Psychosocial Factors in Rotator Cuff Disorders: Catastrophizing, Sleep, Distress and Tear Severity in the Observational Evidence

Physical therapists and physical therapist assistants who see people with rotator cuff related shoulder pain, tendinopathy or cuff tears in outpatient, primary care or pre-surgical settings, and who want a plain-language account of how strongly psychosocial factors track with pain and function in this population.

Licensed physical therapists and physical therapist assistants. Physical therapist assistants may take this course; the content describes their contribution as work carried out under the direction and supervision of the physical therapist, with evaluation, diagnosis and plan-of-care decisions remaining with the physical therapist. Athletic trainers, occupational therapists and other rehabilitation clinicians who manage shoulder pain may also find the material relevant.

Intended audience

Physical Therapy

Level

Intermediate

Delivery format

Online, asynchronous, self-paced course: interactive reading with audio or video, and a scored post-test.

Based on

This course reports only what the following two papers found. No claim is made here that the source documents do not support.

Udayasankar MK, Horgan F, French HP. What Is the Association Between Psychosocial Risk Factors and Pain and Function Outcomes in People With Rotator Cuff Disorders? A Systematic Review. JOSPT Open. 2026:1-52. doi:10.2519/josptopen.2026.0194

Okafor C, Levin JM, Boadi P, Cook C, George S, Klifto C, Anakwenze O. Pain associated psychological distress is more strongly associated with shoulder pain and function than tear severity in patients undergoing rotator cuff repair. JSES Int. 2023;7(4):544-549. doi:10.1016/j.jseint.2023.02.010

After completing this course, you will be able to:

1. Describe which psychosocial factors the JOSPT Open systematic review reported as having the most consistent associations with function in people with rotator cuff disorders, and how confident its authors were in that evidence.
2. State what the JSES International cross-sectional study found when it compared pain-associated psychological distress with rotator cuff tear severity as correlates of shoulder pain and function before cuff repair.
3. Explain why observational studies of this kind cannot show that psychosocial factors cause pain and functional limitation, and distinguish screening and communication approaches described by the two papers from causal claims they did not make.

1. Start Here: Course Overview, Objectives and How to Earn Credit
2. Part One: Psychosocial Risk Factors and Pain and Function in Rotator Cuff Disorders
3. The People and the Studies Behind the Review
4. How the Search, Appraisal and Evidence Grading Were Done
5. What the Review Found for Pain and for Function
6. Where the Evidence Was Thin and What the Authors Concluded
7. Part Two: Psychological Distress Versus Tear Severity Before Rotator Cuff Repair
8. The Surgical Cohort and the Screening Tool Used
9. How Tear Severity Was Classified and Compared
10. What the Comparison Showed for Pain, Function and Distress
11. Limits of a Single-Center Cross-Sectional Snapshot
12. Bringing It Together
13. Where the Two Papers Agree
14. Where They Diverge and Which Paper Found What
15. Screening and Responding Within a Plan of Care
16. What Remains Unanswered
17. Key Takeaways
18. Post-Test and Course Evaluation

Quinn Millington, PT, DPT, ECS is the instructor of record: the licensed clinician who reviewed this course and signed off on it. The name and credentials print on the certificate.

Disclosures. This course was developed by The ConEd Solution, which has a financial interest in its sale. No outside funding or sponsorship was received. The instructor of record has no affiliation with the authors of the source publication or their institutions.

This course awards 1.0 contact hour (60 min). How you earn them:

1. Complete the course. Every lesson, in order.
2. Pass the post-test. Score 80% or higher. Retakes are allowed.
3. Complete the evaluation. A short form rating each learning objective and the course.
4. Download your certificate. It is issued on completion and stays available in My Account.

The episode time is its measured length. Reading, post-test and evaluation times are estimates.

This course is designed to satisfy the quality requirements state boards set for continuing education. Requirements vary by state, and confirming that a course fits your renewal is up to you. Each state’s own acceptance statement is in the credit panel on this page.

1. Udayasankar MK, Horgan F, French HP. What Is the Association Between Psychosocial Risk Factors and Pain and Function Outcomes in People With Rotator Cuff Disorders? A Systematic Review. JOSPT Open. 2026:1-52. doi:10.2519/josptopen.2026.0194
2. Okafor C, Levin JM, Boadi P, Cook C, George S, Klifto C, Anakwenze O. Pain associated psychological distress is more strongly associated with shoulder pain and function than tear severity in patients undergoing rotator cuff repair. JSES Int. 2023;7(4):544-549. doi:10.1016/j.jseint.2023.02.010