Blood Flow Restriction Training in Patients With Rotator Cuff Tendinopathy: A Randomized, Assessor-Blinded, Controlled Trial.

OBJECTIVES: To investigate the effects of low-load blood flow restriction (BFR) training on shoulder muscle thickness, rotator cuff (RC) strength, and shoulder symptoms in patients with RC tendinopathy. DESIGN: A randomized, assessor-blinded, controlled trial. SETTINGS: Physiotherapy clinic at a university. PARTICIPANTS: Twenty-eight patients were randomized into an 8-week (2 times/week) shoulder rehabilitation, that is, BFR or non-BFR group. INTERVENTIONS: BFR training. MAIN OUTCOME MEASURES: (1) RC, deltoid, scapula retractor, and biceps muscle thicknesses and shoulder internal rotation (IR) and external rotation (ER) strengths. (2) Shoulder pain/function. RESULTS: The BFR group had a greater increase in biceps muscle thickness ( P = 0.002) and shoulder IR strength at 60 degrees/s ( P = 0.040) than the non-BFR group. No differences between the 2 groups were observed in other measurements. Significant improvements in supraspinatus, infraspinatus, and scapula retractor muscle thicknesses and in shoulder ER and IR strengths were observed over time in both the groups (all P < 0 .05). Also, shoulder pain decreased and shoulder function increased over time in both the groups (all P < 0 .05). CONCLUSIONS: Low-load BFR training resulted in a greater increase in biceps thickness and shoulder IR strength compared with the non-BFR group in patients with RC tendinopathy. However, there was no superiority of either exercise training regarding the RC, scapula retractor, deltoid muscle thicknesses, or improvements in shoulder ER strength and shoulder pain/function. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER: The study was registered in ClinicalTrials.gov named Blood Flow Restriction Training in Patients with Shoulder Pain and the registration number is NCT04333784.

Cross-education effects on shoulder rotator muscle strength and function after shoulder stabilization surgery: a randomized controlled trial.

HYPOTHESIS: This study aimed to investigate the effects of cross education (CE) on rotator cuff (RC) muscle strength recovery and shoulder function in patients who underwent arthroscopic anterior shoulder stabilization surgery. METHODS: Twenty-eight patients who underwent shoulder stabilization surgery were included in the study (age, 25 ± 6 years; body mass index, 24.8 ± 3.6 kg/m2). The patients were randomly divided into either the CE group (n = 14) or the control group (n = 14). All patients received a standardized rehabilitation program until the end of the 12th postoperative week. The CE group also received isokinetic training of the nonoperative shoulder focusing on the RC muscles (twice a week, 3 sets of 10 repetitions). RC muscle strength was measured preoperatively and at 3 and 6 months postoperatively using an isokinetic dynamometer at 60°/s and 180°/s angular velocities. Shoulder function was assessed with the Closed Kinetic Chain Upper Extremity Stability Test and Y-Balance Test-Upper Quarter. Analyses of covariance were used for the statistical analyses. RESULTS: At 6 months postoperatively, at 60°/s angular velocity, there was higher internal rotator strength in the CE group (P = .02) and similar external rotator strength (P = .62) between the groups. At 180°/s angular velocity, both internal rotator strength (P = .04) and external rotator strength (P = .02) were higher in the CE group. The Closed Kinetic Chain Upper Extremity Stability Test (P = .47), Y-Balance Test-Upper Quarter (P = .95), and Western Ontario Shoulder Instability Index (P = .12) scores were similar between the groups at 6 months after surgery. CONCLUSIONS: CE in the early period of postoperative rehabilitation following stabilization surgery improves RC strength recovery. However, it has no effect on functional outcomes. Integrating a CE program into the postoperative rehabilitation protocol may help to improve dynamic shoulder stability but not functional capacity.

Kinetic chain revisited: consensus expert opinion on terminology, clinical reasoning, examination, and treatment in people with shoulder pain.

BACKGROUND: The purpose of this study was to reach consensus on the most appropriate terminology and issues related to clinical reasoning, examination, and treatment of the kinetic chain (KC) in people with shoulder pain among an international panel of experts. METHODS: A 3-round Delphi study that involved an international panel of experts with extensive clinical, teaching, and research experience in the study topic was conducted. A search equation of terms related to the KC in Web of Science and a manual search were used to find the experts. Participants were asked to rate items across 5 different domains (terminology, clinical reasoning, subjective examination, physical examination, and treatment) using a 5-point Likert-type scale. An Aiken coefficient of validity (V) ≥0.7 was considered indicative of group consensus. RESULTS: The participation rate was 30.2% (n = 16), whereas the retention rate was high throughout the 3 rounds (100%, 93.8%, and 100%). A total of 15 experts from different fields and countries completed the study. After the 3 rounds, consensus was reached on 102 items: 3 items were included in the "terminology" domain; 17 items, in the "rationale and clinical reasoning" domain; 11 items, in the "subjective examination" domain; 44 items, in the "physical examination" domain; and 27 items, in the "treatment" domain. Terminology was the domain with the highest level of agreement, with 2 items achieving an Aiken V of 0.93, whereas the domains of physical examination and treatment of the KC were the 2 areas with less consensus. Together with the terminology items, 1 item from the treatment domain and 2 items from the rationale and clinical reasoning domain reached the highest level of agreement (V = 0.93 and V = 0.92, respectively). CONCLUSION: This study defined a list of 102 items across 5 different domains (terminology, rationale and clinical reasoning, subjective examination, physical examination, and treatment) regarding the KC in people with shoulder pain. The term "KC" was preferred and a agreement on a definition of this concept was reached. Dysfunction of a segment in the chain (ie, weak link) was agreed to result in altered performance or injury to distal segments. Experts considered it important to assess and treat the KC in particular in throwing or overhead athletes and agreed that no one-size-fits-all approach exists when implementing shoulder KC exercises within the rehabilitation process. Further research is now required to determine the validity of the identified items.

Is shoulder joint position sense affected in partial and full-thickness supraspinatus tears?

PURPOSE: Neuromuscular control is important for joint stabilization. Supraspinatus muscle plays an essential role in the perception of proprioceptive sense. The aim of this study is to investigate active joint position sense (AJPS) both in patients with partial and full-thickness supraspinatus tears and in healthy participants. METHODS: Twenty patients with partial supraspinatus tears, 20 patients with full-thickness supraspinatus tears, and 20 healthy participants, aged 40-65 years, were included in the study. Proprioceptive sense was assessed with AJPS measurement. Absolute error was calculated to evaluate joint position sense. RESULTS: Active joint position sense was decreased in partial and full-thickness tears on both in affected and contralateral shoulders compared to control group (p < 0.05). There was no difference between groups with partial and full-thickness tears on the affected and contralateral shoulders at 40° and 100° elevation (p > 0.05). CONCLUSION: AJPS was affected after supraspinatus injury. It was seen as proprioceptive deficit in patients with partial and full-thickness tears in both affected and contralateral shoulders.

Acromiohumeral distance quantification during a variety of shoulder external and internal rotational exercises in recreationally overhead athletes.

To determine whether shoulder external (ER) and internal rotational (IR) exercises at five different shoulder abduction angles affect the acromiohumeral distance (AHD). Twenty recreational overhead athletes were included. AHD was measured using real-time ultrasound for each of the five shoulder conditions as follows: neutral shoulder rotation (active-hold) and during ER and IR exercises (isometric and concentric) at five different shoulder-abduction angles (0°, 30°, 45°, 60°, and 90° of abduction). A two-way ANOVA was used to analyze AHD values. Shoulder abduction angle × exercise interaction for AHD was found (F16,304 = 10.92; p < .001; η2 = 0.37). For both isometric and concentric conditions, AHD increased during IR exercises (p < .05) yet decreased during ER exercises (p < .05) when compared with each active-hold positions. Shoulder ER and IR exercises influence the AHD in recreational overhead athletes. A larger AHD was observed during shoulder IR exercises, whereas ER exercises failed to maintain the AHD.

Tender point examination with palpation in different shoulder pathologies: A retrospective study.

BACKGROUND: Shoulder pain is a common symptom for non-traumatic shoulder pathologies and affects 4.7-66.7% of entire population. Even with the latest technological advantages, palpation still is a cost and time efficient tool to evaluate the shoulder pathologies. Our aim was to investigate and compare palpation findings in different shoulder pathologies. METHOD: We used first assessments of impingement syndrome (IS) (n = 205), rotator cuff tear (RCT) (n = 185) and frozen shoulder (FS) (n = 210) patients who received treatment between 2010 and 2019 years. Two experienced physiotherapists palpated predefined points: long head of biceps brachii, pectoralis minor, lateral intermuscular septum, proximal tendons of extensor group. These points categorized into "proximal", "mid-proximal", "mid-distal", "distal", "irregular". We also grouped patients by their BMIs. RESULTS: We found RCT patients had higher BMI than IS and FS patients (p < 0.001, p = 0.001); more tender intermuscular septum points and night pain than IS patients (p = 0.001, p = 0.003) and more extensor group proximal tendon points than IS and FS patients (p < 0.001, p = 0.001). "No tenderness" group had lesser resting pain than distal group (p < 0.001) and lesser activity and night pain than middle-proximal, middle-distal, and distal groups (all ps < 0.002). Distal group had higher night pain than middle-proximal group (p = 0.003). Morbidly obese patients had higher night pain than normal and overweight patients (p = 0.003 and p = 0.009). CONCLUSIONS: Tender point distribution varies depending on the pathology with biceps brachii being the most common. RCT patients had higher night pain related to more distal tender points. Patients with higher night pain had increased tenderness in septum intermuscular and extensor muscles' proximal tendons.

Translation, cross-cultural adaptation, and validation of the Turkish version of the shoulder instability-return to sport (SI-RSI) after injury scale.

To translate and culturally adapt the shoulder instability-return to sport after injury (SI-RSI) scale into Turkish (SI-RSI-Tr) and examine the psychometric properties of the Turkish version of athletes following a traumatic shoulder instability. The SI-RSI was translated into Turkish using Beaton guidelines. Sixty-nine patients with shoulder instability completed the translated SI-RSI, Western Ontario Shoulder Instability Index (WOSI), the Tampa Scale of Kinesiophobia (TSK), and the Walch-Duplay Scores. We analysed the internal consistency, agreement, reliability, and validity of the SI-RSI-Tr. The SI-RSI-Tr demonstrated excellent internal consistency (Cronbach's alpha = 0.92), test-retest reliability (ICC = 0.95), and feasibility with no ceiling or floor effect. SI-RSI-Tr correlated with WOSI total score (r = -0.824, p < 0.001), its subscales: WOSI-physical (r = -0.683, p < 0.001), WOSI-sports (r = -0.832, p < 0.001), WOSI-lifestyle (r = -0.739, p < 0.001), and WOSI-emotions (r = -0.734, p < 0.001) respectively), Walch-Duplay (r = 0.840, p < 0.001) and TSK (r = -0.828, p < 0.001) scores. The Turkish SI-RSI is a reliable, internally consistent, and valid tool for athletes with shoulder instability. Researchers and clinicians could safely use the SIRSI-Tr to evaluate the shoulder-specific psychological factors on return to sports following an episode of shoulder instability.

Does scapular corrective taping alter periscapular muscle activity and 3-dimensional scapular kinematics? A systematic review.

STUDY DESIGN: This is a systematic review. INTRODUCTION: Scapular taping is widely used in the management of scapular dysfunction. However, its effects on the scapular kinematics and the electromyography (EMG) activity of the periscapular muscles are not clear. PURPOSE OF THE STUDY: The purpose of the study was to systematically review the current literature to examine whether scapular corrective taping alters the EMG activity of the periscapular muscles and the 3-dimensional scapular kinematics. METHOD: MEDLINE and Web of Science databases were searched using specific mesh terms up to April 2018. A hand search was also conducted on the reference list of the included articles. A total of 157 studies were identified, and they were further analyzed for the eligibility to the systematic review. Studies that investigated the effects of scapular corrective taping on the EMG activity of the periscapular muscles and on the 3-dimensional scapular kinematics on patients with shoulder problems or asymptomatic subjects were eligible for the systematic review. The Cochrane Effective Practice and Organization of Care criteria were modified and used for the risk-of-bias assessment. RESULTS: Eleven articles met the inclusion criteria and were included in the systematic review. Five studies investigated the effects of corrective taping on the scapular kinematics and 8 studies reported the effects of corrective taping on the EMG activity of the periscapular muscles. There was an agreement among the studies that scapular upward rotation is increased with the corrective taping, while there are inconsistent results concerning the scapular external rotation and posterior tilt. In addition, studies mostly reported that corrective taping decreases the activity of the upper trapezius, while it has conflicting effects on the activity patterns of other periscapular muscles. DISCUSSION: Scapular corrective taping was found to increase the scapular upward rotation; however, its effects on scapular external rotation and posterior tilt are controversial. It was also found that corrective taping might decrease the EMG activity of the upper trapezius, while it had no effects on the activity of lower trapezius, and its effects on other periscapular muscles were controversial. CONCLUSION: The results of the studies indicated that scapular corrective taping might alter the 3-dimensional scapular kinematics, while there are controversies about the effects of corrective taping on the EMG activity of the periscapular muscles. Further studies are needed to clarify the conflicts.

Effect of taping on scapular kinematics of patients with facioscapulohumeral muscular dystrophy.

The aim of this study is to investigate the effects of scapular taping on scapular kinematics by three-dimensional electromagnetic system during shoulder elevation in facioscapulohumeral muscular dystrophy patients. A total of 11 patients with facioscapulohumeral muscular dystrophy were included in the study. Scapular anterior-posterior tilt, upward-downward rotation, and internal-external rotations were evaluated using the three-dimensional electromagnetic system during the elevation of the upper limbs in the scapular plane before and after kinesio taping. For maximum humerothoracic elevation, there were no differences between the patients before and after taping on both dominant (p = 0.72) and non-dominant sides (p = 0.64). For scapular internal rotation, upward rotation, and posterior tilt, there were no differences between patients before and after taping during humerothoracic elevation on both dominant and non-dominant sides (p > 0.05). These results showed us that the excessive and abnormal movements of the scapula observed during the humeral elevation in facioscapulohumeral muscular dystrophy patients cannot be supported with flexible methods like kinesio taping. Therefore, we recommend to evaluate the scapula position by applying flexible and rigid taping to the patients who can reach over 90o in humerothoracic elevation in future studies.

Correction to: Effect of taping on scapular kinematics of patients with facioscapulohumeral muscular dystrophy.

The published version of this article unfortunately contained a mistake in Fig. 2. Only one graphic of different movement of scapula was published instead of three. The Figure is corrected here.

Which method for frozen shoulder mobilization: manual posterior capsule stretching or scapular mobilization?

OBJECTIVES: This study aimed to compare the superiority of scapular mobilization, manual capsule stretching, and the combination of these two techniques in the treatment of frozen shoulder patients to evaluate the acute effects of these techniques on shoulder movements. METHODS: This study designed to a single-blinded, randomized, and pre-post assessment study. This study was included 54 patients diagnosed with stage 3 frozen shoulder. Group 1 (n=27) received scapular mobilization, and Group 2 (n=27) received manual posterior capsule stretching. After the patients were assessed, the interventions were re-applied with a crossover design to obtain results for the combined application (n=54). The range of motion, active total elevation, active internal rotation, and posterior capsule tensions of the shoulder joint were recorded before and immediately after mobilization. RESULTS: Statistical analysis showed an increase in all range of motion values (p<0.05), except for shoulder internal rotation (p>0.05), without significant difference among the groups (p>0.05). The posterior capsule flexibility did not change in any group (p>0.05). CONCLUSIONS: Scapular mobilization and manual posterior capsule interventions were effective in improving the acute joint range of motion in frozen shoulder patients.

A three-dimensional scapular motion analysis in patients with arthroscopic anterior capsulolabral repair of the shoulder: The effect of scapular stabilization taping.

BACKGROUND: The aim of this study was to investigate the scapular kinematics during dynamic humeral movements in patients with arthroscopic anterior capsulolabral repair of the shoulder along with the potential biomechanical corrective effects of scapular stabilization taping. METHODS: Twenty patients with unilateral traumatic anterior shoulder instability and arthroscopic anterior capsulolabral repair participated in the study. Dynamic shoulder kinematics were assessed during the scapular plane shoulder elevation for both the operated and non operated shoulders and also under two conditions: no-taping and taping. Statistical analysis to compare sides and conditions was performed with analysis of variance models. RESULTS: The scapula was more internally rotated position in operated shoulders than in non operated shoulders. Furthermore, the scapula was less internally rotated and more downwardly rotated at 120° of elevation in the taping condition. CONCLUSIONS: Operated shoulders demonstrated kinematics alterations when compared to non operated shoulders underwent arthroscopic anterior capsulolabral repair. Additionally, changes in the scapular orientation with the taping was very small but followed a pattern, which would be suggested to be an orientation that potentially produce more scapular stability and to increase stress on the inferior glenohumeral ligament.

Relationship Between Middle Trapezius Muscle Activation and Acromiohumeral Distance Change During Shoulder Elevation With Scapular Retraction.

CONTEXT: The scapular retraction exercises are widely used among clinicians to balance the activity of the scapular muscles as well as the rotator cuff muscles in different shoulder abduction positions. OBJECTIVES: The aim of this study was to investigate the relationship between scapular (middle and upper trapezius) and shoulder muscles (middle deltoid and infraspinatus) activation level differences and acromiohumeral distance changes during shoulder abduction with scapular retraction. DESIGN: Cross-sectional study. SETTING: University research laboratory. PARTICIPANTS: Nineteen asymptomatic individuals were included (mean [SD]: age = 22.4 [1.8] y). MAIN OUTCOME MEASURE: The acromiohumeral distance was measured at 0° and 90° shoulder abduction when the scapula was in nonretracted and retracted position with ultrasound imaging. The relationship between muscle activation level changes and acromiohumeral distance difference was analyzed with the Pearson correlation test. RESULTS: Middle trapezius muscle activity change correlated with acromiohumeral distance difference (r = .55, P = .02) from 0° to 90° shoulder abduction when scapula was retracted. For both nonretracted and retracted scapular positions, no correlations were found between middle deltoid, infraspinatus, and upper trapezius muscle activity changes with acromiohumeral distance differences during shoulder abduction (P > .05). CONCLUSIONS: Active scapular retraction exercise, especially focusing on the middle trapezius muscle activation, seems to be an effective treatment option to optimize the acromiohumeral distance during shoulder abduction.

Mobilization with movement and kinesio taping in knee arthritis-evaluation and outcomes.

INTRODUCTION: The aim of this study was to investigate the acute effects of Mulligan mobilization with movement (MwM) and taping on function and pain intensity in patients with osteoarthritis (OA). MATERIALS AND METHODS: Female patients aged between 40 and 70 years with knee OA participated in the study. The patients were divided into three groups and each group received different interventions. Group 1 received MwM and taping according to Mulligan's concept. Group 2 received MwM and placebo taping with no recovery effect and group 3 received placebo taping. Functional tests including lifting, picking up, sit and stand-up, socket tests in addition to climbing up and down stairs, ten metres walk, and timed up and go (TUG) tests were performed before and after intervention. Pain during the test performances were assessed by a visual analog scale. RESULTS: Performance in all tests improved significantly in the MwM + taping group, while only sit and stand-up, ten metres walk, and TUG test performances improved in the MwM + placebo taping group (p < 0.05). Pain intensity during the tests was also significantly better after intervention in those two groups (p < 0.05). Comparison between the groups showed that the pain intensity during all tests was less and functional test scores were better in sit and stand-up, ten metres walk, and walking down stairs in the MwM + taping group than the MwM + placebo taping group. CONCLUSIONS: MwM accompanied by taping improves pain during functional activities as well as the performance. MwM without taping may also improve pain intensity; however, it may be inadequate in increasing the performance.

Stretching Exercises for Subacromial Impingement Syndrome: Effects of 6-Week Program on Shoulder Tightness, Pain, and Disability Status.

CONTEXT: Increasing soft tissue flexibility and joint mobility is one of the important aims of studies to treat subacromial impingement syndrome (SIS). OBJECTIVE: The aim of this study was to investigate the effects of a stretching program on posterior capsule tightness, pectoralis minor tightness, pain severity, and disability status in SIS. DESIGN: Single-group pretest posttest design. SETTING: University outpatient clinic. PARTICIPANTS: 18 participants diagnosed with SIS (34.8±9.4 y, symptoms duration 5.8±4.9 months) were included in the study. INTERVENTION: The 6-week self-stretching program for pectoralis minor, posterior capsule, levator scapula, and latissimus dorsi was performed. MAIN OUTCOME MEASURES: Posterior capsule tightness, pectoralis minor tightness, pain severity (visual analog scale), and self-reported shoulder-related pain and disability status (Shoulder Pain and Disability Index) were used to assess changes in flexibility and symptoms. RESULTS: Comparisons showed that there was significantly less posterior capsule and pectoralis minor tightness, less pain severity on activity and at night, and a lower disability score reported after the 6-week stretching program (P < 0.05). There was no statistically significant difference in pain severity at rest after the 6-week stretching program (P > 0.05). CONCLUSIONS: The findings of the study showed that flexibility, pain severity, and disability gains can be achieved with a 6-week stretching exercise training for participants with SIS. Therefore, shoulder girdle stretching exercises should be recommended early in shoulder rehabilitation program.

Neck and Scapula-Focused Exercise Training on Patients With Nonspecific Neck Pain: A Randomized Controlled Trial.

OBJECTIVES: The purpose of this study was to investigate the effects of additional 6-week scapular stabilization training in patients with nonspecific neck pain (NNP). MATERIALS AND METHODS: A total of 30 patients with NNP were randomly allocated to the study. Fifteen participants in the intervention group received neck-focused exercise and scapular stabilization training, whereas 15 participants in the control group received neck-focused exercise training. All groups were evaluated at baseline and after 6 weeks of rehabilitation. The pain intensity on the neck was measured with the visual analog scale (VAS). The self-reported disability status was measured with the neck disability index (NDI). Three-dimensional scapular kinematics were recorded during dynamic shoulder elevation trials using an electromagnetic tracking device, and data were further analyzed at 30°, 60°, 90°, and 120° of humerothoracic elevations. RESULTS: Comparisons revealed that, regardless of the received treatment, after 6 weeks of training both groups showed significant improvements in VAS (P < .001) and NDI (P < .001) scores. Both VAS and NDI outcomes have a large effect size (r = .618 and r = .619, respectively). For scapular kinematics, there were no group differences, especially for scapular upward-downward rotation and anterior-posterior tilt (P > .05). However, in the intervention group, the scapula was more externally rotated at 120° humerothoracic elevation (P = .04). CONCLUSION: Findings of this study showed that both manual therapy and active interventions, including neck-focused exercise and scapular stabilization training, are effective in decreasing pain and disability level in patients with NNP. More comprehensive studies with longer follow-up durations are needed to better understand the potential effects of scapular stabilization training in patients with NNP.

Effects of Scapular Stabilization Exercise Training on Scapular Kinematics, Disability, and Pain in Subacromial Impingement: A Randomized Controlled Trial.

OBJECTIVE: To investigate the effects of 2 different exercise programs on 3-dimensional scapular kinematics, disability, and pain in participants with subacromial impingement syndrome (SIS). DESIGN: Randomized controlled trial. SETTING: Outpatient clinic and research laboratory. PARTICIPANTS: Participants who were diagnosed with SIS and who also exhibited scapular dyskinesis (N=30). INTERVENTIONS: The participants were randomized in 2 different exercise groups: (1) shoulder girdle stretching and strengthening with additional scapular stabilization exercises based on a kinetic chain approach (intervention group), and (2) shoulder girdle stretching and strengthening exercises only (control group). MAIN OUTCOME MEASURES: Three-dimensional scapular kinematics, self-reported shoulder pain, and disability were evaluated at baseline, after 6 weeks of training, and after 12 weeks of training. RESULTS: Significant differences were observed between the control and intervention groups in external rotation and posterior tilt after 6 weeks of training and in external rotation, posterior tilt, and upward rotation after 12 weeks of training. All groups showed improvement in self-reported pain and disability scores; however, there were no significant differences between the groups. CONCLUSIONS: Progressive exercise training independent from specific scapular stabilization exercises provides decreased disability and pain severity in impingement syndrome.

Translation and cross-cultural adaptation of the anterior cruciate ligament-return to sport after injury (ACL-RSI) scale into Turkish.

PURPOSE: To translate and culturally adapt the anterior cruciate ligament-return to sport after injury (ACL-RSI) scale into Turkish (ACL-RSI-Tr) and examine and evaluate the psychometric properties of the Turkish version in individuals who have undergone anterior cruciate ligament (ACL) reconstruction. METHODS: The ACL-RSI was forward- and back-translated, culturally adapted and validated on ninety-three Turkish individuals who had undergone ACL reconstruction (5 females, 88 males; age 28.7 ± 8.6 years; body mass 80.1 ± 13.9 kg; height 178.8 ± 6.9 cm; body mass index 25.0 ± 3.7 kg/m2). All patients completed the translated ACL-RSI, Tampa Scale of Kinesiophobia (TSK), Knee injury and Osteoarthritis Outcome Score (KOOS) and International Knee Documentary Committee (IKDC) and Lysholm questionnaires. We then analysed the internal consistency, reliability and validity of the newly formed ACL-RSI-Tr scale. RESULTS: The ACL-RSI-Tr showed good internal consistency (Cronbach's alpha 0.86) and test-retest reliability (ICC 0.92) and was significantly correlated with the KOOS 'quality of life' (r = 0.58, p < 0.002), 'symptoms and stiffness' (r = 0.35, p = 0.001), 'pain' (r = 0.49, p < 0.001), 'sports' (r = 0.44, p < 0.001) and 'daily life' (r = 0.42, p < 0.001) subscales. The ACL-RSI-Tr also correlated significantly with the TSK (r = - 0.45, p < 0.001), Lysholm (r = 0.45, p < 0.001) and IKDC (r = 0.44, p < 0.001) scores. CONCLUSIONS: The Turkish version of the ACL-RSI scale was valid, discriminant, consistent and reliable in patients who had undergone ACL reconstruction. This score could be useful to evaluate the effect of psychological factors on return to sport following ACL surgery. LEVEL OF EVIDENCE: Diagnostic study, Level I.

Relationship between kinesiophobia and pain, quality of life, functional status, disease activity, mobility, and depression in patients with ankylosing spondylitis

Background/aim: Our aim was to investigate the association of kinesiophobia with pain, quality of life, clinical measures, and depression in patients with ankylosing spondylitis (AS). Materials and methods: Patients with AS (n: 163) were enrolled in the study. Kinesiophobia was evaluated with the Tampa Scale of Kinesiophobia (TSK), pain with a visual analog scale (VAS), mobility with Bath Ankylosing Spondylitis Metrology Index (BASMI), disease activity with the Bath AS Disease Activity Index (BASDAI), functional status with the Bath AS Functional Index (BASFI), depression level with Beck's Depression Inventory (BDI), and quality of life with the AS Quality of Life Questionnaire (ASQoL). Besides correlation analysis, outcome measures were compared between patients with (TSK ? 37) and without (TSK < 37) kinesiophobia. Results: Kinesiophobia was found to be common with a percentage of 66.6%. TSK scores were correlated with VAS, BASFI, ASQoL, and BDI scores (r = 0.259, r = 0.294, r = 0.392, and r = 0.398, respectively; P < 0.05 for each). There were no correlations between TSK and the BASDAI and BASMI scores (r = 0.142, r = 0.198, respectively; P > 0.05). Patients with kinesiophobia had more pain and poorer BASFI, ASQoL, and BDI scores than patients without kinesiophobia (P < 0.05).Conclusion: Our study is the first study that investigated the relationship between kinesiophobia and other clinical measures in AS patients. Pain and psychological status have an impact on fear of movement and thus functional status and quality of life.

Effect of trapezius muscle strength on three-dimensional scapular kinematics.

[Purpose] This study aimed to investigate the effect of trapezius muscle isometric strength on three-dimensional scapular kinematics in asymptomatic shoulders. [Subjects and Methods] Thirty asymptomatic subjects were included to the study. Isometric strengths of the upper, middle, and lower trapezius muscle were measured using a handheld dynamometer. Three-dimensional scapular kinematics was recorded by an electromagnetic tracking device during frontal and sagittal plane elevation. For each muscle, the cut-off value for muscle strength was determined with the upper bound of the 95% confidence interval, and Student's t-test was used to compare the scapular kinematics between subjects with relatively weaker or stronger trapezius muscles. [Results] Shoulders with stronger upper trapezius muscles showed greater upward scapular rotation at 30°, 60°, 90°, and 120° of elevation in the frontal plane. Shoulders with stronger middle trapezius had greater scapular upward rotation at 90° of elevation in the frontal plane. Shoulders with stronger lower trapezius showed greater scapular posterior tilt at 90° of elevation in the sagittal plane. [Conclusion] This study's findings showed that isometric strength of the trapezius muscle affects upward scapular rotation and posterior tilt in asymptomatic shoulders. Therefore, trapezius muscle strength should be assessed and potential weakness should be addressed in shoulder rehabilitation programs.