Associations of Range of Motion and Muscle Strength with Pain and Disability in Patients with Rotator Cuff–Related Shoulder Pain

Ertan Şahinoğlu

Associations of Range of Motion and Muscle Strength with Pain and Disability in Patients with Rotator Cuff–Related Shoulder Pain

Abstract

Purpose: The aim of this study was to investigate the effect of glenohumeral range of motion and shoulder muscle strength on pain and disability in patients with rotator cuff–related shoulder pain. Methods: Forty‐one patients were included. Pain and disability was assessed with the Shoulder Pain and Disability Index (SPADI). Glenohumeral range of motion (flexion, abduction, total rotation) and shoulder muscle strength (muscle strength in the full-can position and the external rotator/internal rotator muscle strength ratio) were measured. Robust regression analysis was performed using a stepwise approach. Results: Adding range of motion did not significantly improve the model's explanation of the SPADI score, whereas including muscle strength variables did (ΔR2 = 0.12; χ2(2) = 6.70, p = 0.03). The final model explained 39% of the variance in the SPADI score. Lower muscle strength in the full-can position was associated with a greater SPADI score (B = 2.26, 95% CI [4.07, 0.44], p = 0.02). Flexion, abduction, and total rotation ranges of motion, and the external rotator/internal rotator muscle strength ratio were not associated with pain and disability (p > 0.05). Conclusion: Shoulder muscle strength plays a more important role than glenohumeral range of motion in explaining pain and disability in patients with rotator cuff–related shoulder pain. Lower muscle strength in the full-can position is associated with greater pain and disability.

Keywords

Ethical Statement

The study was approved by the Non-invasive Clinical Research Ethics Committee of İzmir Bakırçay University.

References

Lewis J. Rotator cuff related shoulder pain: assessment, management and uncertainties. Man Ther. 2015;23:57–68.
Harryman DT, Hettrich CM, Smith KL, Campbell B, Sidles JA, Matsen FA. A prospective multipractice investigation of patients with full-thickness rotator cuff tears: the importance of comorbidities, practice, and other covariables on self-assessed shoulder function and health status. J Bone Joint Surg Am. 2003;85(4):690–6.
Harris JD, Pedroza A, Jones GL, MOON Shoulder Group. Predictors of pain and function in patients with symptomatic, atraumatic full-thickness rotator cuff tears: a time-zero analysis of a prospective patient cohort enrolled in a structured physical therapy program. Am J Sports Med. 2012;40(2):359–66.
Cho CH, Seo HJ, Bae KC, Lee KJ, Hwang I, Warner JJP. The impact of depression and anxiety on self-assessed pain, disability, and quality of life in patients scheduled for rotator cuff repair. J Shoulder Elbow Surg. 2013;22(9):1160–6.
Maestroni L, Marelli M, Gritti M, Civera F, Rabey M. Is rotator cuff related shoulder pain a multidimensional disorder? An exploratory study. Scand J Pain. 2020;20(2):297–305.
Lemaster NG, Hettrich CM, Jacobs CA, Heebner N, Westgate PM, Mair S, Montgomery JR, Uhl TL. Which risk factors are associated with pain and patient-reported function in patients with a rotator cuff tear? Clin Orthop Relat Res. 2021;479(9):1982–92.
MacDermid JC, Ramos J, Drosdowech D, Faber K, Patterson S. The impact of rotator cuff pathology on isometric and isokinetic strength, function, and quality of life. J Shoulder Elbow Surg. 2004;13(6):593–8.
Anwer S, Alghadir AH, Al-Eisa ES, Iqbal ZA. The relationships between shoulder pain, range of motion, and disability in patients with shoulder dysfunction. J Back Musculoskelet Rehabil. 2018;31(1):163–7.

Engebretsen K, Grotle M, Bautz-Holter E, Ekeberg OM, Brox JI. Determinants of the Shoulder Pain and Disability Index in patients with subacromial shoulder pain. J Rehabil Med. 2010;42(5):499–505.
Maestroni L, Marelli M, Gritti M, Civera F, Rabey M. External rotator strength deficits in non-athletic people with rotator cuff related shoulder pain are not associated with pain intensity or disability levels. Musculoskelet Sci Pract. 2020;48:102156.
Şahinoğlu E, Ünver B, Erkuş S, Yamak K. Efficacy of balance training on postural control in patients with rotator cuff disease: a randomized controlled study. Int J Rehabil Res. 2022;45(2):146–53.
Roach KE, Budiman-Mak E, Songsiridej N, Lertratanakul Y. Development of a Shoulder Pain and Disability Index. Arthritis Care Res. 1991;4(4):143–9.
Williams J, Holleman D, Simel D. Measuring shoulder function with the Shoulder Pain and Disability Index. J Rheumatol. 1995;22(4):727–32.
Hurwitz EE, Simon M, Vinta SR, Zehm CF, Shabot SM, Minhajuddin A, Abouleish AE. Adding examples to the ASA-physical status classification improves correct assignment to patients. Anesthesiology. 2017:126(4):614–22.
Kirkley A, Alvarez C, Griffin S. The development and evaluation of a disease-specific quality-of-life questionnaire for disorders of the rotator cuff: the Western Ontario Rotator Cuff Index. Clin J Sport Med. 2003;13(2):84–92.
Norkin CC, White DJ. Measurement of Joint Motion: A Guide to Goniometry. 5th ed. F.A. Davis Company; 2016.
Hislop H, Avers D, Brown M. Daniels and Worthingham’s Muscle Testing: Techniques of Manual Examination and Performance Testing. 9th ed. Elsevier, Saunders; 2014.
Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175–91.
van Buuren S, Groothuis-Oudshoorn K. mice: Multivariate Imputation by Chained Equations in R. J Stat Softw. 2011;45(3):1–67.
Maechler M, Rousseeuwi P, Croux C, Todorov V, Ruckstuhl A, Salibian-Barrera M, et al. Package “Robustbase.”; 2024.
Fox J, Weisberg S. An R Companion to Applied Regression. 3rd ed. Sage; 2019.
James G, Witten D, Hastie T, Tibshirani R. An Introduction to Statistical Learning with Applications in R. 2nd ed. New York, NY: Springer US; 2021.
Maman E, Harris C, White L, Tomlinson G, Shashank M, Boynton E. Outcome of nonoperative treatment of symptomatic rotator cuff tears monitored by magnetic resonance imaging. J Bone Joint Surg Am. 2009;91(8):1898–906.
Barlow JD, Bishop JY, Dunn WR, Kuhn JE. What factors are predictors of emotional health in patients with full-thickness rotator cuff tears? J Shoulder Elbow Surg. 2016;25(11):1769–73.
Boettcher CE, Ginn KA, Cathers I. The “empty can” and “full can” tests do not selectively activate supraspinatus. J Sci Med Sport. 2009;12(4):435–9.
Escamilla RF, Yamashiro K, Paulos L, Andrews JR. Shoulder muscle activity and function in common shoulder rehabilitation exercises. Sport Med. 2009;39(8):663–85.
Hawkes DH, Alizadehkhaiyat O, Fisher AC, Kemp GJ, Roebuck MM, Frostick SP. Normal shoulder muscular activation and co-ordination during a shoulder elevation task based on activities of daily living: an electromyographic study. J Orthop Res. 2012;30(1):53–60.
Clausen MB, Witten A, Holm K, Christensen KB, Attrup ML, Hölmich P, Thorborg K. Glenohumeral and scapulothoracic strength impairments exists in patients with subacromial impingement, but these are not reflected in the shoulder pain and disability index. BMC Musculoskelet Disord. 2017;18(1):302.

Details

Primary Language

English

Subjects

Physiotherapy

Journal Section

Research Article

Authors

Ertan Şahinoğlu ^*
0000-0002-1755-9922
Türkiye

Publication Date

June 30, 2025

Submission Date

May 19, 2025

Acceptance Date

June 15, 2025

Published in Issue

Year 2025 Volume: 1 Number: 1

IZ

https://izlik.org/JA69WJ87KX

Cite

RIS / Bibtex

APA

Şahinoğlu, E. (2025). Associations of Range of Motion and Muscle Strength with Pain and Disability in Patients with Rotator Cuff–Related Shoulder Pain. Clinical Physiotherapy and Related Research, 1(1), 34-42. https://izlik.org/JA69WJ87KX

AMA

1.Şahinoğlu E. Associations of Range of Motion and Muscle Strength with Pain and Disability in Patients with Rotator Cuff–Related Shoulder Pain. Clinical Physiotherapy and Related Research. 2025;1(1):34-42. https://izlik.org/JA69WJ87KX

Chicago

Şahinoğlu, Ertan. 2025. “Associations of Range of Motion and Muscle Strength With Pain and Disability in Patients With Rotator Cuff–Related Shoulder Pain”. Clinical Physiotherapy and Related Research 1 (1): 34-42. https://izlik.org/JA69WJ87KX.

EndNote

Şahinoğlu E (June 1, 2025) Associations of Range of Motion and Muscle Strength with Pain and Disability in Patients with Rotator Cuff–Related Shoulder Pain. Clinical Physiotherapy and Related Research 1 1 34–42.

IEEE

[1]E. Şahinoğlu, “Associations of Range of Motion and Muscle Strength with Pain and Disability in Patients with Rotator Cuff–Related Shoulder Pain”, Clinical Physiotherapy and Related Research, vol. 1, no. 1, pp. 34–42, June 2025, [Online]. Available: https://izlik.org/JA69WJ87KX

ISNAD

Şahinoğlu, Ertan. “Associations of Range of Motion and Muscle Strength With Pain and Disability in Patients With Rotator Cuff–Related Shoulder Pain”. Clinical Physiotherapy and Related Research 1/1 (June 1, 2025): 34-42. https://izlik.org/JA69WJ87KX.

JAMA

1.Şahinoğlu E. Associations of Range of Motion and Muscle Strength with Pain and Disability in Patients with Rotator Cuff–Related Shoulder Pain. Clinical Physiotherapy and Related Research. 2025;1:34–42.

MLA

Şahinoğlu, Ertan. “Associations of Range of Motion and Muscle Strength With Pain and Disability in Patients With Rotator Cuff–Related Shoulder Pain”. Clinical Physiotherapy and Related Research, vol. 1, no. 1, June 2025, pp. 34-42, https://izlik.org/JA69WJ87KX.

Vancouver

1.Ertan Şahinoğlu. Associations of Range of Motion and Muscle Strength with Pain and Disability in Patients with Rotator Cuff–Related Shoulder Pain. Clinical Physiotherapy and Related Research [Internet]. 2025 Jun. 1;1(1):34-42. Available from: https://izlik.org/JA69WJ87KX