Mapping evidence on psychosocial factors in patients with shoulder pain: a scoping review

To map psychosocial factors investigated in adults with shoulder pain across community, primary, secondary, and tertiary care settings and summarize methodological quality.

This scoping review followed PRISMA-ScR guidance and was registered on the Open Science Framework. Ten databases and gray literature were searched through 10 March 2026. Observational studies and clinical trials assessing psychosocial factors in adults with shoulder pain were included. Two reviewers independently screened studies, extracted data, and evaluated risk of bias using the Newcastle-Ottawa Scale, AXIS, NIH tools, and RoB 2.0.

We included 345 studies, 310 identified through the primary search and an additional 35 identified through a secondary search targeting frozen shoulder (n = 1,909,198; 46% women, 51.9 ± 6.58 years old), mostly from high-income countries. Depression, anxiety, catastrophizing, and general mental health were most frequently assessed. Across recruitment sources, 18.5% of the studies were community-based, 12% were in primary care, 32.2% in secondary care, and 46.6% in tertiary care. Depression, catastrophizing, anxiety, and fear-avoidance predominated in community, primary, and secondary care, whereas tertiary care more often examined depression, anxiety, general mental health, and satisfaction. Positive factors were rarely measured.

Community and early care settings primarily assessed psychological distress and pain-related beliefs, whereas tertiary care emphasized distress and cognitive factors. Positive psychosocial factors remain underrepresented, highlighting opportunities for a more comprehensive biopsychosocial characterization of shoulder pain. Twenty-two potentially eligible full-text articles could not be retrieved despite repeated attempts to contact the authors, which should be considered when interpreting the comprehensiveness of the evidence map.