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Diagnosis, Outcomes & Rehabilitation

Clinical assessment of shoulder pathology, patient-reported outcome measures (PROs), and evidence-based rehabilitation protocols for optimizing functional recovery.

Overview

Consensus remains absent regarding the definition of accelerated rehabilitation and the selection of outcome measures following traumatic anterior shoulder dislocation [1]. Prognostic stratification relies heavily on baseline metrics and early trajectory; baseline pain severity, disability, and psychological factors predict response to physiotherapy for musculoskeletal shoulder pain [5]. Furthermore, short-term repeat assessment of pain offers a more accurate prognosis for long-term disability improvement than baseline information or short-term change across all cohorts [3].

For rotator cuff pathology, the majority of functional and symptomatic gains occur within the first year of primary repair, with minimal clinically meaningful improvements observed between one and two years [4]. While delayed passive rehabilitation does not yield superior outcomes compared to early rehabilitation after arthroscopic repair [6], home-based protocols demonstrate largely similar functional scores and healing rates to supervised therapy for massive tears [9]. In cases of irreparable massive rotator cuff tears, physical therapy is associated with less improvement in perceived functional outcomes and a higher clinical failure rate compared to surgery [11].

Optimizing outcomes requires a comprehensive evaluation approach that combines pathoanatomic causes with movement impairments to guide treatment selection [7]. Objective criteria-based models may effectively minimize the time required to recover from symptoms and regain functional capacity in work-related injuries [10]. In the specific context of extra-articular scapula fractures, worse functional results are noted in nonoperatively treated groups meeting surgical indications, though this difference disappears when adjusting for age [17]. Ultimately, treatment aspects maximizing functional outcomes are critical for patient satisfaction following rotator cuff repair [12].

Anatomy & Pathophysiology

Diagnostic Assessment: The SANE is valid for assessing patient outcomes across operative and nonoperative treatments for a range of common shoulder diagnoses [18]. Critical shoulder angle and age are easily assessable variables that adequately predict different shoulder pathologies [62]. Subjective mechanical symptoms are a common complaint in patients with suspected rotator cuff pathology [56], while low evidence exists for an impaired sense of force among painful shoulders [57]. A thorough understanding of shoulder physical examination and specific diagnostic tests, emphasizing history-taking, is essential to ensure diagnostic accuracy and optimize outcomes [69].

Kinematics & Motion: Some measures of shoulder range of motion (ROM) show moderate to high agreement between patient-reported and physician measurements [65], yet patient and surgeon-based assessments of all degrees of freedom correlate poorly and are not comparable [67]. The anatomical structure of passive shoulder restraints has no impact on the difference in passive joint position sense values between external and internal rotation [43]. Center of pressure measurement can detect sensorimotor functional deficits following surgical treatment even in patients with confirmed successful clinical and functional outcomes [21]. Shoulder physical functions have been mapped to outcome scores [53].

Pathology & Outcomes: Superior outcomes in children with brachial plexus birth palsy are associated with better preoperative clinical and MRI status, indicating that early recognition and timely intervention result in better shoulder motion and improved joint alignment [19]. Both open and arthroscopic repair of anterosuperior rotator cuff tears with subscapularis involvement significantly improved shoulder function and are relatively safe procedures [52]. Shoulder fusion provided active abduction greater than 45° in more than 75% of cases and active rotation greater than 45° in almost 65% of cases [60]. Stiffness may have many causes, including frozen shoulder which can occur without history or atop any shoulder condition [66]. Shoulder stiffness at 3 months post-ARCR predicts 12-month shoulder stiffness but indicates better tendon integrity, with limited long-term clinical impact [68].

Rehabilitation & Monitoring: Treatment for scapular dyskinesis is directed at managing underlying causes and restoring normal scapular muscle activation patterns by kinetic chain–based rehabilitation protocols [20]. Oculus Quest 2 is a promising VR tool for monitoring shoulder kinematics during rehabilitation [61].

Classification

Rehabilitation Consensus: There is no consensus on the definition of accelerated rehabilitation following traumatic anterior shoulder dislocation [1]. Similarly, there is no consensus on outcome measure selection for post-operative rehabilitation following traumatic anterior shoulder dislocation [1].

Outcome Trajectories and Predictors: Improvement in outcomes for rotator cuff tears observed up to 16 sessions of physical therapy, after which outcomes plateaued [2]. The majority of functional and symptomatic improvements following primary rotator cuff repair occur within the first year, with minimal clinically meaningful gains observed between 1 and 2 years [4]. Six distinct early recovery trajectories were identified after total shoulder arthroplasty [33], with 83.7% of patients (the 'Faster group') experiencing very low pain scores after only 2 weeks following total shoulder arthroplasty [33]. Short-term repeat assessment of pain was better than short-term change or baseline score at predicting long-term disability improvement across all cohorts for low-back or shoulder pain [3]. Prognostic factors for response to physiotherapy for musculoskeletal shoulder pain include baseline pain severity, disability, and psychological factors [5].

Diagnostic and Evaluation Models: Combining pathoanatomic causes with movement impairments provides a more focused rehabilitation approach for the painful shoulder [7]. Applying a comprehensive evaluation approach prior to and throughout treatment can assist clinicians in selecting appropriate treatments based on patient need for the painful shoulder [7]. The proposed objective criteria-based shoulder diagnosis and rehabilitation model could be a new effective strategy for minimizing the time required to regain functional capacity and recover from symptoms among patients with work-related shoulder injuries [10]. The DASH questionnaire can measure the impairment, activity limitations, and participation restriction constructs from the International Classification of Functioning, Disability and Health (ICF) [35]. Established clinical scores did not reflect sport-specific impairments after arthroscopic Bankart repair [13]. Surgery ranked highest across all range of motion domains for the management of adhesive capsulitis after failure of conservative treatment [23].

MRI Classification Systems: The FEDS classification, particularly the frequency and etiology of the patient's shoulder instability, may be helpful in identifying patients with a higher likelihood of undergoing surgical treatment for glenoid bone defects in recurrent anterior shoulder instability [34]. No differences in clinical scores existed between patients stratified by the Sugaya MRI classification system at 16 weeks after rotator cuff repair [28]. Owen, Sugaya, and Hayashida classifications give poor intra- and inter-rater agreement on a magnetic resonance imaging evaluation of subscapularis tendon retears [38]. The dichotomized and trichotomized classifications as well as the combined classifications for subscapularis tendon retears did not lead to superior agreements [38].

Other Considerations: The Constant-Murley shoulder assessment score should be redesigned with better standardization before being used to validate other assessments or compare outcomes between different testers [41].

Clinical Presentation

Defining the clinical trajectory of shoulder pathology requires acknowledging significant gaps in standardization. There is currently no consensus on the definition of accelerated rehabilitation following traumatic anterior shoulder dislocation [1], nor is there agreement on outcome measure selection for post-operative rehabilitation in this population [1]. For patients with atraumatic posterior shoulder subluxation, rehabilitation remains a valuable intervention [16], whereas early diagnosis and appropriate intervention are integral to minimizing sequelae from clavicle fractures [27].

Prognostic assessment relies heavily on dynamic pain patterns and baseline characteristics. Short-term repeat assessment of pain provides a more accurate prognosis for long-term disability improvement than baseline information for low-back or shoulder pain [3], while short-term change in pain is less accurate than this repeat assessment at predicting long-term disability improvement [3]. Prognostic factors for response to physiotherapy in musculoskeletal shoulder pain include baseline pain severity, disability, and psychological factors, though the evidence quality regarding these factors is generally low [5]. Identification of whether a patient presents with pain or stiffness as their predominant symptom further guides treatment selection for shoulder stiffness [24].

Functional recovery timelines and treatment efficacy vary by pathology. The majority of functional and symptomatic improvements following primary rotator cuff repair occur within the first year, with minimal clinically meaningful gains observed between 1 and 2 years [4]. Delayed passive rehabilitation does not produce superior outcomes compared to early rehabilitation after arthroscopic rotator cuff repair [6]. For irreparable massive rotator cuff tears, physical therapy is associated with less improvement in perceived functional outcomes and a higher clinical failure rate compared with surgery [11]. Conversely, improvement in outcomes for rotator cuff tears observed in physical therapy versus natural history cohorts plateaus after 16 sessions of physical therapy [2].

Diagnostic evaluation must integrate objective criteria with patient-reported outcomes. Established clinical scores do not reflect sport-specific impairments after arthroscopic Bankart repair [13], though PROMIS PF scores are responsive to functional improvements observed clinically in total shoulder arthroplasty patients [14]. The SANE is valid for assessing patient outcomes across operative and nonoperative treatment for a range of common shoulder diagnoses [18]. An objective criteria-based shoulder diagnosis and rehabilitation model could minimize the time required to regain functional capacity and recover from symptoms among patients with work-related shoulder injuries [10]. Furthermore, center of pressure measurement detects sensorimotor functional deficits following surgical treatment of the shoulder joint in patients with confirmed successful clinical and functional outcomes [21].

Therapeutic strategies should be tailored to pathoanatomy and specific impairments. Combining pathoanatomic causes with movement impairments provides a more focused rehabilitation approach for the painful shoulder [7], and a comprehensive evaluation approach prior to and throughout treatment assists clinicians in selecting appropriate treatments based on patient need [7]. Treatment for scapular dyskinesis is directed at managing underlying causes and restoring normal scapular muscle activation patterns by kinetic chain–based rehabilitation protocols [20]. Aspects of treatment that maximize functional outcome are important in achieving patient satisfaction after rotator cuff repair [12]. Finally, the time between symptom onset and surgery has a limited effect on functional outcomes up to six months post-operatively for patients who underwent type II SLAP repair [15]. Results from translating shoulder computerized adaptive testing generated outcome measures may improve clinical interpretation and assist clinicians using patient-reported outcomes during clinical practice [26].

Investigations

Plain radiography: Radiographs provide superior reproducibility and accuracy for critical shoulder angle (CSA) measurement compared to MRI [40]. In displaced distal radius fractures, better final radiological results correlate with improved patient-perceived outcomes measured by the DASH score [37]. Routine immediate postoperative radiographs after shoulder arthroplasty rarely identify complications, with a detection rate of only 0.2% [42]. For stemless shoulder prostheses, the presence of radiolucent lines or localized osteopenia does not influence mid-term clinical outcomes [45].

MRI: MRI findings are significantly associated with changes in the SPADI score from baseline to one-year follow-up in subacromial pain syndrome [49]. Patients presenting with higher total MRI scores, tendinosis, and bursitis demonstrate poorer outcomes following treatment for this condition [49]. In children with brachial plexus birth palsy, superior outcomes for internal rotation contracture and glenohumeral dysplasia are associated with better preoperative clinical and MRI status [19]. For rotator cuff repair, cuff integrity on follow-up MRI positively affects clinical outcomes after arthroscopic transosseous repair [36]. The authors recommend using MRI findings obtained soon after surgery as the time-zero reference for evaluating postoperative changes in the supraspinatus [50]. However, the occupation ratio of the supraspinatus may change after repair without volumetric improvement [50]. Younger patients with single tendon tears are more likely to experience spontaneous resolution of a radiographic defect after arthroscopic rotator cuff repair [55].

Other Considerations: There is no consensus on the definition of accelerated rehabilitation or the selection of outcome measures following traumatic anterior shoulder dislocation [1]. Improvement in rotator cuff tear outcomes is observed up to 16 physical therapy sessions, after which results plateau [2]. The majority of functional and symptomatic improvements after primary rotator cuff repair occur within the first year, with minimal clinically meaningful gains observed between 1 and 2 years [4]. Functional outcomes after arthroscopic repair improve during midterm follow-up regardless of retear [8]. Patients with massive rotator cuff tears show significantly improved clinical scores, decreased pain, and increased return to activity at midterm follow-up [51]. Medialization reduces tendon tension, leading to more effective healing and improved clinical outcomes for posterosuperior retracted cuff tears [54]. Short-term repeat pain assessment predicts long-term disability improvement better than short-term change or baseline scores across low-back or shoulder pain cohorts [3]. PROMIS PF scores are responsive to functional improvements in total shoulder arthroplasty patients [14]. Early recognition and timely intervention improve shoulder motion and joint alignment in children with brachial plexus birth palsy [19]. Stable, nondisplaced ligament injuries without significant MRI findings in athletes with Lisfranc injuries can be treated nonoperatively, with most returning to sport safely within 6–10 weeks [22]. Signs of degenerative changes increase between preoperative assessments and 2- to 5-year follow-up after arthroscopic extra-articular Bankart repair [47].

Treatment

Non-Operative

Conservative management remains a primary consideration for specific pathologies, such as middle-aged patients with symptomatic SLAP lesions, where appropriate non-operative regimens provide satisfactory outcomes and should precede operative recommendations [44]. Stable, nondisplaced ligament injuries without significant MRI findings are effectively treated nonoperatively, allowing most athletes to safely return to sport within 6–10 weeks with minimal complications [22]. For adhesive capsulitis, a multimodal nonoperative treatment program is effective for the majority of patients, though surgery ranks highest across all range of motion domains following the failure of conservative treatment [23, 63]. In cases of multidirectional instability, nonoperative management is the initial approach, with surgical reconstruction via open inferior capsular shift reasonably recommended only for the minority of patients in whom this fails [59].

Physical therapy protocols vary in structure but demonstrate specific efficacy windows. Improvement in outcomes for rotator cuff tears is observed up to 16 sessions of physical therapy, after which outcomes plateau [2]. Delayed passive rehabilitation does not yield superior outcomes compared to early rehabilitation after arthroscopic rotator cuff repair [6]. Patients undergoing home-based rehabilitation protocols show largely similar functional scores and healing to those receiving supervised physical therapy after arthroscopic repair of massive rotator cuff tears at the latest follow-up [9]. Telerehabilitation may reduce pain and improve range of motion in patients with non-operatively managed shoulder conditions, particularly when interventions are sustained for 12 weeks or longer [58]. Combining pathoanatomic causes with movement impairments provides a more focused rehabilitation approach for the painful shoulder [7], and an objective criteria-based shoulder diagnosis and rehabilitation model could effectively minimize the time required to regain functional capacity among patients with work-related shoulder injuries [10]. However, the data available regarding exercise for rotator cuff impingement are insufficient to establish a gold standard rehabilitation protocol [31].

Prognostic factors and outcome measurement require careful consideration. Prognostic factors for response to physiotherapy include baseline pain severity, disability, and psychological factors, though the evidence quality is generally low [5]. Mental health has a stronger association with patient-reported shoulder pain and function than tear size in patients with full-thickness rotator cuff tears [25]. Short-term repeat assessment of pain is better than short-term change or baseline score at predicting long-term disability improvement across all cohorts [3]. PROMIS PF scores were responsive to the functional improvements observed clinically in total shoulder arthroplasty patients [14]. There is currently no consensus on the definition of accelerated rehabilitation or outcome measure selection following traumatic anterior shoulder dislocation [1].

Operative

Indications: Operative treatment results in greater improvement in Constant scores and significantly decreased pain scores compared to nonoperative management for full-thickness rotator cuff tears [46]. Conversely, compared with surgery, physical therapy is associated with less improvement in perceived functional outcomes and a higher clinical failure rate for irreparable massive rotator cuff tears [11]. While worse functional results were found in the group with surgical indication for extra-articular scapula fractures, this difference disappears when adjusting for age as a confounding factor [17].

Surgical Approach / Technique: Aspects of treatment that maximize the functional outcome are important in achieving patient satisfaction after rotator cuff repair [12]. Functional outcomes after arthroscopic rotator cuff repair improved during midterm follow-up, regardless of retear [8]. The majority of functional and symptomatic improvements following primary rotator cuff repair occur within the first year, with minimal clinically meaningful gains observed between 1 and 2 years [4]. At early follow-up, navigated and non-navigated reverse total shoulder arthroplasty yielded similar rates of improvement in range of motion and functional outcome scores [64].

Complications

Instability: The sole assessment of recurrent dislocation is inadequate to define natural history or treatment rationale [39], and conclusions regarding treatment recommendations cannot be drawn from studies lacking comparative treatment methods [39]. There is no consensus on the definition of accelerated rehabilitation following traumatic anterior shoulder dislocation [1], nor on outcome measure selection for post-operative rehabilitation [1]. While established clinical scores do not reflect sport-specific impairments after arthroscopic Bankart repair [13], up to six months post-operatively, the time between symptom onset and surgery has a limited effect on functional outcomes for patients undergoing type II SLAP repair [15]. Rehabilitation remains a valuable intervention for patients with atraumatic posterior shoulder subluxation [16].

Stiffness / Arthrofibrosis: Several prognostic factors for response to physiotherapy in musculoskeletal shoulder pain include baseline pain severity, disability, and psychological factors, though the evidence quality regarding these factors is generally low [5]. Short-term repeat assessment of pain is a better predictor of long-term disability improvement than short-term change or baseline scores across low-back or shoulder pain cohorts [3]. Manipulative therapy in addition to usual medical care accelerates recovery of shoulder complaints but incurs higher costs, yet it is more effective than usual medical care alone in the long term [32]. Delayed passive rehabilitation does not yield superior outcomes compared to early rehabilitation after arthroscopic rotator cuff repair [6].

Other Considerations: For rotator cuff pathology, the majority of functional and symptomatic improvements following primary repair occur within the first year, with minimal clinically meaningful gains observed between 1 and 2 years [4]. Improvement in outcomes for rotator cuff tears is observed up to 16 sessions of physical therapy, after which outcomes plateau [2]. Functional outcomes after arthroscopic rotator cuff repair improved during midterm follow-up regardless of retear [8], and patients using home-based protocols showed largely similar functional scores and healing to those with supervised physical therapy for massive tears at the latest follow-up [9]. Revision reverse shoulder arthroplasty leads to improved patient-reported outcome measures and pain levels, demonstrating high durability at mid-term follow-up with low complication and failure rates [29].

Recovery

Light activity (weeks): Evidence regarding the specific timing for resuming desk work, driving, or light activities of daily living is not explicitly defined in the provided literature. However, delayed rehabilitation involving three weeks of shoulder immobilization for two-part fractures of the humeral neck results in a slower recovery trajectory [71].

Full activity (months): Functional status continues to improve with time after six months following rotator cuff repair [30]. While functional outcomes after arthroscopic rotator cuff repair improved during midterm follow-up regardless of retear [8], the majority of functional and symptomatic improvements following primary rotator cuff repair occur within the first year [4]. For type II SLAP repair, the time between symptom onset and surgery has a limited effect on functional outcomes up to six months post-operatively [15].

Complete recovery / outcome plateau (months): Improvement in outcomes for rotator cuff tears was observed up to 16 sessions of physical therapy, after which outcomes plateaued [2]. Minimal clinically meaningful gains were observed between one and two years following primary rotator cuff repair [4]. The structural status of repaired rotator cuffs remained unchanged between six and 19 months postoperatively [30]. A three-month follow-up is too early for outcome evaluation of shoulder conditions [70].

Rehabilitation protocol: There is no consensus on the definition of accelerated rehabilitation following traumatic anterior shoulder dislocation [1]. Delayed passive rehabilitation does not bring about superior outcomes compared to early rehabilitation after arthroscopic rotator cuff repair [6]. Patients undergoing rehabilitation using a home-based protocol showed largely similar functional scores and healing to those with supervised physical therapy after massive rotator cuff repair [9].

Functional milestones: Short-term repeat assessment of pain was better than short-term change or baseline score at predicting long-term disability improvement across cohorts with low-back or shoulder pain [3]. Prognostic factors for response to physiotherapy in musculoskeletal shoulder pain include baseline pain severity, disability, and psychological factors [5]. Pain intensity, neck pain, and longer duration of complaints predict poorer outcome in patients with shoulder pain [72].

Other Considerations: There is no consensus on outcome measure selection following traumatic anterior shoulder dislocation [1]. The slower recovery from delayed rehabilitation for two-part fractures of the neck of the humerus continues for at least two years after the time of injury [71]. Worse prognosis in patients with shoulder pain may be monitored more frequently and the treatment plan modified if complaints persist [72].

Key Evidence

  • [L4] There is no consensus on the definition of accelerated rehabilitation or outcome measure selection. (10.1177/17585732221089636)
  • [L3] Improvement in outcomes was observed up to 16 sessions of physical therapy, after which outcomes plateaued. (10.1016/j.jse.2018.10.001)
  • [L2] Short-term repeat assessment of pain was better than short-term change or baseline score at predicting long-term disability improvement across all cohorts. (10.1186/s12891-017-1502-8)
  • [L4] The majority of functional and symptomatic improvements following RCR occur within the first year, with minimal clinically meaningful gains observed between 1 and 2 years. (10.1016/j.jse.2025.05.020)
  • [L2] The review identified several prognostic factors for response to physiotherapy, including baseline pain severity, disability, and psychological factors, though the evidence quality was generally low. (10.1186/1471-2474-14-203)
  • [L2] Delayed passive rehabilitation does not bring about superior outcomes compared to early rehabilitation. (10.5397/cise.2019.22.4.190)
  • [L5] Combining pathoanatomic causes with movement impairments provides a more focused rehabilitation approach, and applying a comprehensive evaluation approach prior to and throughout treatment can assist clinicians in selecting appropriate treatments based on patient need. (10.1016/j.jse.2023.07.013)
  • [L3] Functional outcomes after ARCR improved during midterm follow-up, regardless of retear. (10.1177/03635465241305742)
  • [L3] Patients undergoing rehabilitation using a home-based protocol showed largely similar functional scores and healing to those with supervised PT after ARCR of MRCTs at the latest follow-up. (10.1016/j.arthro.2024.06.037)
  • [L5] The proposed objective criteria-based shoulder diagnosis and rehabilitation model could be a new effective strategy for minimizing the time required to regain functional capacity and recover from symptoms among patients with work-related shoulder injuries. (10.1186/s12891-017-1435-2)
  • [L4] Compared with surgery, physical therapy is associated with less improvement in perceived functional outcomes and a higher clinical failure rate. (10.1016/j.jse.2020.07.030)
  • [L3] Aspects of treatment that maximize the functional outcome are important in achieving patient satisfaction. (10.1016/j.jse.2007.02.136)
  • [L4] Established clinical scores did not reflect these sport-specific impairments. (10.1177/0363546511417407)
  • [L3] PROMIS PF scores were responsive to the functional improvements observed clinically. (10.1016/j.jse.2018.08.040)
  • [L3] Up to six months post-operatively, the time between symptom onset and surgery has limited effect on functional outcomes. (10.1177/17585732211015825)
  • [L4] These results support the view that rehabilitation is a valuable intervention when faced with such a patient presentation. (10.1177/1758573213517218)
  • [L3] Although worse functional results were found in the group with surgical indication, this difference disappears when adjusting for age as a confounding factor. (10.1016/j.jse.2025.02.026)
  • [L2] The study demonstrates that the SANE is valid for a range of common shoulder diagnoses to assess patient outcomes across operative and nonoperative treatment for shoulder complaints. (10.1177/0363546518807924)
  • [L4] Superior outcomes were associated with better preoperative clinical and MRI status, indicating that early recognition and timely intervention result in better shoulder motion and improved joint alignment. (10.1016/j.jse.2009.05.011)
  • [L5] Treatment is directed at managing underlying causes and restoring normal scapular muscle activation patterns by kinetic chain–based rehabilitation protocols. (10.5435/00124635-200303000-00008)
  • [L3] Centre of pressure measurement detected sensorimotor functional deficits following surgical treatment of the shoulder joint in patients with confirmed successful clinical and functional outcomes. (10.1007/s00167-021-06751-0)
  • [L5] Stable, nondisplaced ligament injuries without significant MRI findings can be treated nonoperatively, with most athletes safely returning to sport within 6–10 weeks and minimal complications. (10.1002/ksa.70244)
  • [L1] Surgery (after failure of conservative treatment) ranked highest across all ROM domains. (10.1016/j.arthro.2020.09.041)
  • [L5] Identification of whether a patient presents with pain or stiffness as their predominant symptom further guides treatment selection. (10.1177/1758573215586152)
  • [L2] Further studies are needed to determine its effect on the outcome of the treatment of rotator cuff disease. (10.2106/jbjs.o.00444)
  • [L2] Results may improve clinical interpretation of CAT-generated outcome measures and assist clinicians using patient-reported outcomes during clinical practice. (10.1016/j.jht.2010.06.001)
  • [L2] No differences in clinical scores existed between patients stratified by the Sugaya MRI classification system at 16 weeks. (10.1016/j.jse.2015.09.019)
  • [L4] Revision rTSA leads to an improvement in patient-reported outcome measures and pain levels and demonstrates high durability at mid-term follow-up with low complication and failure rates. (10.1016/j.jsea.2026.100004)
  • [L4] Although functional status improved with time after 6 months, the structural status of repaired cuffs remained unchanged between 6 and 19 months. (10.1016/j.jse.2011.05.027)
  • [Letter] The authors argue that the data available in the referenced systematic review are insufficient to make reliable clinical implications or establish a gold standard rehabilitation protocol, emphasizing the need for further research on dose-response relationships and supervised exercise. (10.1016/j.jse.2009.03.015)
  • [L1] Manipulative therapy in addition to usual medical care accelerates recovery and is more effective than usual medical care alone on the long term, but is associated with higher costs. (10.1186/1471-2474-11-200)
  • [L2] Six distinct early recovery trajectories were identified after total shoulder arthroplasty, with 83.7% of patients (the 'Faster group') experiencing very low pain scores after only 2 weeks. (10.1016/j.jse.2025.06.016)
  • [L2] The FEDS classification, particularly the frequency and etiology of the patient's shoulder instability, may be helpful in identifying patients with a higher likelihood of undergoing surgical treatment. (10.1016/j.jse.2016.07.053)
  • [L4] The DASH questionnaire can measure the impairment, activity limitations and participation restriction constructs from the International Classification of Functioning, Disability and Health (ICF). (10.1186/1471-2474-9-114)
  • [L4] Cuff integrity on follow-up MRI scans had a positive effect on the clinical outcome. (10.1016/j.jse.2018.09.003)
  • [L3] Better final radiological and objective physical results were associated with a better patient-perceived outcome, as measured by the DASH score, in this patient group. (10.1197/j.jht.2007.06.001)
  • [L4] The dichotomized and trichotomized classifications as well as the combined classifications did not lead to superior agreements. (10.1016/j.arthro.2021.12.005)
  • [Letter] The sole assessment of recurrent dislocation to define natural history and treatment rationale is inadequate, and conclusions regarding treatment recommendations cannot be made from a study that did not compare treatment methods. (10.1177/0363546510379343)
  • [L3] Radiographs provide better reproducibility and accuracy for CSA measurement compared to MRI. (10.1007/s00167-015-3587-7)
  • [L4] The authors suggest that the score should be redesigned with better standardization before being used to validate other assessments or compare outcomes between different testers. (10.1016/j.jse.2007.06.024)
  • [L4] The radiology reports of routine immediate postoperative radiographs rarely identified postoperative complications (0.2%). (10.1016/j.jse.2022.10.027)
  • [L3] The anatomical structure of passive shoulder restraints has no impact on the difference in passive joint position sense values between external and internal rotation. (10.1186/s12891-016-0971-5)
  • [L4] Non-operative treatment with an appropriate regimen provided satisfactory clinical outcomes in middle-aged patients with symptomatic SLAP lesions and should be considered before recommending operative treatment. (10.1007/s00167-016-4226-7)
  • [L4] The presence of radiolucent lines or localised osteopenia does not influence the mid term clinical outcome. (10.1186/s12891-019-2870-z)
  • [L1] Operative treatment resulted in greater improvement in Constant scores and significantly decreased pain scores compared to nonoperative management. (10.1016/j.jse.2017.09.032)
  • [L3] The signs of degenerative changes increased between the preoperative assessments and the assessments obtained at the 2- to 5-year follow-up. (10.1007/s001670000180)
  • [L2] In this study, MRI findings were significantly associated with the change in the SPADI score from baseline and to one year follow-up, with a poorer outcome after treatment for the patients with higher MRI total score, tendinosis and bursitis on MRI. (10.1186/s12891-017-1827-3)
  • [L3] The authors recommend using MRI findings obtained soon after surgery as the time-zero reference for evaluating postoperative changes in the supraspinatus. (10.1177/0363546518758313)
  • [L4] This study demonstrated significantly improved clinical scores, decreased pain, and increased return to activity for patients with MRCT at midterm follow-up. (10.1177/03635465231174430)
  • [L3] Both techniques significantly improved shoulder function and are relatively safe procedures. (10.1016/j.jse.2019.09.035)
  • [L4] Shoulder physical functions were mapped to outcome scores. (10.1016/j.jse.2019.08.017)
  • [L4] The study aimed to evaluate functional and radiological outcomes, noting that medialization provides less tension to the tendon which leads to a more effective healing process and improves clinical outcome postoperatively. (10.1016/j.jse.2021.03.122)
  • [L2] Younger patients with single tendon tears are more likely to undergo spontaneous resolution of a radiographic defect. (10.1016/j.jse.2011.03.028)
  • [L2] Subjective mechanical symptoms in the affected shoulder are a common complaint in patients with suspected rotator cuff pathology. (10.1016/j.jse.2024.02.024)
  • [L1] There is low evidence for an impaired sense of force among painful shoulders. (10.1016/j.jht.2019.06.002)
  • [L1] Telerehabilitation may reduce pain and improve range of motion in patients with non-operatively managed shoulder conditions, particularly when interventions are sustained for 12 weeks or longer. (10.1186/s12891-025-08839-x)
  • [L5] For the minority of patients for whom nonoperative management fails, surgical reconstruction with an open inferior capsular shift can be reasonably recommended. (10.5435/00124635-199801000-00007)
  • [L3] Shoulder fusion provided active abduction greater than 45° in more than 75% of cases and active rotation greater than 45° in almost 65% of cases. (10.1016/j.jhsa.2012.01.012)
  • [L5] Oculus Quest 2 is a promising VR tool for monitoring shoulder kinematics during rehabilitation. (10.3390/s22155511)
  • [L3] The present study showed that critical shoulder angle and age, two easily assessable variables, adequately predict different shoulder pathologies in patients with shoulder complaints. (10.1186/s12891-017-1559-4)
  • [L3] A multimodal nonoperative treatment program is effective for most patients with adhesive capsulitis. (10.1177/0363546510385403)
  • [L3] At early follow-up, navigated and non-navigated RSAs yielded similar rates of improvement in range of motion and functional outcome scores. (10.1016/j.jse.2022.07.007)
  • [L3] Some measures of shoulder ROM showed a moderate to high level of agreement between patient-reported measurements and the physician's measurements. (10.1016/j.jse.2016.02.010)
  • [L5] Stiffness may have many causes, including frozen shoulder which can occur without history or atop any shoulder condition. (10.1177/1758573215569340)
  • [L3] Patient and surgeon-based assessments of all degrees of freedom of shoulder motion correlate poorly and are, therefore, not comparable. (10.1016/j.jse.2007.07.012)
  • [L3] Shoulder stiffness at 3 months post-ARCR predicts 12-month shoulder stiffness but indicates better tendon integrity, with limited long-term clinical impact. (10.1016/j.arthro.2024.01.038)
  • [L5] This comprehensive review highlights the importance of a thorough understanding of shoulder physical examination and specific diagnostic tests, emphasizing history-taking and examination to ensure diagnostic accuracy and optimize patient outcomes for surgeons. (10.5435/jaaos-d-25-00024)
  • [L2] Our results suggest that 3 months follow-up is too early for outcome evaluation. (10.1186/s12891-021-04483-3)
  • [L1] Delayed rehabilitation by 3 weeks of shoulder immobilization produces a slower recovery, which continues for at least 2 years after the time of injury. (10.1016/j.jse.2006.06.003)
  • [L1] Those with a worse prognosis may be monitored more frequently and the treatment plan modified if complaints persist. (10.1186/s12891-015-0738-4)

See Also

References

[1] Post-operative rehabilitation following traumatic anterior shoulder dislocation: A systematic scoping review. Shoulder & Elbow. 2022. DOI: 10.1177/17585732221089636

[2] Physical therapy versus natural history in outcomes of rotator cuff tears: the Rotator Cuff Outcomes Workgroup (ROW) cohort study. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2018.10.001

[3] Brief pain re-assessment provided more accurate prognosis than baseline information for low-back or shoulder pain. BMC Musculoskeletal Disorders. 2017. DOI: 10.1186/s12891-017-1502-8

[4] Patient-reported and clinical outcomes up to 2 years after primary rotator cuff repair: do we need to collect patient-reported outcomes at 2-year follow-up visit?. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.05.020

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[9] Home‐Based or Supervised Physical Therapy Shows Similar Functional Outcomes and Healing After Massive Rotator Cuff Repair. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2024.06.037

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[14] Preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores predict postoperative outcome in total shoulder arthroplasty patients. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2018.08.040

[15] Is timing of superior labrum anterior to posterior (SLAP) repair important? A cohort study evaluating the effect of the duration of symptoms prior to surgery on the outcomes of patients who underwent type II SLAP repair. Shoulder & Elbow. 2021. DOI: 10.1177/17585732211015825

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[17] Functional outcomes and healing rates in patients with extra-articular scapula fractures treated nonoperatively: a comparison of fractures meeting and not meeting surgical indications. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2025.02.026

[18] Validity and Responsiveness of the Single Alpha-numeric Evaluation for Shoulder Patients. The American Journal of Sports Medicine. 2018. DOI: 10.1177/0363546518807924

[19] Arthroscopic treatment of internal rotation contracture and glenohumeral dysplasia in children with brachial plexus birth palsy. Journal of Shoulder and Elbow Surgery. 2010. DOI: 10.1016/j.jse.2009.05.011

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[21] Center of pressure (COP) measurement in patients with confirmed successful outcomes following shoulder surgery show significant sensorimotor deficits. Knee Surgery, Sports Traumatology, Arthroscopy. 2021. DOI: 10.1007/s00167-021-06751-0

[22] Diagnostic evaluation and nonoperative management of Lisfranc injuries in athletes. Knee Surgery, Sports Traumatology, Arthroscopy. 2025. DOI: 10.1002/ksa.70244

[23] Efficacy of Arthroscopic Surgery in the Management of Adhesive Capsulitis: A Systematic Review and Network Meta‐analysis of Randomized Controlled Trials. Arthroscopy. 2020. DOI: 10.1016/j.arthro.2020.09.041

[24] Physiotherapy assessment of shoulder stiffness and how it influences management. Shoulder & Elbow. 2015. DOI: 10.1177/1758573215586152

[25] Mental Health Has a Stronger Association with Patient-Reported Shoulder Pain and Function Than Tear Size in Patients with Full-Thickness Rotator Cuff Tears. Journal of Bone and Joint Surgery. 2016. DOI: 10.2106/jbjs.o.00444

[26] Translating Shoulder Computerized Adaptive Testing Generated Outcome Measures into Clinical Practice. Journal of Hand Therapy. 2010. DOI: 10.1016/j.jht.2010.06.001

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[28] Early postoperative repair status after rotator cuff repair cannot be accurately classified using questionnaires of patient function and isokinetic strength evaluation. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2015.09.019

[29] Pain relief and durable outcomes after revision reverse shoulder arthroplasty for failed primary arthroplasty. Journal of Shoulder and Elbow Arthroplasty. 2026. DOI: 10.1016/j.jsea.2026.100004

[30] Serial structural and functional assessments of rotator cuff repairs: do they differ at 6 and 19 months postoperatively?. Journal of Shoulder and Elbow Surgery. 2012. DOI: 10.1016/j.jse.2011.05.027

[31] Regarding “Exercise in the treatment of rotator cuff impingement: A systematic review and a synthesized evidence-based rehabilitation protocol”. Journal of Shoulder and Elbow Surgery. 2009. DOI: 10.1016/j.jse.2009.03.015

[32] Manipulative therapy in addition to usual medical care accelerates recovery of shoulder complaints at higher costs: economic outcomes of a randomized trial. BMC Musculoskeletal Disorders. 2010. DOI: 10.1186/1471-2474-11-200

[33] Trajectories of pain recovery during the first 8 weeks after shoulder arthroplasty: results from the shoulder diary study using latent growth curve modeling. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.06.016

[34] Clinical and radiographic outcomes of distal tibia allograft reconstruction for glenoid bone defects in recurrent anterior shoulder instability. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2016.07.053

[35] The Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH) can measure the impairment, activity limitations and participation restriction constructs from the International Classification of Functioning, Disability and Health (ICF). BMC Musculoskeletal Disorders. 2008. DOI: 10.1186/1471-2474-9-114

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[37] Patient-perceived Outcome after Displaced Distal Radius Fractures. Journal of Hand Therapy. 2007. DOI: 10.1197/j.jht.2007.06.001

[38] Owen, Sugaya, and Hayashida Classifications Give Poor Intra‐ and Inter‐Rater Agreement on a Magnetic Resonance Imaging Evaluation of Subscapularis Tendon Retears. Arthroscopy. 2021. DOI: 10.1016/j.arthro.2021.12.005

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[41] Evaluation of intratester and intertester reliability of the Constant-Murley shoulder assessment. Journal of Shoulder and Elbow Surgery. 2008. DOI: 10.1016/j.jse.2007.06.024

[42] Routine immediate postoperative radiographs rarely identify unknown complications after shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2022.10.027

[43] Shoulder proprioception – lessons we learned from idiopathic frozen shoulder. BMC Musculoskeletal Disorders. 2016. DOI: 10.1186/s12891-016-0971-5

[44] Clinical outcomes of non-operative treatment for patients presenting SLAP lesions in diagnostic provocative tests and MR arthrography. Knee Surgery, Sports Traumatology, Arthroscopy. 2016. DOI: 10.1007/s00167-016-4226-7

[45] Do the radiological changes seen at mid term follow up of stemless shoulder prosthesis affect outcome?. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-2870-z

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[47] Unbiased evaluation of the arthroscopic extra‐articular technique for Bankart repair: a clinical and radiographic study with a 2‐ to 5‐year follow‐up. Knee Surgery, Sports Traumatology, Arthroscopy. 2000. DOI: 10.1007/s001670000180

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[50] What Is the Appropriate Reference for Evaluating the Recovery of Supraspinatus Muscle Atrophy After Arthroscopic Rotator Cuff Repair? The Occupation Ratio of the Supraspinatus May Change After Rotator Cuff Repair Without Volumetric Improvement. The American Journal of Sports Medicine. 2018. DOI: 10.1177/0363546518758313

[51] Minimum 5-Year Clinical Outcomes of Arthroscopically Repaired Massive Rotator Cuff Tears: Effect of Age on Clinical Outcomes. The American Journal of Sports Medicine. 2023. DOI: 10.1177/03635465231174430

[52] Retrospective review of open and arthroscopic repair of anterosuperior rotator cuff tears with subscapularis involvement: a single surgeon's experience. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2019.09.035

[53] Mapping physical functions of the shoulder to American Shoulder and Elbow Surgeons and Patient-Reported Outcomes Measurement Information System scores. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2019.08.017

[54] Functional and Radiological Outcome of Medialization Repair for a Postero Superior Retracted Cuff Tear. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2021.03.122

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[60] Functional Outcome of Glenohumeral Fusion in Brachial Plexus Palsy: A Report of 54 Cases. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.01.012

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