Does scapular muscle training program preoperatively improve the functional outcomes and decrease coracoid pain?: A randomized controlled trial

Introduction Rotator cuff tears (RCTs) are associated with altered scapular mechanics and impaired periscapular muscle coordination, which may persist even after arthroscopic rotator cuff repair (ARCR). Although scapular-focused rehabilitation is commonly incorporated into postoperative protocols, the role of preoperative scapular-focused prehabilitation remains unclear. Objectives To evaluate whether a structured scapular-focused prehabilitation program improves periscapular muscle strength recovery and symmetry, as well as postoperative clinical outcomes and scapular control, following ARCR. Methods This prospective, randomized controlled trial enrolled 50 patients with RCTs scheduled for ARCR; the operating surgeon and outcome assessors were blinded to group allocation. Participants were randomized to a scapular-focused prehabilitation group or a control group. The intervention group completed a 4–6-week scapular-focused preoperative rehabilitation program emphasizing scapular stabilization and periscapular muscle strengthening. Clinical outcomes included the visual analog scale (VAS), the American Shoulder and Elbow Surgeons (ASES) score, the Shoulder Pain and Disability Index (SPADI), the Constant score, the EuroQol-5 Dimension 5-Level (EQ-5D-5L), the SICK Scapular Rating Scale, and coracoid tenderness, assessed preoperatively and at 6 weeks, 3 months, and 6 months postoperatively. Isometric periscapular muscle strength was measured preoperatively and at 3 and 6 months postoperatively. Results Both groups demonstrated substantial and progressive postoperative improvement in all patient-reported outcomes, with no statistically significant between-group differences in VAS (p = 0.909), ASES (p = 0.254), Constant score (p = 0.497), or SPADI (p = 0.903) at 6 months. The intervention group showed a higher proportion of patients with improvement in lower trapezius strength than the control group (41.2% vs. 10.5%), though this difference was not statistically significant (p = 0.06). Coracoid tenderness resolved progressively in both groups, with no statistically significant between-group differences at any postoperative timepoint (6 weeks: p=0.825; 3 months: p=0.137; 6 months: p=0.622). Conclusion Scapular-focused prehabilitation before ARCR did not improve patient-reported clinical outcomes compared with standard rehabilitation. More patients in the intervention group showed improvement in lower trapezius strength, though this difference was not statistically significant. Further studies are needed to confirm whether targeted prehabilitation improves postoperative neuromuscular recovery. Level of Evidence Level I, randomized controlled trial.