Addressing Shoulder Weakness in Individuals With Rotator Cuff-Related Shoulder Pain: A Systematic Review With Meta-analysis.

Abstract

<b>OBJECTIVE:</b> To estimate the effects of rehabilitation interventions on strength in people with rotator cuff-related shoulder pain (RCRSP). <b>DESIGN:</b> Intervention systematic review with meta-analysis. <b>LITERATURE SEARCH:</b> Seven databases were searched from inception to April 2024. <b>STUDY SELECTION CRITERIA:</b> Clinical trials or cohort studies reporting the effects of interventions lasting at least 6 weeks on objective strength outcomes in adults with RCRSP were included. Studies were excluded if they involved adults with other shoulder-related pathologies, focused exclusively on rotator cuff tears, or included participants who had undergone shoulder surgery. <b>DATA SYNTHESIS:</b> We grouped strength testing results from individual studies according to the direction of the strength test. Meta-analyses were conducted using standardized within-group mean difference from baseline to primary follow-up for each study intervention arm. <b>RESULTS:</b> Twenty-eight studies were included in the meta-analysis. Rehabilitation interventions had a moderate effect on shoulder external rotation strength (standardized mean difference [SMD], 0.56; 95% confidence interval [CI]: 0.39, 0.74; I² = 78%; <i>P</i> < .01) and a small effect on shoulder abduction (SMD, 0.47; 95% CI: 0.32, 0.63; I² = 54%; <i>P</i> < .01), internal rotation (SMD, 0.41; 95% CI: 0.30, 0.52; I² = 25%; <i>P</i> < .08), flexion (SMD, 0.25; 95% CI: 0.01, 0.49; I² = 0%; <i>P</i> = .46), and scaption (SMD, 0.48; 95% CI: 0.27, 0.70; I² = 35%; <i>P</i> = .14) strength. Interventions that included strength training or active exercises had small-to-moderate effects on all strength outcomes. Interventions without exercises or strength training had no effects. <b>CONCLUSION:</b> Rehabilitation interventions improved strength in people with RCRSP. Interventions that incorporated active exercises or strength training are recommended to address strength deficits in people with RCRSP. <i>J Orthop Sports Phys Ther 2026;56(2):67-84. Epub 16 December 2025. doi:10.2519/jospt.2025.13445</i>.