What Is the Association Between Psychosocial Risk Factors and Pain and Function Outcomes in People With Rotator Cuff Disorders? A Systematic Review

OBJECTIVE: To describe the association between psychosocial factors and pain and function/disability in people with rotator cuff (RC) disorders.

DESIGN: Aetiology systematic review.

LITERATURE SEARCH: Systematic searches were conducted in CINAHL, Embase, MEDLINE, PsycINFO and Scopus databases from inception to November 2025. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline was followed.

STUDY SELECTION CRITERIA: Studies were eligible if they included adults with RC disorders and examined associations between psychosocial factors and pain and/or functional outcomes.

DATA SYNTHESIS: Study quality was assessed using the Joanna Briggs Institute critical appraisal tool. Due to study heterogeneity, results were presented narratively.

RESULTS: Thirty-eight observational studies (n = 4845; 2024 males, 2170 females, 651 sex not reported) were included. Over 70% of studies were of medium-high methodological quality. Pain catastrophising (r = −0.50 to 0.62, β = −0.54 to 0.50) and sleep (r = −0.59 to 0.54, β = −0.41) had moderate-to-strong associations with functional outcomes. Fear-avoidance had weak to strong associations with function (r = −0.61 to 0.24, β = −0.59 to −0.27, odds ratio [OR] = 1.39). Moderate evidence supported associations between fear-avoidance, sleep disturbance, pain catastrophising, and functional outcomes. Poorer mental health had a moderate to strong association with pain severity (r = −0.52 to −0.48) and impaired function (r = −0.61 to 0.75); the strength of evidence was limited. Weak to strong associations with limited strength of evidence were observed between remaining psychosocial factors and pain.

CONCLUSION: Pain catastrophising and sleep disturbance had moderate to strong associations with functional impairment in people with RC disorders. Fear-avoidance beliefs had heterogenous associations with function. Poor emotional health was associated with greater pain severity and functional impairment.