Persistent shoulder pain after surgery for rotator cuff disease may be caused by conditions that are either extrinsic or intrinsic to the shoulder. Extrinsic causes of persistent shoulder pain include cervical radiculopathy, suprascapular neuropathy, abnormalities of scapular rotation (due to long-thoracic or spinal-accessory neuropathy), and adjacent or metastatic neoplasms. Causes of persistent pain that are intrinsic to the shoulder include both intra-articular conditions (e.g., glenohumeral osteoarthritis, adhesive capsulitis, recurrent anterior subluxation, and labral and bicipital tendon abnormalities) and extra-articular conditions (e.g., persistent subacromial impingement, persistent or recurrent rotator cuff defects, acromioclavicular arthropathy, and deltoid muscle deficiency). Successful management requires an accurate diagnosis, maximal rehabilitation, judicious use of surgical intervention, and a well-motivated patient. The results of revision surgery in patients with persistent subacromial impingement, with or without an intact cuff, are inferior to reported results after primary acromioplasty or rotator cuff repair.