This masterclass reframes subacromial impingement as rotator cuff related shoulder pain (RCRSP). It reviews rotator cuff function, aetiology, imaging, and surgery, and asks which structures actually drive symptoms. The central question: does the acromion cause cuff pathology, and does exercise match surgery for these patients?
When a patient presents with activity-related shoulder pain and weakness in elevation and external rotation, resist the urge to anchor on the acromion or a tear seen on MRI. The tear-location data (mostly articular-sided) and the asymptomatic-imaging data (up to 80% of elderly people have tears without pain) mean structural findings do not reliably identify the pain source.
This reframes the diagnosis as rotator cuff related shoulder pain and shifts first-line management to a graduated, progressive exercise program, which trials show matches surgery for impingement, tendinopathy, and atraumatic tears.
A practical pitfall: avoid threatening language like the acromion is wearing away the tendon. It reinforces a mechanical model the evidence does not support and may increase the patient's fear of movement. Stratify management into irritable, non-irritable, and advanced presentations to match load and exercise selection to the patient in front of you.
This masterclass reframes subacromial impingement as rotator cuff related shoulder pain (RCRSP). It reviews rotator cuff function, aetiology, imaging, and surgery, and asks which structures actually drive symptoms. The central question: does the acromion cause cuff pathology, and does exercise match surgery for these patients?
When a patient presents with activity-related shoulder pain and weakness in elevation and external rotation, resist the urge to anchor on the acromion or a tear seen on MRI. The tear-location data (mostly articular-sided) and the asymptomatic-imaging data (up to 80% of elderly people have tears without pain) mean structural findings do not reliably identify the pain source.
This reframes the diagnosis as rotator cuff related shoulder pain and shifts first-line management to a graduated, progressive exercise program, which trials show matches surgery for impingement, tendinopathy, and atraumatic tears.
A practical pitfall: avoid threatening language like the acromion is wearing away the tendon. It reinforces a mechanical model the evidence does not support and may increase the patient's fear of movement. Stratify management into irritable, non-irritable, and advanced presentations to match load and exercise selection to the patient in front of you.