Intensity and distribution of shoulder pain in patients with different sized postero-superior rotator cuff tears

J Shoulder Elbow Surg. 2014 Jun;23(6):807-13. doi: 10.1016/j.jse.2013.09.011. Epub 2013 Dec 27.


Background: The vast majority of studies regarding rotator cuff tears (RCTs) are focused on etiopathogenesis and treatments, but information on shoulder pain characteristics needs further investigation. We analyzed the intensity and distribution of shoulder pain in patients with different sizes of RCTs.

Methods: Two hundred eighty-five consecutive patients with postero-superior RCTs were enrolled for this study. Tear size was intraoperatively classified. Before surgery, all patients completed an upper limb pain map (dermatome map made by Keegan). Shoulder pain intensity was assessed with a visual analogue scale (VAS). Data were submitted to statistical analysis.

Results: Shoulder pain intensity caused by a RCT was greater in females (P = .024); it did not vary with the side nor with age. Pain intensity was less in massive tears (P < .05) and in patients whose pain was distributed only to the shoulder (P = .035). Furthermore, patients whose pain persisted for more than 6 months maintained the same pain intensity. Pain was localized predominantly on dermatomes C5-C6, was more diffuse in massive tears (P < .05), and rarely extended beyond the elbow. In the presence of intense shoulder pain, its precise distribution was not well-delimited.

Conclusion: Shoulder pain characteristics in patients with RCTs may be influenced by gender and size of tear. Cuff tear pain distribution principally involves the antero-lateral aspect of the shoulder with extension down the lateral surface of the arm to the elbow. Information about pain intensity and distribution in patients with RCTs may contribute to a more accurate diagnosis.

Levels of evidence: Level III, cross sectional study.

Keywords: Rotator cuff tear; pain distribution; pain intensity; shoulder pain.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pain Measurement*
  • Rotator Cuff Injuries*
  • Shoulder Pain / etiology