Effects of blood flow restriction training in adult upper-limb musculoskeletal rehabilitation

BACKGROUND: Blood flow restriction training (BFRT) has been proposed as a low-load rehabilitation strategy for symptomatic and postoperative upper-limb musculoskeletal conditions. This review evaluated the clinical effects, tolerability, and prescription characteristics of BFRT in adult upper-limb musculoskeletal rehabilitation. METHODS: This systematic review was registered in International Prospective Register of Systematic Reviews (CRD420261299726) and reported with reference to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. CENTRAL/Cochrane Library, Embase via Ovid, MEDLINE/PubMed, Science Citation Index/Web of Science, and Scopus were searched without a start-date restriction before February 18, 2026; backward reference-list/citation checking was also used. Randomized trials, case series, and case reports were eligible. Findings were synthesized narratively because of heterogeneity, and studies were appraised using risk of bias 2 or design-appropriate Joanna Briggs Institute checklists. RESULTS: Twenty reports were included: 9 parallel-group randomized trials, 1 randomized crossover trial, 2 case series, and 8 case-report publications. Across the reports, 340 participants were enrolled or randomized and 326 contributed to the analyzed/treated clinical samples; 158 were men (48.5%) and 168 were women (51.5%). In a sham-controlled lateral elbow tendinopathy trial, BFRT resulted in a significantly greater reduction in 12-week pain (between-group difference -1.54, 95% confidence interval [CI] -2.89 to -0.18; P = .026) and patient-rated tennis elbow evaluation (PRTEE) (-15.23, 95% CI -23.57 to -6.90; P < .001). In patients with chronic lateral epicondylitis, PRTEE reduction (-24.20 ± 4.02 vs -15.60 ± 3.71; P = .001) and quick disabilities of the arm, shoulder and hand reduction (-12.83 ± 4.97 vs -7.51 ± 4.72; P = .025) were significantly greater with BFRT plus conventional therapy, whereas between-group pain and strength changes were not significant. In nonoperative distal-radius-fracture rehabilitation, mean activity-pain reduction was 4.0 versus 2.3 points (P = .03). In rotator-cuff tendinopathy, BFRT resulted in significantly greater biceps thickness (P = .002) and internal-rotation strength (P = .040). Conversely, a pragmatic elbow trial found no significant between-group difference in 12-month PRTEE (adjusted contrast + 4.32, 95% CI -9.17 to 17.81; P = .53). CONCLUSION: BFRT may be considered a low-load adjunct in adult upper-limb musculoskeletal rehabilitation settings, but it is not consistently superior to active rehabilitation for pain, strength, or function. Confidence remains limited by small samples, heterogeneous prescriptions and co-interventions, uncontrolled designs, and incomplete adverse-event ascertainment.