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Peer-reviewedCC BY 4.0PLOS One

Scapular endurance, dyskinesis, and functional outcomes after rotator cuff repair: A cross-sectional mediation analysis

  • Wael M. Alzahrani1
  • Baraa Abdulraheem Baltow2
  • Ziad Ahmed Alanazi3
  • Saleh M. Kardm4
  • Ravi Shankar Reddy
  • Ghada Mohamed. Koura
  • Ajay Prashad Gautam
4 affiliations
  1. 1Department of Surgery, College of Medicine, Najran University, Najran, Saudi Arabia
  2. 2Department of Orthopedic Surgery, AlHada Armed Forces Hospital, Taif, Saudi Arabia
  3. 3Department of Surgery, Orthopedic Division, College of Medicine, Jouf University, Sakaka, Saudi Arabia
  4. 4Program of Physical Therapy, Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
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Abstract

This cross-sectional study investigates the relationship between scapular muscle endurance and shoulder function in patients who had undergone arthroscopic rotator cuff repair (RCR) 6–18 months before study enrollment. A total of 110 patients were assessed using the Scapular Retraction Endurance Test (SRET), the Scapular Dyskinesis Test, and the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST). Patient-reported outcomes were measured using the American Shoulder and Elbow Surgeons (ASES) score, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and a Numerical Rating Scale (NRS) for pain. Findings revealed that higher scapular endurance and better CKCUEST performance were significantly associated with improved shoulder function (higher ASES scores) and reduced disability (lower DASH scores). Scapular dyskinesis was associated with poorer clinical and functional outcomes and mediated the relationship between scapular endurance and functional status. Mediation analyses confirmed that both scapular dyskinesis and CKCUEST performance partially explained the impact of endurance on functional recovery. The results suggest that scapular muscle endurance is a key predictor of postoperative shoulder function and is influenced by scapular motion quality and upper extremity stability. These findings support the incorporation of endurance training and scapular control assessments into rehabilitation protocols for patients following RCR.

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Cite

BibTeXRIS
BibTeX
@article{alzahrani2026scapular,
  title = {{Scapular endurance, dyskinesis, and functional outcomes after rotator cuff repair: A cross-sectional mediation analysis}},
  author = {Wael M. Alzahrani and Baraa Abdulraheem Baltow and Ziad Ahmed Alanazi and Saleh M. Kardm and Ravi Shankar Reddy and Ghada Mohamed. Koura and Ajay Prashad Gautam},
  journal = {PLOS One},
  year = {2026},
  month = sep,
  doi = {10.1371/journal.pone.0357765},
  url = {https://doi.org/10.1371/journal.pone.0357765},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Scapular endurance, dyskinesis, and functional outcomes after rotator cuff repair: A cross-sectional mediation analysis
AU  - Wael M. Alzahrani
AU  - Baraa Abdulraheem Baltow
AU  - Ziad Ahmed Alanazi
AU  - Saleh M. Kardm
AU  - Ravi Shankar Reddy
AU  - Ghada Mohamed. Koura
AU  - Ajay Prashad Gautam
PY  - 2026
DA  - 2026/09/15
JO  - PLOS One
DO  - 10.1371/journal.pone.0357765
UR  - https://doi.org/10.1371/journal.pone.0357765
AB  - This cross-sectional study investigates the relationship between scapular muscle endurance and shoulder function in patients who had undergone arthroscopic rotator cuff repair (RCR) 6–18 months before study enrollment. A total of 110 patients were assessed using the Scapular Retraction Endurance Test (SRET), the Scapular Dyskinesis Test, and the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST). Patient-reported outcomes were measured using the American Shoulder and Elbow Surgeons (ASES) score, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and a Numerical Rating Scale (NRS) for pain. Findings revealed that higher scapular endurance and better CKCUEST performance were significantly associated with improved shoulder function (higher ASES scores) and reduced disability (lower DASH scores). Scapular dyskinesis was associated with poorer clinical and functional outcomes and mediated the relationship between scapular endurance and functional status. Mediation analyses confirmed that both scapular dyskinesis and CKCUEST performance partially explained the impact of endurance on functional recovery. The results suggest that scapular muscle endurance is a key predictor of postoperative shoulder function and is influenced by scapular motion quality and upper extremity stability. These findings support the incorporation of endurance training and scapular control assessments into rehabilitation protocols for patients following RCR.
SN  - 1932-6203
ER  -