Repetitive Transcranial Magnetic Stimulation for Post-Stroke Shoulder-Hand Syndrome: A Systematic Review and Meta-Analysis

Background The rehabilitative management of post-stroke shoulder-hand syndrome (SHS) is a complex clinical challenge. Repetitive transcranial magnetic stimulation (rTMS), a non-invasive neuromodulation technique, has been widely used to enhance neurological recovery after stroke. However, its therapeutic value in SHS remains unclear, and strong evidence-based support is still lacking. This study aims to systematically evaluate the rehabilitative efficacy of rTMS for post-stroke SHS, in order to inform clinical practice with scientific evidence. Methods Using a combination of medical subject headings and free-text terms, we conducted a comprehensive search of PubMed, Embase, Cochrane Library, Web of Science, Wanfang, CNKI, CSTJ, and SinoMed to identify randomized controlled trials (RCTs) up to July 24, 2025. The Cochrane RoB-I tool was used to assess risk of bias, and statistical analysis was performed with Review Manager 5.4.1. Result A total of 12 RCTs involving 885 patients were included. Meta-analysis indicated that, compared to controls, rTMS produced significantly greater improvements in pain, edema, activities of daily living (ADL), and upper extremity motor function in post-stroke SHS patients. Subgroup analysis showed that at 30 days post-intervention, improvements in ADL ability and upper limb function were greater than those observed at 14 days post-intervention. Additionally, subgroup analysis suggested that an rTMS intervention frequency of 3 Hz produced the greatest improvement in patient symptoms. Conclusion rTMS has a positive effect on alleviating pain and edema and improving ADL and upper limb motor function in post-stroke SHS patients, and these benefits are optimal with longer-duration rTMS at 3Hz. System overview registration ID: CRD420251135339