A Shot in the Dark: The Paradoxical Effects of GLP-1 Receptor Agonists on Rotator Cuff Disease and Surgical Outcomes

This systematic evidence review evaluates four retrospective cohort studies examining the relationship between Glucagon-Like Peptide-1 receptor agonist (GLP-1 RA) therapy and rotator cuff disease outcomes. GLP-1 RAs are a rapidly expanding class of medications prescribed for obesity and type 2 diabetes mellitus, with semaglutide becoming one of the most widely prescribed medications in the United States by 2023. While their metabolic benefits are well established, their musculoskeletal effects remain poorly understood. Emerging evidence suggests a paradoxical relationship in which chronic GLP-1 RA use may modestly increase the risk of native shoulder pathology – particularly adhesive capsulitis and atraumatic rotator cuff tears – while perioperative use may reduce postoperative complications and retear rates following arthroscopic rotator cuff repair. Because GLP-1 RAs are increasingly prescribed to the same patient populations at elevated risk for rotator cuff disease – adults with obesity and type 2 diabetes mellitus – understanding their musculoskeletal effects is clinically important. Determining whether these medications confer net musculoskeletal benefit or harm will inform risk stratification and shared decision-making for clinicians prescribing GLP-1 RAs in this growing population.