Blood Flow Restriction in Upper-Extremity Rehabilitation: A Systematic Review of Clinical Studies

To evaluate the effects of blood flow restriction (BFR) therapy on upper-extremity strength, pain, range of motion, and functional outcomes.

This systematic review followed the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, and Scopus were searched from January 2000 through August 2025 for studies evaluating upper-extremity BFR during resistance or therapeutic exercise. Studies were included if they were randomized controlled trials or prospective studies published in English that reported pre- and postintervention outcomes of strength, pain, range of motion, muscle morphology, or validated functional scores.

A total of 492 studies were identified, 5 of which met inclusion criteria, encompassing 128 participants. Four studies (80%) were randomized controlled trials, and 1 study (20%) was a prospective cohort study. Clinical indications for the use of BFR included rotator cuff tendinopathy, lateral epicondylitis, distal radius fracture rehabilitation, and postoperative shoulder rehabilitation. Four of 5 studies (80%) showed statistically significant BFR-related improvements in strength, with the remaining study reporting within-group improvements that did not reach between-group significance. Three of 4 studies (75%) that assessed pain reported significant reductions favoring BFR, with the fourth showing clinically within-group pain reductions in both BFR and control. Notable findings included a significant between-group improvement in internal rotation strength at 60°/s favoring BFR in rotator cuff tendinopathy (P = .04) and significant pain reduction in distal radius fracture rehabilitation (visual analog scale: 5.5 → 1.5, P = .03).

In this systematic review, 4 of 5 studies (80%) reported statistically significant strength improvements favoring BFR, and 3 of 4 studies (75%) assessing pain showed significant reductions favoring BFR, with no serious adverse events reported. These findings support BFR as a promising adjunct in upper-extremity rehabilitation; however, heterogeneity in study design and intervention parameters limits definitive conclusions.

Level IV, systematic review of Level I and IV studies.