Author(s): SHAHEEN, A.1, FORD, H.1, LOW, D.1, OLDFIELD, M.2, Institution: BRUNEL UNIVERSITY OF LONDON, Country: UNITED KINGDOM, Abstract-ID: 2258

INTRODUCTION:
Exercise is recommended as first-line management for Rotator Cuff Related Shoulder Pain (RCRSP), yet factors influencing long-term outcomes following successful conservative treatment remain unclear (Lewis., 2016). In particular, the prognostic value of shoulder strength and biomechanics after discharge has not been established. The aim is to investigate the role of shoulder muscle strength and biomechanics in the long-term prognosis of RCRSP.
METHODS:
Twenty-one individuals who had recently completed successful conservative management for RCRSP and 21 age-, sex- and activity-matched controls were recruited. Baseline assessment included patient-reported outcome measures (QuickDASH, MSK-HQ, shoulder satisfaction), upper and lower limb muscle performance testing, and 3D kinematic and trapezius EMG analysis during active shoulder tasks and a functional lifting task.

Participants with a history of RCRSP were prescribed a 9-month, experience-tailored resistance training programme. Training adherence and patient-reported outcomes were evaluated at 3, 6, and 9 months, with the full muscle performance and biomechanical assessment repeated at 9 months. Between-group differences were examined using independent t-tests. Measures of association and binary logistic regression analyses were employed to identify predictors of clinically meaningful deterioration (≥0.3 SD decline) in patient-reported outcomes over the 9-month follow-up period.
RESULTS:
Despite good clinical recovery at baseline, previously symptomatic participants exhibited significantly lower upper and lower limb muscle performance than controls, including performance on the single-leg sit-to-stand test and measures of shoulder abduction, external rotation, and internal rotation assessed using the ExtRA Capacity Tests and hand-held dynamometry. No baseline strength, kinematic, or EMG variables were predictive of long-term outcomes. Adherence to the resistance training programme emerged as the strongest predictor of a favourable prognosis (OR 2.02). Improvements in shoulder abduction and external rotation capacity, particularly as assessed by the ExtRA Capacity Test (Ford et al., 2025), were independently associated with reduced odds of symptom deterioration.
CONCLUSION:
Long-term prognosis following conservative management of RCRSP cannot be determined from discharge assessments alone. Sustained engagement in resistance training, with specific improvements in shoulder abduction and external rotation capacity, appears critical for maintaining favourable outcomes and reducing symptom recurrence.

References:
Lewis, J., 2016. Rotator cuff related shoulder pain: assessment, management and uncertainties. Manual therapy, 23, pp.57-68.

Ford, H., Lewis, J., Tyros, V., Low, D. C., Bateman, W. R., Lee, Y., ... & Shaheen, A. F. (2025). The ExtRA Capacity Test: Reliability, validity and normative data of a new clinical tool for assessing shoulder muscle performance. Physiotherapy, 101868.