tissue damage. Pain in RCRSP isn’t always correlated with structural damage seen on imaging. In fact, many people with rotator cuff tears—usually seen via MRI or ultrasound—experience no pain at all.

This disconnect challenges the traditional tissue-pathology model and encourages a more nuanced view that includes biopsychosocial (i.e. biomedical, psychological and social) factors, tendon adaptability, and individual loading tolerance.

Partial vs Full Thickness Tears: What Do They Mean?

When it comes to rotator cuff tears, terminology matters:

• Partial Thickness Tear: This means the tendon is only frayed or torn on one side—either the bursal (outer) or articular (inner) surface. It’s often likened to a crack in a rope rather than a complete snap.
• Full Thickness Tear: Here, the tear goes all the way through the tendon, and is ranked by the size of the tear (small, large or massive)

However, it’s crucial to remember that the presence of a tear doesn’t predict pain or function. Many asymptomatic individuals over 50 have full thickness tears and don’t even know it.

Why Exercise is Key (and Often the Best Medicine)

Instead of rushing to surgical solutions, evidence strongly supports exercise-based rehabilitation as a first-line approach for RCRSP. Progressive loading of the rotator cuff tendons can improve capacity, reduce pain, and restore function.

The overarching message from recent research is that shoulder pain does not always mean damage, and recovery is often possible without surgery. Tailored, consistent exercise can not only help modulate pain but can also improve the strength of shoulder muscles and improve outcomes through improving confidence in the shoulders capability and reducing fear or anxiety about moving/working one’s shoulder.

Final Thoughts

RCRSP isn’t just about torn tendons—it’s about understanding the whole person and their circumstances, needs and goals. While imaging can inform, it shouldn’t dictate care. With the right guidance and commitment to rehab, most people with RCRSP can reclaim shoulder function and reduce pain without the scalpel.

For further information, check out these sources.

1. Lewis, J. S. (2016). Rotator cuff related shoulder pain: Assessment, management and uncertainties. Manual Therapy, 23, 57–68. https://doi.org/10.1016/j.math.2016.03.009
2. Lewis, J. (2018). A new paradigm for shoulder rehabilitation. British Journal of Sports Medicine, 52(18), 1123–1124. https://doi.org/10.1136/bjsports-2017-098983
3. Powell, J. (2020). Shoulder pain: A clinical perspective beyond structure. Available from https://www.jaredphysio.com
4. Kuhn, J. E. (2009). Exercise in the treatment of rotator cuff impingement: A systematic review and a synthesized evidence-based rehabilitation protocol. Journal of Shoulder and Elbow Surgery, 18(1), 138–160.
5. Minagawa, H., Yamamoto, N., Abe, H., et al. (2013). Prevalence of symptomatic and asymptomatic rotator cuff tears in the general population: From mass-screening in one village. Journal of Orthopaedics, 10(1), 8–12.