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

OBJECTIVE

To estimate the effects of rehabilitation interventions on strength in people with rotator cuff-related shoulder pain (RCRSP).

DESIGN

Intervention systematic review with meta-analysis. LITERATURE SEARCH: Seven databases were searched from inception to April 2024. STUDY SELECTION CRITERIA: 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. DATA SYNTHESIS: 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.

RESULTS

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%; P < .01) and a small effect on shoulder abduction (SMD, 0.47; 95% CI: 0.32, 0.63; I2 = 54%; P < .01), internal rotation (SMD, 0.41; 95% CI: 0.30, 0.52; I2 = 25%; P < .08), flexion (SMD, 0.25; 95% CI: 0.01, 0.49; I2 = 0%; P = .46), and scaption (SMD, 0.48; 95% CI: 0.27, 0.70; I2 = 35%; P = .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.

CONCLUSION

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. J Orthop Sports Phys Ther 2026;56(2):67-84. Epub 16 December 2025. doi:10.2519/jospt.2025.13445.