Shoulder pain ranks third among common, but enigmatic, musculoskeletal disorders, prompting patients to visit a wide variety of healthcare practitioners. ¹ The general population’s prevalence of shoulder pain varies greatly, averaging 16% (range: 0.67 to 55.2%). According to the global burden of shoulder pain survey, the incidence of shoulder discomfort ranges from 7.7 to 62 per 1000 persons per year (median 37.8). ² Accounting for more than half of the shoulder issues addressed by healthcare providers, RC disorders contribute significantly to shoulder pain and dysfunction. ^{3, 4} RC disorders are inclusive of RC tendinopathies, calcified tendinopathies, and partial/full-thickness RC tears. ⁵ The shoulder joint is the most mobile in the body because of the RC muscles’ contribution to its static and dynamic stability. ⁶ Between 4% and 32% of patients with RC disorders present with symptoms such as pain, weakness, and limitations in daily activities, reflecting the demand placed on these muscles. ⁷ Shoulder pain can also result in lost productivity, absences from work, and early retirement in workers, especially those who are subjected to heavy physical demands or repetitive overhead activities. ⁸ A systematic review has outlined the challenges in decision-making for conservative or surgical management of RC tears. ⁹ The review findings suggest that earlier surgical intervention may be necessary in cases of weakness and significant functional disability. It also appears that worker’s compensation claims may negatively impact the treatment outcomes.

Over the last decade, the surgical management of RC tears has changed from open to mini-open to arthroscopic repair. ¹⁰ Currently, ARCR surgery is the most common treatment for RC tears. After ARCR , functional outcomes of traumatic and non-traumatic RC tears have shown similar and satisfactory results. ^{11– 13} Improved function, quality of life, range of motion, strength, and pain relief can be attained with the ARCR procedure. ^{14, 15} The incidence of ARCR has seen a linear increase in various developed ¹⁶ and developing ¹⁷ countries and this rate is expected to rise with an increase in the aging population. The overall cost of ARCR surgery for the National Health Service in England exceeded £60 million, whilst the anticipated yearly cost of repair in the United States is said to be between US$1.2 and 1.6 billion. ¹⁸ Furthermore, there has been a prominent change in the performance of ARCR procedures at ambulatory surgery centers. These healthcare facilities are known for discharging patients on the same day they undergo surgery. ¹⁹

While several studies have reported positive outcomes on early postoperative pain control, a subgroup of patients report persistent shoulder pain of varying severity and duration following ARCR. ^{20– 22} Persistent post-surgical pain is defined by the International Classification of Diseases – 11 as pain that develops or gets worse following surgery or tissue damage and lasts for at least three months after the initial occurrence, beyond the healing phase. ²³ The transition from postoperative acute pain to persistent post-surgical pain is a complex and multifactorial phenomenon. ²⁴ Persistent postoperative pain is largely underdiagnosed and frequently inadequately managed. ²⁵ Studies have reported reduced shoulder range of motion, strength deficits, and significantly lower functional scores in patients with persistent shoulder pain following the ARCR procedure. ²⁶ Orthopedic surgeries in general are related to an increased risk of experiencing moderate to severe persistent pain at one-year follow-up when compared to other surgical procedures. ²⁷ This could be due to the presence of pre-existing nociplastic pain and central sensitivity changes before the surgical intervention in a variety of orthopedic conditions. ^{28, 29} Research supporting the role of psychological variables in chronic shoulder pain is emerging. Preoperative psychological disorders such as depression and anxiety, as well as behaviors such as pain catastrophizing, kinesiophobia, and psychological discomfort, may cause patients to experience increased shoulder pain. ³⁰

The degree of persistent postoperative pain beyond three months and the patterns of pain at the follow-up period are unknown. Numerous factors including fatty infiltration of the RC musculature, tear size, and diabetes mellitus are known to predict poor outcomes. ³¹ In addition, factors like opioid consumption, psychological and socioenvironmental, and acute postoperative conditions help explain the occurrence of persistent pain following ARCR. ³² Orthopedic surgeons and physical therapists may be better able to predict results and comprehend this patient population if they are aware of factors contributing to persistent pain following ARCR. Pre-operative pain control could be a preventive measure towards reducing the incidence and development of persistent postoperative pain. ³³ It would be beneficial to identify patients at higher risk of developing persistent pain before the surgical procedure or during initial rehabilitation. This would enable targeted preoperative or perioperative interventions to better manage the transition to persistent postoperative pain. These targeted interventions could potentially be incorporated into a comprehensive care plan for patients undergoing ARCR. Numerous trials have been undertaken to assess the effectiveness of postoperative pharmacological therapies in reducing acute pain ^{34, 35} but no comprehensive evaluation has yet been conducted to assess factors contributing to persistent pain after ARCR.

This protocol has been developed based on JBI methodology for scoping reviews ³⁶ and will be in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). ³⁷ Details of this review project are available on Figshare: 10.6084/m9.figshare.26885746. ³⁸

The authors have no conflict of interest to report.

Ethics and consent are not applicable for this study.