Strengthening Exercises for Humeral Head Depressor Muscles

March 2, 2026 updated by: Caner Karartı, Hacettepe University

The Effect of Strengthening Exercises for Humeral Head Depressor Muscles on Clinical Outcomes After Reverse Shoulder Arthroplasty

Postoperative rehabilitation after reverse shoulder arthroplasty aims to improve pain control, range of motion, and functional capacity. However, studies examining the effects of strengthening exercises targeting the humeral head depressor muscles are limited. This randomized controlled trial will evaluate the effects of adding a specific strengthening program to standard rehabilitation on pain, range of motion, quality of life, and functional outcomes.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

Reverse shoulder arthroplasty (RSA) is an effective surgical method, particularly in cases of massive rotator cuff tears that lead to irreversible loss of shoulder function. The primary goals of postoperative rehabilitation are to reduce pain, improve shoulder joint functions, optimize scapulothoracic rhythm, and safely restore functional use. However, studies examining the effects of specific strengthening exercises targeting the humeral head depressor muscle group (latissimus dorsi, teres major, infraspinatus, etc.) on clinical outcomes are quite limited. This study aims to evaluate the effects of a specific strengthening protocol designed for the humeral head depressor muscles following reverse shoulder arthroplasty on pain, range of motion (ROM), quality of life, functional status, and psychological well-being. Planned as a randomized controlled trial, the research will apply an additional humeral head depressor muscle strengthening program to the standard conventional rehabilitation protocol in the experimental group, while the control group will receive only the standard rehabilitation program.

Study Type

Interventional

Enrollment (Estimated)

27

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Patients scheduled for primary reverse total shoulder arthroplasty Intact teres minor confirmed by physical examination (Hornblower's test) and intraoperative assessment Ability to participate in physiotherapy or a home exercise program

Exclusion Criteria:

  • Active infection Deltoid muscle insufficiency Inability or unwillingness to comply with randomization Prior shoulder arthroplasty on the same side Unwillingness to participate Inability to read or understand written instructions

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Conventional Rehabilitation Group

Participants undergoing reverse shoulder arthroplasty will receive a standard conventional rehabilitation program starting at postoperative 6 th week . The patient will receive treatment 5 days a week for 6 weeks, for a total of 30 sessions. The program consists of passive, active-assisted, and active/resisted exercises.

Exercises Included:

Passive / Assisted

  • Scapular mobilization
  • Scapular clock
  • Passive external rotation with a stick Passive → Active-Assisted
  • Active-assisted flexion and abduction with a stick
  • Glenohumeral joint mobilization Active / Light Resistance
  • Scapular retraction
  • Light-resistance strengthening of biceps, triceps, and serratus anterior using a theraband Active / Resistance
  • Theraband-based resisted biceps, triceps, and serratus anterior strengthening
  • Continuation of glenohumeral mobilization
  • Flexion and abduction above 90°
  • Posterior capsule stretching
Other: Conventional Rehabilitation Group
After randomization and baseline assessments, participants will undergo a standard 6-week postoperative shoulder rehabilitation program, consisting of range-of-motion exercises, scapular stabilization training, and progressive strengthening. No additional depressor muscle-specific exercises will be applied.
Experimental: Depressor Muscle Strengthening Program

Participants will receive specific strengthening exercises targeting the shoulder depressor muscles in addition to the conventional rehabilitation program. These exercises will be performed throughout the 6-week intervention period.

Additional Exercises:

Latissimus dorsi: Seated rowing exercise - 3 sets × 10 repetitions Pectoralis major: Supine fly exercise - 3 sets × 10 repetitions Teres major: Prone shoulder adduction, extension, and internal rotation exercise
Other: Conventional Rehabilitation Group
After randomization and baseline assessments, participants will undergo a standard 6-week postoperative shoulder rehabilitation program, consisting of range-of-motion exercises, scapular stabilization training, and progressive strengthening. No additional depressor muscle-specific exercises will be applied.
Other: Depressor Muscle Strengthening Group
After randomization and baseline assessments, participants will receive a 6-week rehabilitation program consisting of conventional postoperative shoulder rehabilitation combined with a specific strengthening protocol targeting the shoulder depressor muscles.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Pain Intensity (Visual Analog Scale - VAS)
Time Frame: 6 weeks
Pain intensity will be assessed using the Visual Analog Scale, a 10-cm line ranging from "no pain" to "worst imaginable pain." The distance from the "no pain" anchor to the participant's mark will be measured in millimeters (0-100 mm), with higher scores indicating higher pain intensity.
6 weeks
Upper Extremity Disability (Disabilities of the Arm, Shoulder and Hand Questionnaire - DASH)
Time Frame: 6 weeks
The DASH is a 30-item self-administered questionnaire assessing upper-extremity functional limitations. Items are scored 1-5 and converted to a 0-100 scale, where higher scores indicate greater disability.
6 weeks
Shoulder Range of Motion (ROM)
Time Frame: 6 weeks
Active shoulder flexion, abduction, external rotation, and internal rotation will be measured using a standard goniometer. Results will be recorded in degrees (°).
6 weeks

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Shoulder Function (American Shoulder and Elbow Surgeons Score - ASES)
Time Frame: 6 weeks
The ASES score includes pain and functional assessments, yielding a total score between 0 and 100. Higher scores represent better shoulder function.
6 weeks
Thoracic Kyphosis Angle (Spinal Mouse Assessment)
Time Frame: 6 weeks
Thoracic spine curvature will be evaluated using the Spinal Mouse device during flexion and extension. The system provides non-invasive, objective measurements of thoracic kyphosis.
6 weeks
Pain Catastrophizing (Pain Catastrophizing Scale - PCS)
Time Frame: 6 weeks
The PCS consists of 13 items assessing rumination, magnification, and helplessness. Total scores range from 0 to 52, with higher scores indicating greater catastrophizing.
6 weeks
Anxiety and Depression (Hospital Anxiety and Depression Scale - HADS)
Time Frame: 6 weeks
HADS includes 14 items (7 anxiety, 7 depression), each scored 0-3. Higher scores indicate higher levels of anxiety or depression.
6 weeks
Kinesiophobia (Tampa Scale of Kinesiophobia - TSK)
Time Frame: 6 weeks
The TSK is a 17-item tool measuring fear of movement and reinjury. Scores range between 17 and 68, with higher scores indicating greater kinesiophobia.
6 weeks
Quality of Life (12-Item Short-Form Health Survey - SF-12)
Time Frame: 6 weeks
The SF-12 generates Physical Component Summary (PCS) and Mental Component Summary (MCS) scores ranging from 0 to 100. Higher scores reflect better health-related quality of life.
6 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Hacettepe University

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

January 2, 2026

Primary Completion (Estimated)

September 2, 2026

Study Completion (Estimated)

December 2, 2026

Study Registration Dates

First Submitted

December 15, 2025

First Submitted That Met QC Criteria

December 15, 2025

First Posted (Actual)

December 30, 2025

Study Record Updates

Last Update Posted (Actual)

March 3, 2026

Last Update Submitted That Met QC Criteria

March 2, 2026

Last Verified

March 1, 2026

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • 20251224

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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