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Pain & Function

Subacromial pain syndrome: etiology, clinical presentation, and management of rotator cuff tendinopathy and bursitis in the context of the coracoacromial arch.

Overview

Pain and physical function are primary determinants of quality of life following amputation for musculoskeletal tumours [1]. In the context of shoulder pathology, pain significantly influences patient-reported function in subacromial impingement, whereas strength impairments do not [3]. Psychological status and health-related quality of life improve with decreasing pain and increasing functional ability starting three months after rotator cuff repair [6].

Surgical and nonoperative interventions demonstrate variable efficacy across conditions. Humeral head replacement with nonprosthetic glenoid arthroplasty provides durable pain relief, improved function, and greater range of motion [4]. Revision reverse shoulder arthroplasty leads to an improvement in patient-reported outcome measures and pain levels with high durability at mid-term follow-up [14]. Graded motor imagery as an adjunct to comprehensive physiotherapy results in significant improvements in pain, range of motion, functionality, and pain-related fear [5]. Regarding degenerative rotator cuff disease, physiotherapy is preferred, though more evidence is needed to support this recommendation [12].

Outcomes assessment and prognostic factors remain critical. Nearly all patients (98%) with a preoperative MCS score ≥40 achieved an acceptable state of pain relief following rotator cuff repair compared with only 56% of patients with a preoperative MCS score <40 [15]. The effect of preoperative pain on postoperative outcomes in total knee arthroplasty becomes less important when the patient has radiographic evidence of more severe osteoarthritis [21]. Creating a uniformly accepted, validated outcomes tool that assesses pain, function, patient satisfaction, and anatomic integrity would enable consistent outcomes assessment after operative and nonoperative management [7]. There is minimal evidence to justify the use of separate subscales for pain and disability in the Shoulder Pain and Disability Index for patients with adhesive capsulitis [9]. The exclusive use of pain scores in postoperative pain management should be limited to prevent complications [2].

Anatomy & Pathophysiology

Kinematics and Scapular Mechanics

Analysis of scapular and humeral movements is critical for the comprehensive evaluation of the upper limb in patients with rotator cuff tears [44]. Patients with symptomatic rotator cuff tears who reached at least 85° compensated for the loss of glenohumeral motion by increasing scapulothoracic contribution [46]. Hand dominance may influence scapular kinematics [48]. The pectoralis minor stretching protocol did not alter pectoralis minor length or scapular kinematics in subjects with or without shoulder pain [20]. Exercise therapy for supraspinatus tears does not change glenohumeral kinematics during internal/external rotation with the arm at the side [43]. Updates on thrower's shoulder anatomy, mechanics, and pathomechanics remain essential for clinicians treating or investigating the shoulder [32]. Findings suggest a plausible mechanical progression of kinematic and strength changes associated with rotator cuff pathology development [37].

Motion, Strength, and Functional Thresholds

Glenohumeral arthritis is associated with substantial loss of shoulder motion during overhead reach tasks mimicking daily activities [53]. This arthritis leads to compensatory increases in cervical, lumbar, pelvic, and elbow kinematics during the same overhead reach task [53]. Range of motion and strength thresholds can identify subjects with normal shoulder function [55]. Less range of motion is required to perform functional tasks used in common outcome tools than is needed to attain full motion [50]. Isometric muscle strength tests during abduction and rotation tasks measured using the Biodex dynamometer can investigate the effect of different shoulder joint pathologies on muscle strength [52]. The loss of strength following selective experimental suprascapular nerve block was independent of the angle of abduction [56]. This loss confirms the substantial contribution of the infraspinatus to shoulder strength [56].

Assessment Technologies and Outcomes

Technology using the Microsoft Kinect sensor plus Medical Interactive Recovery Assistant (MIRA) software may allow precise shoulder range of motion measurement outside the clinic setting [45]. Inertial measurement unit (IMU)-based parameters for dynamic motion quality could be considered an option for assessing shoulder function [51]. Shoulder physical functions have been mapped to American Shoulder and Elbow Surgeons and Patient-Reported Outcomes Measurement Information System scores [60]. Future studies on shoulder overuse injuries in wheelchair athletes should focus on biomechanical modeling to develop knowledge of load and its effects [47].

Surgical Implications and Load Dynamics

Both open and arthroscopic repair of anterosuperior rotator cuff tears with subscapularis involvement significantly improved shoulder function [59]. Both open and arthroscopic repair of these tears are relatively safe procedures [59]. Increasing glenosphere diameter in reverse shoulder arthroplasty significantly increased joint load and deltoid force [58]. The clinical impact of increased joint load and deltoid force from increasing glenosphere diameter in reverse shoulder arthroplasty is presently unclear [58].

Classification

Outcome Assessment Frameworks: Validated tools assessing pain, function, patient satisfaction, and anatomic integrity are required to enable consistent outcomes assessment after operative and nonoperative management [7]. While a wide range of measures for shoulder pain and functioning exists, few are explicitly mapped to the International Classification of Functioning, Disability and Health (ICF) framework [63]. Demographic variables such as advanced age, low family income, and multiple medical conditions significantly affect scoring systems for total knee arthroplasty outcomes [66]. Activity overlap on pain and function subscales plays a causal role in limiting the WOMAC physical function subscale's ability to detect change in functional status [68].

Shoulder-Specific Metrics: Only pain significantly influences patient-reported function in patients with subacromial impingement, while strength impairments do not [3]. There is minimal evidence to justify the use of separate subscales for pain and disability in the Shoulder Pain and Disability Index for patients with adhesive capsulitis [9]. No single treatment emerged superior regarding range of motion, pain symptoms, and functional status in the management of adhesive capsulitis [24]. Careful clinical assessment can differentiate between causes of shoulder pain after a cerebrovascular accident or traumatic brain injury to guide best management [10].

Back and Lower-Extremity Metrics: Combinations of low- and high-threshold clinical movement-control tests have discriminative validity for prior back pain but were inconclusive for lower-extremity pain [19].

Other Considerations: Pain and physical function significantly impact quality of life after amputation for musculoskeletal tumours [1]. The exclusive use of pain scores in postoperative pain management should be limited to prevent complications [2]. Humeral head replacement with nonprosthetic glenoid arthroplasty provides durable pain relief, improved function, and greater range of motion [4]. Graded motor imagery as an adjunct to comprehensive physiotherapy results in significant improvements in pain, range of motion, functionality, and pain-related fear [5]. The BESS Patient Care Pathway provides summary guidance for the management of Subacromial Pain using the GRADE system to rate literature quality and evidence strength [25].

Clinical Presentation

Pain and physical function are the primary determinants of quality of life following amputation for musculoskeletal tumours [1]. In the context of shoulder pathology, pain significantly influences patient-reported function in subacromial impingement, whereas strength impairments do not [3]. Subjective mechanical symptoms are a common complaint in patients with suspected rotator cuff pathology [39]. Higher shoulder pain intensity, concomitant neck pain, longer symptom duration, greater disability, and previous shoulder pain predict poorer outcomes [41]. Conversely, patients with reduced complaints in subacromial pain syndrome demonstrate significant decreases in pain and functional improvements compared to those with persistent complaints [33].

Psychological status and health-related quality of life improve with decreasing pain and increasing functional ability starting three months after rotator cuff repair [6]. Nearly all patients (98%) with a preoperative mental health composite score (MCS) ≥40 achieved acceptable pain relief following rotator cuff repair, compared with only 56% of patients with a preoperative MCS score <40 [15]. Reduced psychosocial functioning in subacromial pain syndrome is associated with the persistence of complaints after four years [11]. Careful clinical assessment is required to differentiate causes of shoulder pain following cerebrovascular accident or traumatic brain injury to guide management [10].

Regarding specific interventions and outcomes, humeral head replacement with nonprosthetic glenoid arthroplasty provides durable pain relief, improved function, and greater range of motion [4]. Graded motor imagery as an adjunct to comprehensive physiotherapy results in significant improvements in pain, range of motion, functionality, and pain-related fear [5]. For degenerative rotator cuff disease, physiotherapy is the preferred management for pain, though more evidence is needed to support this recommendation [12]. In patients with glenohumeral arthritis, no consistent clinically important differences in pain or function were discovered regarding radiographic or demographic factors [13]. Neither pain intensity nor body mass index (BMI) influenced balance ability and postural stability outcomes in patients with painful shoulder disorders and healthy controls [36].

The majority of functional and symptomatic improvements following rotator cuff repair occur within the first year, with minimal clinically meaningful gains observed between one and two years [8]. A uniformly accepted, validated outcomes tool assessing pain, function, patient satisfaction, and anatomic integrity is needed to enable consistent outcomes assessment after operative and nonoperative management [7]. There is minimal evidence to justify the use of separate subscales for pain and disability in the Shoulder Pain and Disability Index for patients with adhesive capsulitis [9]. The exclusive use of pain scores in postoperative pain management should be limited to prevent complications [2].

Combinations of low- and high-threshold clinical movement-control tests have discriminative validity for prior back pain but were inconclusive for lower-extremity pain [19]. A pectoralis minor stretching protocol did not change pectoralis minor length or scapular kinematics in subjects with or without shoulder pain [20].

Investigations

Plain radiography: In patients with glenohumeral arthritis, radiographic factors do not correlate with consistent clinically important differences in pain or function [13]. While radiographic evidence of severe osteoarthritis can diminish the predictive value of preoperative pain on total knee arthroplasty outcomes, plain films remain a foundational component of the diagnostic workup [21].

MRI: Clinical and MRI variables provide no additional predictive information for work participation in sickness absentees with neck or shoulder pain compared to demographic and patient-reported data alone [72]. Synthesis of detailed findings from multiple studies suggests that pathological MRI patterns in manual wheelchair users with shoulder pain can be associated with specific risk factors and activities [73].

Laboratory: Evaluation of a painful total shoulder arthroplasty necessitates a methodical approach incorporating blood work to guide further management [67].

Aspiration: Joint aspirations are a required component of the methodical evaluation for a painful total shoulder arthroplasty [67].

Other Considerations: Careful clinical assessment is essential to differentiate causes of shoulder pain following cerebrovascular accidents or traumatic brain injury to guide management [10]. Clinicians should not exclude carpal tunnel syndrome in the presence of shoulder pain, nor should they pursue extensive examinations for shoulder or cervical pathology without indication [69]. Optimizing surgical indications for snapping scapula syndrome requires comprehensive patient selection involving history, examination, and radiologic assessment rather than reliance on a single diagnostic test [74]. The prevalence of reported musculoskeletal shoulder disorders varies considerably based on the outcome measure, showing a striking difference between subjective symptoms and standardized clinical or imaging examinations [71]. Pain and physical function significantly impact quality of life after amputation for musculoskeletal tumours [1]. The exclusive use of pain scores in postoperative pain management should be limited to prevent complications [2]. Only pain significantly influences patient-reported function in subacromial impingement, whereas strength impairments do not [3]. The BESS Patient Care Pathway provides summary guidance for managing subacromial pain using the GRADE system [25]. Tranexamic acid for visualization during arthroscopic rotator cuff repair provides no measurable improvement in arthroscopic visualization or early pain scores [70]. A higher combined diaphyseal cortical thickness is not associated with clinically significant differences in functional outcomes after arthroscopic rotator cuff repair [75].

Treatment

Non-Operative

Nonoperative management is a critical first-line strategy for several shoulder pathologies. For quadrilateral space syndrome, nonoperative treatment for at least 6 months is recommended before pursuing operative intervention [54]. In chronic, full-thickness rotator cuff tears, nonoperative treatment remains an effective and lasting option for many patients [57]. While patients with rotator cuff tears initially show significantly better outcomes with nonoperative care compared to surgery, this trend reverses in the longer term [65]. For degenerative rotator cuff disease, physiotherapy is preferred, though more evidence is needed to support this recommendation and caution is advised [12]. Regarding adhesive capsulitis, no one treatment emerged superior regarding range of motion, pain symptoms, and functional status [24]. Following nonsurgical management of type V acromioclavicular injuries, most patients are able to return to work but have limited functional outcome scores [64].

Operative

Indications: Surgical intervention is considered when conservative measures fail or specific functional deficits persist. Arthroscopic release of the scapular tunnel provides a treatment option for posterior shoulder pain when conservative treatment fails [62]. Patients with rheumatic diseases undergoing shoulder surgery accepted less pain at rest than during activity, underlining the importance of assessing both aspects of pain [42]. Regarding reverse total shoulder arthroplasty, patients with preserved preoperative forward elevation and moderate pain achieve similar final range of motion, pain reduction, and strength compared with patients who undergo the procedure with restricted preoperative forward elevation [61].

Surgical Approach / Technique: Humeral head replacement with nonprosthetic glenoid arthroplasty provides durable pain relief, improved function, and greater range of motion [4]. Clinical results for rotator cuff retear repair showed improvements in scores and decreased pain, especially in patients treated with a new repair [35]. Comprehensive rehabilitation shows a statistically and clinically significant difference compared to conventional physiotherapy in improving pain, range of motion, functional disability, quality of life, and treatment effectiveness after arthroscopic rotator cuff tendon repair [38].

Adjuncts: Graded motor imagery as an adjunct to comprehensive physiotherapy results in significant improvements in pain, range of motion, functionality, and pain-related fear [5]. Improvement in function and pain was more effective with combined manual therapy and stabilizing exercises compared to stabilizing exercises alone for forward head and rounded shoulder postures [31]. Both exercise protocols for the rotator cuff and scapular stabilizers are effective in terms of pain, function, and shoulder active range of motion for patients with subacromial syndrome [40]. Exercise has statistically and clinically significant effects on pain reduction and improving function in rotator cuff impingement, but not on range of motion or strength [34].

Pain Management: Pain and physical function significantly impact quality of life after amputation for musculoskeletal tumours [1]. The exclusive use of pain scores in postoperative pain management should be limited to prevent complications [2]. Nearly all patients (98%) with a preoperative MCS score ≥40 achieved an acceptable state of pain relief following rotator cuff repair compared with only 56% of patients with a preoperative MCS score <40 [15]. Pain self-efficacy did not moderate the relationship between treatment and outcome for manual therapy, acupuncture, and electrotherapy in people with shoulder pain [17].

Other Considerations: Psychological status and health-related quality of life improve with decreasing pain and increasing functional ability from 3 months after rotator cuff repair [6]. Reduced psychosocial functioning in subacromial pain syndrome is associated with persistence of complaints after 4 years [11]. The majority of functional and symptomatic improvements following rotator cuff repair occur within the first year, with minimal clinically meaningful gains observed between 1 and 2 years [8]. There is minimal evidence to justify the use of separate subscales for pain and disability in the Shoulder Pain and Disability Index for patients with adhesive capsulitis [9]. Creating a uniformly accepted, validated outcomes tool that assesses pain, function, patient satisfaction, and anatomic integrity would enable consistent outcomes assessment after operative and nonoperative management [7].

Complications

Stiffness / Arthrofibrosis: Preoperative symptom duration of six months or longer predicts poorer functional outcomes following arthroscopic treatment of rotator cuff tears complicated by shoulder stiffness [27]. Manipulation under anesthesia achieves full range of motion improvement and eliminates pain in 90% of patients in the long term [22]. Hydrodilatation should be utilized judiciously as an adjunct to structured rehabilitation to translate pain relief into restored motion rather than serving as a quick fix [29].

Other Considerations: Pain and physical function significantly impact quality of life after amputation for musculoskeletal tumours [1]. Only pain significantly influences patient-reported function, whereas strength impairments do not in patients with subacromial impingement [3]. Psychological status and health-related quality of life improve with decreasing pain and increasing functional ability at three months following both rotator cuff repair [6] and total shoulder arthroplasty [23]. In patients with glenohumeral arthritis, no consistent clinically important differences in pain or function are observed regarding radiographic or demographic factors [13]. Pain self-efficacy does not moderate the relationship between treatment and outcome in patients with shoulder pain undergoing manual therapy, acupuncture, or electrotherapy [17]. Education is the most consistent predictor of pain and disability, alongside work status at one-year follow-up in patients with subacromial shoulder pain [28]. A significant proportion of the global population experiences shoulder pain daily, yearly, and throughout a lifetime [26]. Shoulder pain is most frequently reported in co-occurrence with neck pain in a 14-year longitudinal population study [77].

Revision and Long-Term Durability: Revision reverse shoulder arthroplasty demonstrates high durability at mid-term follow-up with low complication and failure rates [14]. Patients with massive rotator cuff tears show significantly improved clinical scores, decreased pain, and increased return to activity at midterm follow-up [16]. Short-, mid-, and long-term results of the Latarjet procedure indicate positive clinical outcomes [18]. The functional result of reverse total shoulder arthroplasty is likely to deteriorate progressively after six years [30]. Long-term follow-up of fifteen to twenty years after total shoulder replacement demonstrates a high revision rate despite significant and longitudinal improvement in shoulder function and pain relief [49]. The exclusive use of pain scores in postoperative pain management should be limited to prevent complications [2].

Recovery

Light activity (weeks): While specific week ranges for light activity are not explicitly defined in the provided evidence, patients with subacromial impingement and those undergoing rotator cuff repair demonstrate that psychological status and health-related quality of life improve with decreasing pain and increasing functional ability by 3 months postoperatively [3, 6]. Similarly, patients with total shoulder arthroplasty show significant improvements in psychological status and quality of life at 3 months as pain decreases and functional ability increases [23].

Full activity (months): The majority of functional and symptomatic improvements following rotator cuff repair occur within the first year, with minimal clinically meaningful gains observed between 1 and 2 years [8]. Pain and strength continuously improve over time up to 2 years after surgery for operatively treated distal radius fractures, whereas supination plateaus more quickly, usually within the first 3 to 6 months [80]. Patients with massive rotator cuff tears demonstrated significantly improved clinical scores, decreased pain, and increased return to activity at midterm follow-up [16].

Complete recovery / outcome plateau (months): Functional results for reverse total shoulder arthroplasty are likely to deteriorate progressively after six years, and functional outcome scores for Grammont style reverse shoulder arthroplasty were less predictable over time at a minimum of 10-year follow-up [30, 78]. Manipulation under anesthesia leads to full improvement of range of motion and leaves no pain in 90% of patients in the long term (23 years) for frozen shoulder [22]. A prospective study demonstrates the chronology of improvements in the pattern of limitations experienced by patients with respect to pain, sleep, and activities of daily living in the early postoperative period after total shoulder arthroplasty [79].

Rehabilitation protocol: Hydrodilatation should be used judiciously as an adjunct to structured rehabilitation, translating pain relief into restored motion rather than serving as a quick fix, with timing reframed away from a calendar threshold toward patient phenotype, especially baseline pain [29]. The exclusive use of pain scores in postoperative pain management should be limited to prevent complications [2].

Functional milestones: Pain and physical function significantly impact quality of life after amputation for musculoskeletal tumours [1]. Only pain significantly influenced patient-reported function in patients with subacromial impingement, while strength impairments did not [3]. Reduced psychosocial functioning in subacromial pain syndrome is associated with persistence of complaints after 4 years [11]. Revision reverse shoulder arthroplasty 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 [14]. Short-, mid-, and long-term results of the Latarjet procedure indicate positive clinical outcomes [18].

Other Considerations: A preoperative duration of symptoms of 6 months or longer led to poorer functional outcomes after arthroscopic treatment of rotator cuff tears with shoulder stiffness [27]. Education was the most consistent predictor of pain and disability, and work status at 1 year follow-up in patients with subacromial shoulder pain [28]. A significant proportion of the population across the world will experience shoulder pain daily, yearly, and throughout a lifetime [26]. Mild complaints of the arm, neck, and/or shoulder demonstrate an overall stable course during one-year follow-up in a university population [76].

Key Evidence

  • [L4] Pain and physical function significantly impact on QOL. (10.1302/0301-620x.97b9.35192)
  • [L4] The exclusive use of pain scores in postoperative pain management should be limited to prevent complications. (10.1016/j.arthro.2006.11.002)
  • [L4] Only pain significantly influenced patient-reported function, while impairments did not. (10.1186/s12891-017-1667-1)
  • [L4] Durable pain relief, improved function, and greater range of motion were observed. (10.1016/j.jse.2014.10.022)
  • [L1] Both groups showed significant improvements in pain, range of motion, functionality, and pain-related fear. (10.1186/s12891-025-08783-w)
  • [L2] Psychological status and HRQoL improved with decreasing pain and increasing functional ability from 3 months after surgery. (10.1007/s11999-015-4258-1)
  • [L4] Creating a uniformly accepted, validated outcomes tool that assesses pain, function, patient satisfaction, and anatomic integrity would enable consistent outcomes assessment after operative and nonoperative management and allow comparisons across the literature. (10.1016/j.jse.2015.08.007)
  • [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)
  • [L4] We found minimal evidence to justify the use of separate subscales for pain and disability. (10.1186/1471-2474-9-103)
  • [L5] This review article describes how careful clinical assessment can differentiate between causes of shoulder pain and guide best management. (10.1016/j.jse.2014.12.003)
  • [L2] Future studies may investigate whether a multimodal treatment with assessment of psychosocial functioning may facilitate pain relief and recovery. (10.1016/j.jse.2020.08.039)
  • [L1] Regarding pain management, physiotherapy is preferred; however, more evidence is needed to support this recommendation and caution is advised. (10.1186/s13018-024-05129-5)
  • [L3] In patients with glenohumeral arthritis, no consistent clinically important differences in pain or function were discovered with respect to radiographic or demographic factors. (10.1097/corr.0000000000001950)
  • [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)
  • [L3] Nearly all patients (98%) with preoperative MCS score ≥40 achieved an acceptable state of pain relief compared with only 56% of patients with preoperative MCS score <40. (10.1016/j.jse.2023.12.011)
  • [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)
  • [L2] Pain self-efficacy did not moderate the relationship between treatment and outcome. (10.1177/17585732221105562)
  • [L4] Short-, mid-, and long-term results indicate positive clinical outcomes. (10.1016/j.jseint.2025.04.033)
  • [L4] Combinations of low- and high-threshold tests have discriminative validity for prior back pain, but were inconclusive for lower-extremity pain. (10.1186/1471-2474-13-263)
  • [L2] The pectoralis minor stretching protocol did not change pectoralis minor length or scapular kinematics in subjects with or without shoulder pain. (10.1016/j.jht.2016.06.006)
  • [L2] However, the effect of preoperative pain on the postoperative outcomes seems to become less important when the patient has radiographic evidence of more severe OA. (10.2106/jbjs.18.00642)
  • [L4] MUA leads to full improvement of ROM and leaves no pain in 90% of patients in the long term. (10.1007/s11999-012-2542-x)
  • [L3] Psychological status and HRQoL significantly improved with decreasing pain and increasing functional ability at 3 months after surgery. (10.1016/j.jse.2016.12.018)
  • [L1] No one treatment emerged superior in regard to ROM, pain symptoms, and functional status. (10.1016/j.arthro.2020.09.041)
  • [L1] This article provides summary guidance for the management of Subacromial Pain using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) of rating quality of literature and grading the strength of available evidence. (10.1177/17585732251374282)
  • [L1] Our review demonstrates that a significant proportion of the population across the world will experience shoulder pain daily, yearly, and throughout a lifetime. (10.1186/s12891-022-05973-8)
  • [L2] A preoperative duration of symptoms of 6 months or longer led to poorer functional outcomes, suggesting that surgeons should propose surgical treatment before symptoms persist for 6 months. (10.1177/0363546517707202)
  • [L2] Education was the most consistent predictor of pain and disability, and work status at 1 year followup. (10.1186/1471-2474-11-218)
  • [L5] Hydrodilatation should be used judiciously as an adjunct to structured rehabilitation, translating pain relief into restored motion rather than serving as a quick fix, with timing reframed away from a calendar threshold toward patient phenotype, especially baseline pain. (10.5397/cise.2026.00080)
  • [L3] The functional result is likely to deteriorate progressively after six years. (10.2106/jbjs.e.00851)
  • [L1] However, the improvement in function and pain were more effective in the combined manual therapy and stabilizing exercises group compared to stabilizing exercises alone. (10.1186/s12891-019-2438-y)
  • [L5] Updates on the thrower's shoulder, including anatomy, mechanics, pathomechanics, and treatment, are essential for clinicians and researchers treating or investigating the shoulder. (10.1016/j.arthro.2022.02.024)
  • [L2] Patients with reduced complaints showed a significant decrease in pain and improvement in functional scores compared to those with persistent complaints. (10.1016/j.jse.2018.06.015)
  • [L1] Exercise has statistically and clinically significant effects on pain reduction and improving function, but not on range of motion or strength. (10.1016/j.jse.2008.06.004)
  • [L4] Clinical results showed improvements in scores and decreased pain, especially in patients treated with a new repair. (10.1016/j.jse.2021.03.121)
  • [L3] Neither pain intensity nor BMI influenced the outcome parameters. (10.1186/1471-2474-14-282)
  • [L3] Furthermore, these findings suggest a plausible mechanical progression of kinematic and strength changes associated with the development of rotator cuff pathology. (10.1016/j.jse.2016.11.048)
  • [L1] Comprehensive rehabilitation, compared to conventional physiotherapy, has shown a statistically and clinically significant difference in improving pain, ROM, functional disability, quality of life, and treatment effectiveness in patients after ARCR. (10.1016/j.jht.2023.09.009)
  • [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] Both interventions are effective in terms of pain, function, and shoulder active range of motion. (10.1016/j.jht.2017.11.041)
  • [L1] Clinicians may take factors such as higher shoulder pain intensity, concomitant neck pain, longer duration of symptoms, greater disability, and previous shoulder pain into account in the management of their patients. (10.1186/s12891-015-0738-4)
  • [L3] The PASS thresholds for pain showed that patients accepted less pain at rest than during activity, underlining the importance of assessing both aspects of pain. (10.1016/j.jht.2010.10.006)
  • [L2] Despite satisfactory clinical outcomes following exercise therapy, glenohumeral kinematics did not change. (10.1007/s00167-017-4695-3)
  • [L4] The method used in the present study reveals the potential importance of the analysis of the scapular and humeral movements for comprehensive evaluation of the upper limb. (10.1186/s12891-019-2987-0)
  • [L5] This technology, which can be easily set up, may also allow precise shoulder ROM measurement outside the clinic setting. (10.1016/j.jse.2017.06.004)
  • [L4] Patients who reached at least 85° compensated for the loss of glenohumeral motion by increased scapulothoracic contribution, suggesting that structural damage interferes with motion mechanics. (10.1016/j.jse.2016.02.031)
  • [L1] Future studies on shoulder overuse injuries of wheelchair athletes should be directed towards biomechanical modeling to develop knowledge of load and its effects. (10.1371/journal.pone.0188410)
  • [L4] Hand dominance could have an influence on the scapular kinematics, which should be taken into consideration when describing and comparing neuromuscular characteristics in individuals with chronic neck pain. (10.1186/1471-2474-12-267)
  • [L4] Although there is a significant and longitudinal improvement in shoulder function and pain relief after total shoulder replacement, long-term follow-up of fifteen to twenty years demonstrated a high revision rate in this cohort. (10.2106/jbjs.m.00079)
  • [L5] Although attaining full motion is a reasonable goal of all shoulder treatment, our results indicate that less ROM is required to perform the functional tasks used in common outcome tools. (10.1016/j.jse.2011.07.032)
  • [L4] Hence, IMU-based parameters for dynamic motion quality could be considered as an option for assessing the function of the shoulder. (10.1016/j.jse.2019.07.038)
  • [L2] These isometric muscle strength tests can be further employed to investigate the effect of different shoulder joint pathology on muscle strength. (10.1016/j.jse.2023.03.025)
  • [L4] Glenohumeral arthritis is associated with substantial loss of shoulder motion during an overhead reach task that mimics daily activities, which leads to compensatory increases in cervical, lumbar, pelvic, and elbow kinematics. (10.1016/j.jse.2026.02.019)
  • [L5] Nonoperative treatment for at least 6 months is recommended before pursuing operative intervention. (10.1016/j.jse.2017.10.024)
  • [L3] Range of motion and strength thresholds can identify subjects with normal shoulder function. (10.1016/j.jse.2010.06.005)
  • [L5] The loss of strength was independent of the angle of abduction, confirming the substantial contribution of the infraspinatus to shoulder strength. (10.1016/j.jse.2007.02.120)
  • [L2] Nonoperative treatment is an effective and lasting option for many patients with a chronic, full-thickness rotator cuff tear. (10.1016/j.jse.2017.10.009)
  • [L5] Although increasing glenosphere diameter significantly increased joint load and deltoid force, the clinical impact of these changes is presently unclear. (10.1016/j.jse.2014.10.018)
  • [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)
  • [L3] Patients indicated for RTSA with preserved preoperative forward elevation and moderate pain achieve similar final ROM, pain reduction, and strength compared with patients who undergo RTSA with restricted preoperative forward elevation. (10.1016/j.jseint.2021.10.004)
  • [L5] The surgical technique provides a treatment option when conservative treatment fails in the patient with posterior shoulder pain. (10.1016/j.arthro.2007.03.098)
  • [L1] The review identified a wide range of measures for shoulder pain and functioning, but few were explicitly mapped to the ICF framework. (10.1186/1471-2474-14-73)
  • [L4] Following nonsurgical management of type V AC injuries, most patients are able to return to work but have limited functional outcome scores. (10.5435/jaaos-d-16-00176)
  • [L2] Patients undergoing nonoperative treatment had significantly better outcomes in the initial follow-up period compared with patients undergoing a surgical procedure, but this trend reversed in the longer term. (10.2106/jbjs.19.01112)
  • [L4] Numerous scoring systems have been devised to evaluate patients who have symptoms related to the knee, but demographic variables such as advanced age, low family income, and multiple medical conditions significantly affect scores. (10.2106/00004623-199706000-00009)
  • [L5] Surgeons must be methodical in the evaluation using blood work, advanced imaging, joint aspirations, and other diagnostic tools to diagnose and treat the various pathologies causing pain. (10.5435/jaaos-d-22-01006)
  • [L4] These findings support the hypothesis that activity overlap on the pain and function subscales plays a causal role in limiting the WOMAC physical function subscale's ability to detect change. (10.1186/1471-2474-5-17)
  • [L3] Clinicians should not exclude CTS as a diagnosis in the presence of shoulder pain, nor should they pursue extensive or unnecessary examinations for shoulder or cervical pathology. (10.1177/17531934241302697)
  • [L2] Additionally, there was no measurable improvement in arthroscopic visualization or early pain scores. (10.1016/j.jse.2022.06.027)
  • [L4] Depending on the outcome measure used, the prevalence of reported MSDs of the shoulder varies considerably, with a striking difference between subjective reported symptoms and standardized clinical/imaging examinations. (10.1186/1471-2474-15-118)
  • [L2] Clinical and MRI variables provide no additional information for the prediction of work participation compared with only demographic and patient-reported information among sickness absentees with neck or shoulder pain. (10.1186/s12891-019-2906-4)
  • [L4] However, synthesis of detailed findings from multiple studies could define patterns of pathological MRI findings allowing for associations of imaging findings to risk factors including specific activities. (10.1155/2014/769649)
  • [Commentary] Optimizing surgical indications for snapping scapula syndrome requires comprehensive patient selection involving history, examination, radiologic assessment, and consideration of physical and psychological well-being, rather than relying on a single diagnostic test. (10.1016/j.arthro.2020.09.010)
  • [L3] Although a higher combined cortical thickness is not associated with clinically significant differences in functional outcomes, further studies examining postoperative imaging as well as perioperative optimization of bone mineral density may yield valuable results regarding the impact of cortical thickness on cuff healing and functional outcomes. (10.1016/j.arthro.2019.04.004)
  • [L2] The results demonstrate mild complaints at baseline and an overall stable course during one-year follow-up. (10.1186/s12891-018-2116-5)
  • [L2] Shoulder pain was reported most frequently in co-occurrence with neck pain. (10.1177/1758573214552007)
  • [L4] Functional outcome scores were less predictable over time. (10.1177/17585732251331474)
  • [L4] This prospective study demonstrates the chronology of improvements in pattern of limitations experienced by patients with respect to pain, sleep, and ADLs in the early postoperative period after TSA. (10.1016/j.jseint.2022.09.017)
  • [L2] Pain and strength continuously improve over time up to 2 years after surgery, whereas supination plateaus more quickly, usually within the first 3 to 6 months. (10.1016/j.jhsa.2012.01.028)

See Also

References

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b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.