Effectiveness of the therapeutic rehabilitation methods applied to scapula on rotator cuff pathologies: A systematic review of randomized controlled trials.

Background: In terms of different scapula-focused interventions included in the treatment for restoration of altered biomechanics and diminished motor control in rotator cuff injuries, evidence supporting the superiority of any method is limited.

Purpose: The aim was to investigate the effectiveness of scapula-focused interventions primarily on pain and function under the subtitle of rotator cuff injuries, and to synthesize evidence in order to inform clinical practice by compiling the current literature.

Study design: Literature synthesis, systemic review.

Methods: PubMed, Cochrane, Scopus, Proquest, Pedro, and Google Scholar databases were searched based on December 2024 using the determined search strategy. PEDro scale for methodological quality and revised Cochrane risk-of-bias tool for risk-of-bias assessment were used. Studies obtained were evaluated independently by two researchers in terms of title, abstract, and full text.

Results: A total of 743 articles were identified from database searches. Eleven studies (565 participants/age range 20-66) of moderate-to-high quality, rated 5-9 according to the PEDro quality assessment, were included. In conservative rehabilitation of rotator cuff pathologies, scapular stabilization exercises showed a large effect size in reducing pain (Cohen's d = 2.07) and a large effect size in improving function (Cohen's d = 2.35). In postoperative rehabilitation of rotator cuff pathologies, scapular training exercises showed the greatest effect in improving function (Cohen's d = 1.58), while the combination of scapular training exercises and scapular manual interventions showed the greatest effect in reducing pain (Cohen's d = 1.18). Scapular stabilization exercises were also found to have a large effect size for shoulder abduction range of motion (Cohen's d = 2.07).

Conclusions: It is concluded that additional scapular training exercises, and a combination of the scapular training exercises and scapular manual interventions create a significant difference in pain, function, and range of motion in individuals with postoperative rotator cuff injuries; whereas additional scapular stabilization exercises create a significant difference in pain and function in a conservatively treated rotator cuff patient.