Gender Disparities in Shoulder Pain and Shoulder Surgery: A Current Concepts Review

TL;DR

This review explores how gender influences shoulder pain, surgery outcomes, and recovery, highlighting differences in pain and function between males and females.

Contribution

The paper provides a synthesis of gender-related differences in shoulder surgery outcomes and management strategies.

Findings

Female patients show worse pre-operative functional scores and higher pain levels despite similar structural disease severity.

Postoperatively, females report higher early pain and lower functional outcomes after shoulder arthroplasty and instability surgery.

Outcomes after rotator cuff repair and anterior instability stabilization are largely comparable between genders.

Abstract

Shoulder pain and shoulder surgery are increasingly prevalent and encompass a broad spectrum of pathologies, including rotator cuff disease, glenohumeral osteoarthritis, and shoulder instability. Growing evidence suggests that gender-related factors influence disease presentation, patient-reported outcomes, and postoperative recovery; however, these effects remain inconsistently reported across the literature. This current concepts review synthesizes available evidence on the influence of gender on pre-operative characteristics, non-operative management, and postoperative outcomes following common shoulder procedures, including rotator cuff repair, anatomic and reverse shoulder arthroplasty, and surgical stabilization for instability. A comprehensive literature search of PubMed, the Cochrane Library, and Google Scholar was performed for studies published through October 2025, with outcomes assessed using validated instruments such as the Western Ontario Rotator Cuff Index, American Shoulder and Elbow Surgeons score, Constant–Murley score, Simple Shoulder Test, Visual Analog Scale, and Shoulder Pain and Disability Index. Across shoulder pathologies, female patients consistently demonstrated worse pre-operative functional scores, higher pain levels, and greater perceived disability despite similar structural disease severity. Postoperatively, both genders experienced meaningful clinical improvement; however, females often reported higher early postoperative pain and lower absolute functional outcomes, particularly following shoulder arthroplasty for glenohumeral osteoarthritis and surgical treatment of multidirectional instability. In contrast, outcomes following rotator cuff repair and anterior instability stabilization were largely comparable between genders. Recognition of these gender-related differences is essential for individualized patient counseling, expectation setting, and optimization of management strategies, and highlights the need for future studies with robust gender-disaggregated analyses.

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