Effectiveness of a scapular exercise program on functional outcomes in patients with hand, wrist or elbow disorders: A comprehensive systematic review with meta-analysis

Background: Usually, patients with hand, wrist/forearm disorders report musculoskeletal complaints in the shoulder. Although, role of scapula is fundamental for movement and functional stability across the upper limb kinetic chain; however, there are no systematic reviews and meta-analyses that have analyzed the effect of scapular exercises in these patients.

Purpose: This study aimed to determine the effectiveness of a scapular exercise program on functional outcomes in patients with hand, wrist or elbow disorders.

Study design: Systematic review with meta-analysis.

Methods: An electronic search was performed of the MEDLINE, EMBASE, Web of Science, Scopus, CENTRAL, Epistemonikos, CINAHL, SPORTDiscus, PEDro, and LILACS databases. The eligibility criteria included randomized clinical trials that investigated the effects of scapular exercises added to a conventional physiotherapy program on functional outcomes in patients with hand, wrist or elbow injuries or pathologies. Two authors independently performed the search, study selection, data extraction, and risk of bias assessment.

Results: Six trials met the eligibility criteria and were included in the quantitative synthesis. For the comparison of scapular exercises plus conventional physiotherapy versus conventional physiotherapy alone, the mean difference for elbow and wrist function was 7.6 points (p = 0.04), upper limb function was 16.1 points (p < 0.01), grip strength was 15.4% (p = 0.01), pain free grip strength was 19.1 N (p = 0.13) and pain intensity at rest was -1.1 cm (p < 0.01). Additionally, there was a significant increase in muscle strength of serratus anterior 46.2 N (p < 0.01), middle trapezius 29.9 N (p = 0.01) and lower trapezius 45.9 N (p < 0.01).

Conclusions: In the short term, adding scapular exercises to conventional physiotherapy showed statistically significant differences in functional outcomes in patients with lateral elbow tendinopathy and distal radius fracture. However, most of these differences did not reach the minimum threshold to be considered clinically important. The evidence strength was high to low according to the GRADE approach. More quantity and quality of clinical trials is needed to confirm our findings.

Prospero registration: CRD42022364829.