Elif Turgut

Three-dimensional scapular kinematics during open and closed kinetic chain movements in asymptomatic and symptomatic subjects.

The combination of open kinetic chain (OKC) and closed kinetic chain (CKC) exercises is commonly recommended in shoulder rehabilitation, aiming at improving strength and sport-specific performance. This study aimed to investigate the three-dimensional (3-D) scapular kinematics and bilateral symmetry of scapular motion during dynamic OKC and CKC movements in asymptomatic and symptomatic shoulders. Fifty subjects with unilateral shoulder pain (symptomatic subjects diagnosed with subacromial impingement syndrome, n=20) or without shoulder pain during active shoulder elevation (asymptomatic subjects, n=30) participated in the study. Furthermore, 3-D scapular kinematics were recorded using an electromagnetic tracking device in the sagittal plane of shoulder elevation for both the OKC and CKC conditions performed with slings. Data for scapular kinematics and symmetry angle (SA) were analyzed at 30°, 45°, 60°, 90°, and 120° of humerothoracic elevation. Analysis of variance models and Student׳s t-test were used to make comparisons between conditions. In general, the scapula was more externally rotated, upwardly rotated and anteriorly tilted for asymptomatic shoulders, and more upwardly rotated for symptomatic shoulders during CKC shoulder elevation. Further, comparisons of SA obtained during OKC and CKC movements revealed that during CKC, scapular motion was more symmetrical for upward-downward rotation and anterior-posterior tilt in asymptomatic shoulders and for anterior-posterior tilt in symptomatic shoulders, especially above 90° humerothoracic elevation. Differences in scapular motion during the CKC condition were in a specific pattern and enhanced symmetry, which would be considered to be a position less likely to produce compression of the rotator cuff tendons for both training in asymptomatic populations and for treatment in early rehabilitation of patients, such as those who have shoulder impingement syndrome.

The effect of Laser and taping on pain, functional status and quality of life in patients with fibromyalgia syndrome: A placebo- randomized controlled clinical trial

BACKGROUND Conservative treatments have been proved to be effective to control pain and optimize function in fibromyalgia, however there is need for scientific evidence to make better clinical application across various physiotherapy applications. OBJECTIVE The aim of this study was to investigate the effects of Laser and taping applications on pain, flexibility, anxiety, depression, functional status and quality of life in patients with fibromyalgia syndrome. METHODS Forty-five female patients with fibromyalgia syndrome were included to the study and randomly allocated into three treatment groups; Laser (n= 15), placebo Laser (n= 15), and taping applications (n= 15). Visual analogue scale for pain intensity, trunk flexibility, Fibromyalgia Impact Questionnaire for functional status, Short Form 36 Questionnaire for quality of life and health status, and Beck Depression Inventory for anxiety level were evaluated before and after three weeks interventions. RESULTS There were decreased pain severity in activity (p= 0.028), anxiety level (p= 0.01) and improved general health status, quality of life (p= 0.01) found at Laser group, whereas there were increased trunk flexibility, flexion (p= 0.03), extension (p= 0.02) found at taping group. After interventions, there were decreased pain severity for whole groups at night for Laser group (p= 0.04), placebo Laser group (p= 0.001), taping group (p= 0.01) and improved functional status found for Laser group (p= 0.001), placebo Laser group (p= 0.001), taping group (p= 0.01). CONCLUSIONS Kinesiotape application had a similar effect on parameters in FMS patient, so this method could be preferred instead of Laser application for rehabilitation program.

Scapular asymmetry in participants with and without shoulder impingement syndrome; a three-dimensional motion analysis

BACKGROUND This study analyzed the dynamic three-dimensional scapular kinematics and scapular asymmetry in participants with and without shoulder impingement syndrome. METHODS Twenty-nine participants with shoulder impingement syndrome, have been suffering from unilateral shoulder pain at the dominant arm lasting more than six weeks and thirty-seven healthy controls participated in the study. Scapular kinematics was measured with an electromagnetic tracking device during shoulder elevation in the sagittal plane. Data for bilateral scapular orientation were analyzed at 30°, 60°, 90°, and 120° of humerothoracic elevation and lowering. The symmetry angle was calculated to quantify scapular asymmetry throughout shoulder elevation. FINDINGS Statistical comparisons indicated that the scapula was more downwardly rotated (p<0.001) and anteriorly tilted (p=0.005) in participants with shoulder impingement syndrome compared to healthy controls. Side-to-side comparisons revealed that the scapula was more anteriorly tilted on the involved side of participants with shoulder impingement syndrome (p=0.01), and the scapula was rotated more internally (p=0.02) and downwardly (p=0.01) on the dominant side of healthy controls. Although there were side-to-side differences in both groups, symmetry angle calculation revealed that the scapular movement was more asymmetrical for scapular internal and upward rotation in individuals with shoulder impingement syndrome when compared with healthy controls (p<0.05). INTERPRETATION The findings of the study increase our knowledge and understanding of scapular alterations in symptomatic and asymptomatic populations, which creates biomechanical considerations for shoulder assessment and rehabilitation.

Distal radius fractures result in alterations in scapular kinematics: a three-dimensional motion analysis.

BACKGROUND Scapular motion is closely integrated with arm motion. Injury to a distal segment requires compensatory changes in the proximal segments leading to alterations in scapular motion. Since the effects of distal injuries on scapular kinematics remain unknown, in the present study we investigated the influences on scapular motion in patients with distal injuries. METHODS Sixteen subjects with a history of distal radius fracture and 20 asymptomatic healthy subjects (controls) participated in the study. Three-dimensional scapular and humeral kinematic data were collected on all 3 planes of shoulder elevation: frontal, sagittal, and scapular. All testing was performed in a single session; therefore, the sensors remained attached to the participants for all testing. The position and orientation data of the scapula at 30°, 60°, 90°, and 120° humerothoracic elevation and 120°, 90°, 60°, and 30° lowering were used for statistical comparisons. Independent samples t-test was used to compare the scapular internal/external rotation, upward/downward rotation, and anterior/posterior tilt between the affected side of subjects with a distal radius fracture and the dominant side of asymptomatic subjects at the same stage of humerothoracic elevation. FINDINGS Scapular internal rotation was significantly increased at 30° elevation (P=0.01), 90° elevation (P=0.03), and 30° lowering (P=0.03), and upward rotation was increased at 30° and 60° elevation (P<0.001) on the affected side during frontal plane elevation. Scapular upward rotation and anterior tilt were significantly increased during 30° lowering on both the scapular (P=0.002 and 0.02, respectively) and sagittal planes (P=0.01 and 0.02. respectively). INTERPRETATION Patients with distal radius fractures exhibit altered scapular kinematics, which may further contribute to the development of secondary musculoskeletal pathologies.

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.

Effects of slow and accelerated rehabilitation protocols on range of motion after arthroscopic rotator cuff repair

OBJECTIVE The aim of the study was to investigate the effects of the early initiation of passive and active range of motion exercises following arthroscopic rotator cuff repair. METHODS The study included 40 patients who underwent arthroscopic rotator cuff repair. Patients were quasi-randomly assigned into accelerated (ACCEL) protocol (n=19) and slow (SLOW) protocol (n=21) groups. Patients in both groups were treated with the same protocol. Active range of motion was begun at the 3rd week in the ACCEL group and the 6th week in the SLOW group. Range of motion was recorded at postoperative weeks 3, 5, 8, 12, and 24. RESULTS While active range of motion for all measurements improved across weeks, there were no differences between groups, with the exception of active total elevation which was greater at all time point measurements in the ACCEL group (p<0.05). CONCLUSION The early initiation of passive and gentle controlled active motion exercise following rotator cuff repairs does not appear to affect range of motion in the first 6 postoperative months.

Validity and Reliability of Visual Analog Scale Foot and Ankle: The Turkish Version

ABSTRACT The present study tested the reliability and validity of the Turkish version of the visual analog scale foot and ankle (VAS‐FA) among healthy subjects and patients with foot problems. A total of 128 participants, 65 healthy subjects and 63 patients with foot problems, were evaluated. The VAS‐FA was translated into Turkish and administered to the 128 subjects on 2 separate occasions with a 5‐day interval. The test–retest reliability and internal consistency were assessed with the intraclass correlation coefficient and Cronbachs &agr;. The validity was assessed using the correlations with Turkish versions of the Foot Function Index, the Foot and Ankle Outcome Score, and the Short‐Form 36‐item Health Survey. A statistically significant difference was found between the healthy group and the patient group in the overall score and subscale scores of the VAS‐FA (p < .001). The internal consistency of the VAS‐FA was very good, and the test–retest reliability was excellent. Adequate to good correlations were found between the overall VAS‐FA score and the Foot Function Index, Foot and Ankle Outcome Score, and Short‐Form 36‐item Health Survey scores in the healthy and patient groups both. The Turkish version of the VAS‐FA is sensitive enough to distinguish foot and ankle‐specific pathologic conditions from asymptomatic conditions. The Turkish version of the VAS‐FA is a reliable and valid method and can be used for foot‐related problems.

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.

Scapular motion adaptations in junior overhead athletes: a three-dimensional kinematic analysis in tennis players and non-overhead athletes

Abstract Adult overhead athletes without a history of shoulder injury show scapular adaptations. There is a lack of detailed assessment of scapular kinematics in junior overhead athletes. This study aims to investigate three-dimensional scapular kinematics in junior overhead athletes. We recruited a total of 20 junior tennis players and 20 healthy children without participation in any overhead sports in this study. Bilateral scapular kinematic data were recorded using an electromagnetic tracking device for scapular plane glenohumeral elevation. The data were further analysed at 30°, 45°, 60°, 90° and 120° during glenohumeral elevation and lowering. Statistical comparisons of the data between groups (junior overhead athletes and non-overhead athletes) and sides (serve dominant and non-dominant shoulders of the overhead athletes) were analysed with the ANOVA. Comparisons showed that, in general, the scapula was more upwardly rotated and anteriorly tilted in overhead athletes when compared to non-overhead athletes, however there was no side-to-side differences when serve dominant and non-dominant shoulders compared in junior overhead athletes. The serve dominant arm of junior overhead athletes had alternations in scapular kinematics when compared with the non-overhead athletes. These findings provide clinical evaluation implications and the need for clinicians to assess for potential adaptations in junior overhead athletes.

Effect of flexibility deficit on scapular asymmetry in individuals with and without shoulder pain

BACKGROUND Many studies have investigated the relationship between soft tissue tightness and shoulder kinematics. However, there is a lack of information on the dynamic properties responsible for side-to-side differences such as scapular asymmetry. OBJECTIVE To determine the relationship between a deficit in soft tissue flexibility and scapular asymmetry. METHODS A total of 58 individuals (29 patients with shoulder pain and 29 asymptomatic participants) were enrolled. Bilateral shortening of the pectoralis minor muscle and posterior shoulder tightness were assessed. Additionally, side-to-side flexibility deficit was calculated. Scapular kinematics were measured with an electromagnetic tracking device while individuals were standing in a resting position and during arm elevation. The symmetry angle was calculated to quantify scapular asymmetry. RESULTS The pectoralis minor and the posterior capsule flexibility deficit showed a significant positive relationship with the symmetry angle in the resting position separately for both asymptomatic (r=0.47, r=0.37 relatively) and symptomatic groups (r=0.58, r=0.38 relatively), indicating that the increased deficit in the pectoralis minor and posterior capsule flexibility were associated with increased scapular asymmetry. However, no significant relationship was found between flexibility deficit and scapular asymmetry during arm elevation and lowering for both asymptomatic and symptomatic groups. CONCLUSION The findings of the study provided information on the relationship of a flexibility deficit on the scapular position and orientation in asymptomatic and symptomatic populations.