Periarthritic Shoulder Cupping Therapy: Clinical Mechanisms, Rehabilitation Integration, and Outcomes in Musculoskeletal Shoulder Disorders

Abstract

Periarthritic Shoulder conditions, including adhesive capsulitis, rotator cuff–related shoulder pain, and periarticular inflammatory disorders, represent a significant cause of pain, functional limitation, and disability worldwide. Conventional rehabilitation approaches such as therapeutic exercise, manual therapy, electrotherapy, and pharmacological interventions demonstrate variable outcomes, particularly in chronic and refractory cases. Cupping therapy, an ancient therapeutic modality rooted in traditional medicine systems, has gained renewed interest as a complementary intervention in musculoskeletal rehabilitation. Emerging evidence suggests that cupping therapy may modulate pain, enhance local circulation, reduce inflammation, and improve tissue extensibility, thereby supporting functional recovery. This paper provides a comprehensive review of periarthritic shoulder cupping therapy, examining its physiological mechanisms, clinical rationale, integration within contemporary shoulder rehabilitation programs, and therapeutic outcomes in musculoskeletal shoulder disorders. Mechanistic pathways including neurophysiological pain modulation, microcirculatory enhancement, fascial decompression, and immunological responses are explored. Clinical protocols for dry cupping and moving cupping in periarthritic shoulder conditions are discussed, alongside safety considerations and contraindications. Outcome measures such as pain intensity, shoulder range of motion, muscle activation, and functional performance are critically analysed. The synthesis of current evidence supports cupping therapy as a valuable adjunct to physiotherapy-based rehabilitation, particularly when integrated into multimodal treatment strategies. Further high-quality randomized controlled trials are recommended to establish standardized protocols and long-term efficacy.