PROJECT SUMMARY In the last 30 years, clinical outcomes for individuals with rotator cuff tears have not substantially improved, which is problematic for the 4.5 million Americans that seek medical care for rotator cuff tears each year. Our long-term goal is to maximize functional recovery following rotator cuff tears by identifying patients most likely to benefit from targeted pain interventions. This knowledge is necessary to optimize treatments of impaired pain processing. Our central hypothesis is that the nervous system plays a larger role in symptom severity and recovery than conventionally believed. The rationale for this hypothesis is based on the disconnect between the rotator cuff structural damage and pain severity and the poor relationship between the extent of structural damage (i.e., tear size, retraction, etc.) and functional recovery. Dr. Pozzi, a physical therapist with expertise in biomechanics and movement science, will take his research in a new direction by approaching rotator cuff tears from pain and neuroscience perspectives. Dr. Pozzi assembled a team with extensive clinical, pain, neuroimaging, and pain-neuroscience expertise to test his central hypothesis through three specific aims: 1) test the association between brain function during a shoulder motor-task, chronicity of injury, and clinical pain symptoms in individuals with rotator cuff tears; 2) test the relationship between pain phenotypes, chronicity of injury, and clinical pain symptoms in individuals with rotator cuff tears; and 3) test the utility of baseline dispositional traits, quantitative sensory testing, and brain function to predict recovery following rotator cuff repair. This application is innovative because we will recruit the three injury etiologies of rotator cuff tears (traumatic- symptomatic, chronic-symptomatic, and asymptomatic), which provide a key advantage in studying chronic pain. We are uniquely positioned to shed light on how the nervous system reacts to sudden and chronic loss of tendon structural integrity with and without pain symptoms. We have the potential to test specific central features of acute rotator cuff-induced pain that may become chronic. We designed a novel experiment in which we will acquire functional brain images during precisely controlled submaximal isometric shoulder contractions. We will elucidate factors influencing movement-evoked pain of body areas associated with the primary clinical symptoms, thus providing evidence of potential intervention targets. Our study will provide a significant contribution by identifying additional factors that may influence the variability in patient outcomes. Further, our findings will move us toward the long-term goals of this line of investigation: informing precision pain medicine with consideration for specific pain phenotypes in individuals with rotator cuff tears. The knowledge gained in this study will not be incremental; it will springboard a paradigm shift in treating patient...