Most Common Cause of Shoulder Pain
Rotator cuff pathology is the leading cause of shoulder pain, accounting for over two-thirds of all cases. 1, 2
Epidemiological Evidence
The American Academy of Orthopaedic Surgeons definitively states that rotator cuff pathology represents the primary source of shoulder-related disability, with approximately 4.5 million patient visits for shoulder pain occurring annually in the United States. 1 This burden is substantial—chronic shoulder pain affects approximately 8% of all American adults, making it the second most common musculoskeletal complaint after knee pain. 1
Age-Related Prevalence
The prevalence of rotator cuff pathology increases dramatically with age:
- 13% in the fifth decade of life 1
- 20% in the sixth decade 1
- 31% in the seventh decade 1
- 54% of asymptomatic patients aged 60+ have rotator cuff tears 1
Importantly, not all rotator cuff tears are symptomatic, with cadaveric studies showing 19% full-thickness and 32% partial-thickness tears. 1
Other Common Causes by Context
While rotator cuff pathology dominates overall, the etiology varies by clinical presentation:
In Acute Traumatic Settings
Trauma becomes the predominant cause, including:
- Fractures (clavicle, scapula, proximal humerus) 1
- Soft tissue injuries (rotator cuff, acromioclavicular ligaments, labroligamentous complex) 1
- Glenohumeral dislocations 1
In Post-Stroke Patients
Shoulder pain affects 1-84% of stroke patients (varying by definition and acuity), with the following specific causes: 1
- Adhesive capsulitis 1
- Complex regional pain syndrome 1
- Rotator cuff tears 1
- Bursitis/tendonitis 1
- Shoulder subluxation (though its association with pain remains controversial) 1
The incidence in stroke patients during the first year ranges from 1-22%, with motor weakness and shoulder subluxation being the strongest predictors. 1
Clinical Implications
The dominance of rotator cuff pathology as the primary cause has driven a 141% increase in rotator cuff repairs from 1996 to 2006, with approximately 250,000 repairs performed annually in the United States. 1 This surgical volume continues to rise despite the fact that many rotator cuff tears remain asymptomatic. 1
Key Risk Factors for Rotator Cuff Pathology
- Age over 40 years (degenerative tears from normal wear and tear) 1
- Repetitive overhead activities (athletes, painters, carpenters) 1
- Dominant arm involvement 1
- Traumatic injury in younger patients (falls, dislocations) 1
Important Caveat
While rotator cuff disease is the most common cause overall, clinical diagnosis requires careful history and imaging to differentiate from other shoulder pathologies, as treatment approaches differ significantly. 2, 3 The presence of comorbidities like diabetes mellitus, hypertension, and dyslipidemia are associated with higher rates of specific rotator cuff lesions. 4