xml: <clinical_study>
    <!-- This xml conforms to an XML Schema at:
      https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
    <required_header>
      <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
      <link_text>Link to the current ClinicalTrials.gov record.</link_text>
      <url>https://clinicaltrials.gov/ct2/show/NCT05976035</url>
    </required_header>
    <id_info>
      <org_study_id>A-3456789876</org_study_id>
      <nct_id>NCT05976035</nct_id>
    </id_info>
    <brief_title>Exercise vs. Supplements in Rotator Cuff-Related Shoulder Pain</brief_title>
    <official_title>Do Taking Supplements Provide Additional Benefits in Rotator Cuff-Related Shoulder Pain?</official_title>
    <sponsors>
      <lead_sponsor>
        <agency>Istanbul University - Cerrahpasa (IUC)</agency>
        <agency_class>Other</agency_class>
      </lead_sponsor>
    </sponsors>
    <source>Istanbul University - Cerrahpasa (IUC)</source>
    <oversight_info>
      <has_dmc>No</has_dmc>
      <is_fda_regulated_drug>No</is_fda_regulated_drug>
      <is_fda_regulated_device>No</is_fda_regulated_device>
    </oversight_info>
    <brief_summary>
      <textblock>
        Rotator cuff-related shoulder pain is a pathology characterized by pain and functional&#xD;
        impairment originating from one or more rotator cuff tendons. The lifetime incidence of&#xD;
        rotator cuff-related shoulder pain is around 67%, with an annual incidence exceeding 1%. Many&#xD;
        patients continue to experience pain and functional loss for up to one year, and more than&#xD;
        half of the patients report shoulder pain persisting for over three years.&#xD;
  &#xD;
        The pathophysiology underlying rotator cuff-related shoulder pain continues to be a subject&#xD;
        of ongoing research and uncertainty, with many aspects yet to be fully elucidated. The most&#xD;
        common belief regarding its pathogenesis involves the role of inflammation. This hypothesis&#xD;
        is supported by the accumulation of inflammatory cells in tendons, oxidative stress, and&#xD;
        increased levels of pro-inflammatory cytokines. In tendon pathologies with inflammatory cell&#xD;
        accumulation and increased cytokine levels, the use of antioxidants and anti-inflammatory&#xD;
        agents in addition to conservative treatment contributes to tendon healing. Anti-oxidants and&#xD;
        anti-inflammatories are substances capable of preventing or delaying certain cell damage.The&#xD;
        use of anti-inflammatory and antioxidant supplements such as Vitamin C (Vit-C), Vitamin D&#xD;
        (Vit-D), Omega-3, and Magnesium (Mg) is recommended. Despite indicating exercise as the gold&#xD;
        standard for managing rotator cuff-related shoulder pain and the demonstrated&#xD;
        anti-inflammatory and anti-oxidant properties of the mentioned supplements, there are still&#xD;
        gaps in the understanding of their effectiveness in rotator cuff-related shoulder pain.&#xD;
  &#xD;
        Based on these gaps, the goal of this study is to investigate the effects of supplements&#xD;
        (Vit-C, Vit-D, Omega-3, and Mg) given in addition to exercise on patients' blood parameters&#xD;
        (TNF-a, IL-6, and CRP levels), pain, functional status, quality of life, and patient&#xD;
        satisfaction in individuals with rotator cuff-related shoulder pain.&#xD;
      </textblock>
    </brief_summary>
    <detailed_description>
      <textblock>
        58 participants older than 40 years of age with rotator cuff-related shoulder pain for at&#xD;
        least 3 months will be included in the study. Signed voluntary consent will be obtained from&#xD;
        the patients. Participants will be divided into two groups. Study groups will be as follows:&#xD;
        a) Exercise &amp; Supplement Group and b) Exercise Group.&#xD;
      </textblock>
    </detailed_description>
    <overall_status>Not yet recruiting</overall_status>
    <start_date type="Anticipated">January 1, 2024</start_date>
    <completion_date type="Anticipated">April 1, 2025</completion_date>
    <primary_completion_date type="Anticipated">January 1, 2025</primary_completion_date>
    <phase>N/A</phase>
    <study_type>Interventional</study_type>
    <has_expanded_access>No</has_expanded_access>
    <study_design_info>
      <allocation>Randomized</allocation>
      <intervention_model>Parallel Assignment</intervention_model>
      <intervention_model_description>Participants will be divided into two groups with equal numbers by computer randomization method.</intervention_model_description>
      <primary_purpose>Treatment</primary_purpose>
      <masking>Single (Outcomes Assessor)</masking>
      <masking_description>The investigator administering the treatment and the investigator performing the assessment will be different. The assessor will not know about the interventions that the participants received.</masking_description>
    </study_design_info>
    <primary_outcome>
      <measure>Visual Analog Scale (VAS)</measure>
      <time_frame>change from baseline pain at 12 weeks</time_frame>
      <description>The scale has range 0 to 10mm. The left side (0mm) shows no pain, and the right side (10mm) shows the most severe pain imaginable. Patients will be asked to mark the severity of their shoulder pain at a point on the scale using this scale. Higher points indicate higher severity and lower points indicate lower severity.</description>
    </primary_outcome>
    <primary_outcome>
      <measure>The American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (ASES)</measure>
      <time_frame>change from baseline pain at 12 weeks</time_frame>
      <description>Among the self-assessment of the patients, there are 11 items including pain level and functionality. For pain in scoring, they describe pain of increasing severity between 0 and 10; In functionality, a 4-point Likert-type scale is used to determine whether they can perform activities of daily living or not. The total score ranges from 0 (absence of function) to 100 (normal function).</description>
    </primary_outcome>
    <primary_outcome>
      <measure>Quick Disabilities of The Arm, Shoulder and Hand Questionnaire (Quick DASH)</measure>
      <time_frame>change from baseline pain at 12 weeks</time_frame>
      <description>Quick DASH is an 11-item questionnaire used to assess upper extremity functionality. The score ranges from 0 (no injury) to 100 (most severe injury).</description>
    </primary_outcome>
    <secondary_outcome>
      <measure>Rotator Cuff Quality of Life (RC-QoL)</measure>
      <time_frame>3 times for 12 weeks</time_frame>
      <description>It is a self-assessment questionnaire consisting of a total of 34 questions and 5 sections assessing the disease-specific quality of life. Each question is assessed on a 100 mm visual analog scale, with 0 representing the lowest score and 100 the best score, and the total score is given as a percentage. Low scores represent low quality of life.</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>Global Rating of Change Scale (GRC)</measure>
      <time_frame>3 times for 12 weeks</time_frame>
      <description>It is a scale to evaluate patient satisfaction. It is designed to determine the extent to which the patient improves or worsens over time. In our study, the change between the pre-treatment status of the participants and their current status at the 8th and 12th weeks after the treatment will be questioned. In our study, GRC consisting of 5 levels between -2 and +2 value ranges (-2: I am much worse, -1: I am worse, 0: I am the same, 1: I am better, 2: I am much better) will be preferred.</description>
    </secondary_outcome>
    <number_of_arms>2</number_of_arms>
    <enrollment type="Anticipated">58</enrollment>
    <condition>Rotator Cuff Syndrome</condition>
    <arm_group>
      <arm_group_label>Exercise &amp; Supplement Group</arm_group_label>
      <arm_group_type>Active Comparator</arm_group_type>
      <description>Exercise &amp; Supplement group will take supplements that are prescribed by the orthopedist every day for 8 weeks in addition to a structured exercise program under the supervision of a physiotherapist 3 days per week for 8 weeks.</description>
    </arm_group>
    <arm_group>
      <arm_group_label>Exercise Group</arm_group_label>
      <arm_group_type>Active Comparator</arm_group_type>
      <description>Exercise group will follow a structured exercise program under the supervision of a physiotherapist 3 days per week for 8 weeks.</description>
    </arm_group>
    <intervention>
      <intervention_type>Other</intervention_type>
      <intervention_name>Exercise</intervention_name>
      <description>Structured exercise program under the supervision of a physiotherapist 3 days per week for 8 weeks</description>
      <arm_group_label>Exercise &amp; Supplement Group</arm_group_label>
      <arm_group_label>Exercise Group</arm_group_label>
    </intervention>
    <intervention>
      <intervention_type>Other</intervention_type>
      <intervention_name>Supplement</intervention_name>
      <description>Receiving supplement that are prescribed by a orthopedist every day for 8 weeks</description>
      <arm_group_label>Exercise &amp; Supplement Group</arm_group_label>
    </intervention>
    <eligibility>
      <criteria>
        <textblock>
          Inclusion Criteria:&#xD;
  &#xD;
            -  Being over the age of 40&#xD;
  &#xD;
            -  Diagnosing with rotator cuff-related shoulder pain confirming through clinical&#xD;
               examination (Hawkins Kennedy and Empty Can tests) and MRI imaging&#xD;
  &#xD;
            -  Having shoulder pain for at least three months&#xD;
  &#xD;
          Exclusion Criteria:&#xD;
  &#xD;
            -  Having full-thickness or massive rotator cuff tear,&#xD;
  &#xD;
            -  Having a history of symptoms onset due to trauma,&#xD;
  &#xD;
            -  Having a history of surgery on the same shoulder,&#xD;
  &#xD;
            -  Having shoulder passive external rotation &lt;30° and flexion &lt;120°,&#xD;
  &#xD;
            -  Having shoulder instability,&#xD;
  &#xD;
            -  Having an allergy to any supplement,&#xD;
  &#xD;
            -  Having psychological, emotional, or cognitive problems&#xD;
  &#xD;
            -  Presence of shoulder problems caused by systemic diseases,&#xD;
  &#xD;
            -  Presence of diabetes, presence of pregnancy or breastfeeding,&#xD;
  &#xD;
            -  Malignancy.&#xD;
        </textblock>
      </criteria>
      <gender>All</gender>
      <minimum_age>40 Years</minimum_age>
      <maximum_age>65 Years</maximum_age>
      <healthy_volunteers>No</healthy_volunteers>
    </eligibility>
    <overall_official>
      <last_name>Derya Çelik, Prof.</last_name>
      <role>Study Director</role>
      <affiliation>Istanbul University - Cerrahpasa (IUC)</affiliation>
    </overall_official>
    <overall_contact>
      <last_name>Derya Çelik, Prof</last_name>
      <phone>+905327940169</phone>
      <email>derya.celik@iuc.edu.tr</email>
    </overall_contact>
    <location>
      <facility>
        <name>Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpaşa</name>
        <address>
          <city>Istanbul</city>
          <zip>34500</zip>
          <country>Turkey</country>
        </address>
      </facility>
      <contact>
        <last_name>Derya Çelik, Prof</last_name>
        <phone>+905327940169</phone>
        <email>derya.celik@iuc.edu.tr</email>
      </contact>
    </location>
    <location_countries>
      <country>Turkey</country>
    </location_countries>
    <reference>
      <citation>Lewis J, McCreesh K, Roy JS, Ginn K. Rotator Cuff Tendinopathy: Navigating the Diagnosis-Management Conundrum. J Orthop Sports Phys Ther. 2015 Nov;45(11):923-37. doi: 10.2519/jospt.2015.5941. Epub 2015 Sep 21.</citation>
      <PMID>26390274</PMID>
    </reference>
    <reference>
      <citation>Luime JJ, Koes BW, Hendriksen IJ, Burdorf A, Verhagen AP, Miedema HS, Verhaar JA. Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol. 2004;33(2):73-81. doi: 10.1080/03009740310004667.</citation>
      <PMID>15163107</PMID>
    </reference>
    <reference>
      <citation>Tashjian RZ. Epidemiology, natural history, and indications for treatment of rotator cuff tears. Clin Sports Med. 2012 Oct;31(4):589-604. doi: 10.1016/j.csm.2012.07.001. Epub 2012 Aug 30.</citation>
      <PMID>23040548</PMID>
    </reference>
    <reference>
      <citation>Macfarlane GJ, Hunt IM, Silman AJ. Predictors of chronic shoulder pain: a population based prospective study. J Rheumatol. 1998 Aug;25(8):1612-5.</citation>
      <PMID>9712108</PMID>
    </reference>
    <reference>
      <citation>Litchfield R. Progressive strengthening exercises for subacromial impingement syndrome. Clin J Sport Med. 2013 Jan;23(1):86-7. doi: 10.1097/JSM.0b013e31827e9fb5.</citation>
      <PMID>23269329</PMID>
    </reference>
    <reference>
      <citation>Vaysman M, Alben M, Todd M, Ruotolo C. Pharmacologic Enhancement of Rotator Cuff Repair: A Narrative Review. Orthop Rev (Pavia). 2022 Sep 4;14(3):37782. doi: 10.52965/001c.37782. eCollection 2022.</citation>
      <PMID>36072503</PMID>
    </reference>
    <reference>
      <citation>Yuan T, Qian H, Yu X, Meng J, Lai CT, Jiang H, Zhao JN, Bao NR. Proteomic analysis reveals rotator cuff injury caused by oxidative stress. Ther Adv Chronic Dis. 2021 Mar 17;12:2040622320987057. doi: 10.1177/2040622320987057. eCollection 2021.</citation>
      <PMID>33796243</PMID>
    </reference>
    <reference>
      <citation>Metsios GS, Moe RH, Kitas GD. Exercise and inflammation. Best Pract Res Clin Rheumatol. 2020 Apr;34(2):101504. doi: 10.1016/j.berh.2020.101504. Epub 2020 Apr 2.</citation>
      <PMID>32249021</PMID>
    </reference>
    <reference>
      <citation>Delgado DA, Lambert BS, Boutris N, McCulloch PC, Robbins AB, Moreno MR, Harris JD. Validation of Digital Visual Analog Scale Pain Scoring With a Traditional Paper-based Visual Analog Scale in Adults. J Am Acad Orthop Surg Glob Res Rev. 2018 Mar 23;2(3):e088. doi: 10.5435/JAAOSGlobal-D-17-00088. eCollection 2018 Mar.</citation>
      <PMID>30211382</PMID>
    </reference>
    <reference>
      <citation>Celik D, Atalar AC, Demirhan M, Dirican A. Translation, cultural adaptation, validity and reliability of the Turkish ASES questionnaire. Knee Surg Sports Traumatol Arthrosc. 2013 Sep;21(9):2184-9. doi: 10.1007/s00167-012-2183-3. Epub 2012 Aug 30.</citation>
      <PMID>22932692</PMID>
    </reference>
    <reference>
      <citation>Beaton DE, Wright JG, Katz JN; Upper Extremity Collaborative Group. Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am. 2005 May;87(5):1038-46. doi: 10.2106/JBJS.D.02060.</citation>
      <PMID>15866967</PMID>
    </reference>
    <reference>
      <citation>Cinar-Medeni O, Ozengin N, Baltaci G, Duzgun I. Turkish version of the Rotator Cuff Quality of Life questionnaire in rotator cuff-impaired patients. Knee Surg Sports Traumatol Arthrosc. 2015 Feb;23(2):591-5. doi: 10.1007/s00167-014-3290-0. Epub 2014 Sep 11.</citation>
      <PMID>25209207</PMID>
    </reference>
    <reference>
      <citation>Kamper SJ, Maher CG, Mackay G. Global rating of change scales: a review of strengths and weaknesses and considerations for design. J Man Manip Ther. 2009;17(3):163-70. doi: 10.1179/jmt.2009.17.3.163.</citation>
      <PMID>20046623</PMID>
    </reference>
    <reference>
      <citation>Matthews TJ, Hand GC, Rees JL, Athanasou NA, Carr AJ. Pathology of the torn rotator cuff tendon. Reduction in potential for repair as tear size increases. J Bone Joint Surg Br. 2006 Apr;88(4):489-95. doi: 10.1302/0301-620X.88B4.16845.</citation>
      <PMID>16567784</PMID>
    </reference>
    <reference>
      <citation>Millar NL, Hueber AJ, Reilly JH, Xu Y, Fazzi UG, Murrell GA, McInnes IB. Inflammation is present in early human tendinopathy. Am J Sports Med. 2010 Oct;38(10):2085-91. doi: 10.1177/0363546510372613. Epub 2010 Jul 1.</citation>
      <PMID>20595553</PMID>
    </reference>
    <reference>
      <citation>Andersson G, Backman LJ, Scott A, Lorentzon R, Forsgren S, Danielson P. Substance P accelerates hypercellularity and angiogenesis in tendon tissue and enhances paratendinitis in response to Achilles tendon overuse in a tendinopathy model. Br J Sports Med. 2011 Oct;45(13):1017-22. doi: 10.1136/bjsm.2010.082750. Epub 2011 May 2.</citation>
      <PMID>21540192</PMID>
    </reference>
    <verification_date>August 2023</verification_date>
    <study_first_submitted>July 27, 2023</study_first_submitted>
    <study_first_submitted_qc>July 27, 2023</study_first_submitted_qc>
    <study_first_posted type="Actual">August 4, 2023</study_first_posted>
    <last_update_submitted>August 8, 2023</last_update_submitted>
    <last_update_submitted_qc>August 8, 2023</last_update_submitted_qc>
    <last_update_posted type="Actual">August 9, 2023</last_update_posted>
    <responsible_party>
      <responsible_party_type>Principal Investigator</responsible_party_type>
      <investigator_affiliation>Istanbul University - Cerrahpasa (IUC)</investigator_affiliation>
      <investigator_full_name>Aysenur Erekdag</investigator_full_name>
      <investigator_title>Principal Investigator</investigator_title>
    </responsible_party>
    <keyword>Exercise</keyword>
    <keyword>Physical Therapy</keyword>
    <keyword>Anti-oxidant</keyword>
    <keyword>Anti-Inflammatory</keyword>
    <condition_browse>
      <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
      <mesh_term>Shoulder Pain</mesh_term>
    </condition_browse>
    <!-- Results have not yet been posted for this study                                          -->
  </clinical_study>
  
  
text: download date: ClinicalTrials.gov processed this data on September 20, 2023
  link text: Link to the current ClinicalTrials.gov record.
  url: https://clinicaltrials.gov/ct2/show/NCT05976035
  org study id: A-3456789876
  nct id: NCT05976035
  lead sponsor: 
  has dmc: No
  is fda regulated drug: No
  is fda regulated device: No
  Rotator cuff-related shoulder pain is a pathology characterized by pain and functional
        impairment originating from one or more rotator cuff tendons. The lifetime incidence of
        rotator cuff-related shoulder pain is around 67%, with an annual incidence exceeding 1%. Many
        patients continue to experience pain and functional loss for up to one year, and more than
        half of the patients report shoulder pain persisting for over three years.
  
        The pathophysiology underlying rotator cuff-related shoulder pain continues to be a subject
        of ongoing research and uncertainty, with many aspects yet to be fully elucidated. The most
        common belief regarding its pathogenesis involves the role of inflammation. This hypothesis
        is supported by the accumulation of inflammatory cells in tendons, oxidative stress, and
        increased levels of pro-inflammatory cytokines. In tendon pathologies with inflammatory cell
        accumulation and increased cytokine levels, the use of antioxidants and anti-inflammatory
        agents in addition to conservative treatment contributes to tendon healing. Anti-oxidants and
        anti-inflammatories are substances capable of preventing or delaying certain cell damage.The
        use of anti-inflammatory and antioxidant supplements such as Vitamin C (Vit-C), Vitamin D
        (Vit-D), Omega-3, and Magnesium (Mg) is recommended. Despite indicating exercise as the gold
        standard for managing rotator cuff-related shoulder pain and the demonstrated
        anti-inflammatory and anti-oxidant properties of the mentioned supplements, there are still
        gaps in the understanding of their effectiveness in rotator cuff-related shoulder pain.
  
        Based on these gaps, the goal of this study is to investigate the effects of supplements
        (Vit-C, Vit-D, Omega-3, and Mg) given in addition to exercise on patients' blood parameters
        (TNF-a, IL-6, and CRP levels), pain, functional status, quality of life, and patient
        satisfaction in individuals with rotator cuff-related shoulder pain.
  58 participants older than 40 years of age with rotator cuff-related shoulder pain for at
        least 3 months will be included in the study. Signed voluntary consent will be obtained from
        the patients. Participants will be divided into two groups. Study groups will be as follows:
        a) Exercise & Supplement Group and b) Exercise Group.
  allocation: Randomized
  intervention model: Parallel Assignment
  intervention model description: Participants will be divided into two groups with equal numbers by computer randomization method.
  primary purpose: Treatment
  masking: Single (Outcomes Assessor)
  masking description: The investigator administering the treatment and the investigator performing the assessment will be different. The assessor will not know about the interventions that the participants received.
  measure: Visual Analog Scale (VAS)
  time frame: change from baseline pain at 12 weeks
  description: The scale has range 0 to 10mm. The left side (0mm) shows no pain, and the right side (10mm) shows the most severe pain imaginable. Patients will be asked to mark the severity of their shoulder pain at a point on the scale using this scale. Higher points indicate higher severity and lower points indicate lower severity.
  measure: The American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (ASES)
  time frame: change from baseline pain at 12 weeks
  description: Among the self-assessment of the patients, there are 11 items including pain level and functionality. For pain in scoring, they describe pain of increasing severity between 0 and 10; In functionality, a 4-point Likert-type scale is used to determine whether they can perform activities of daily living or not. The total score ranges from 0 (absence of function) to 100 (normal function).
  measure: Quick Disabilities of The Arm, Shoulder and Hand Questionnaire (Quick DASH)
  time frame: change from baseline pain at 12 weeks
  description: Quick DASH is an 11-item questionnaire used to assess upper extremity functionality. The score ranges from 0 (no injury) to 100 (most severe injury).
  measure: Rotator Cuff Quality of Life (RC-QoL)
  time frame: 3 times for 12 weeks
  description: It is a self-assessment questionnaire consisting of a total of 34 questions and 5 sections assessing the disease-specific quality of life. Each question is assessed on a 100 mm visual analog scale, with 0 representing the lowest score and 100 the best score, and the total score is given as a percentage. Low scores represent low quality of life.
  measure: Global Rating of Change Scale (GRC)
  time frame: 3 times for 12 weeks
  description: It is a scale to evaluate patient satisfaction. It is designed to determine the extent to which the patient improves or worsens over time. In our study, the change between the pre-treatment status of the participants and their current status at the 8th and 12th weeks after the treatment will be questioned. In our study, GRC consisting of 5 levels between -2 and +2 value ranges (-2: I am much worse, -1: I am worse, 0: I am the same, 1: I am better, 2: I am much better) will be preferred.
  arm group label: Exercise & Supplement Group
  arm group type: Active Comparator
  description: Exercise & Supplement group will take supplements that are prescribed by the orthopedist every day for 8 weeks in addition to a structured exercise program under the supervision of a physiotherapist 3 days per week for 8 weeks.
  arm group label: Exercise Group
  arm group type: Active Comparator
  description: Exercise group will follow a structured exercise program under the supervision of a physiotherapist 3 days per week for 8 weeks.
  intervention type: Other
  intervention name: Exercise
  description: Structured exercise program under the supervision of a physiotherapist 3 days per week for 8 weeks
  arm group label: Exercise & Supplement Group
  arm group label: Exercise Group
  intervention type: Other
  intervention name: Supplement
  description: Receiving supplement that are prescribed by a orthopedist every day for 8 weeks
  arm group label: Exercise & Supplement Group
  criteria: 
  gender: All
  minimum age: 40 Years
  maximum age: 65 Years
  healthy volunteers: No
  last name: Derya Çelik, Prof.
  role: Study Director
  affiliation: Istanbul University - Cerrahpasa (IUC)
  last name: Derya Çelik, Prof
  phone: +905327940169
  email: derya.celik@iuc.edu.tr
  facility: 
  contact: 
  country: Turkey
  citation: Lewis J, McCreesh K, Roy JS, Ginn K. Rotator Cuff Tendinopathy: Navigating the Diagnosis-Management Conundrum. J Orthop Sports Phys Ther. 2015 Nov;45(11):923-37. doi: 10.2519/jospt.2015.5941. Epub 2015 Sep 21.
  PMID: 26390274
  citation: Luime JJ, Koes BW, Hendriksen IJ, Burdorf A, Verhagen AP, Miedema HS, Verhaar JA. Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol. 2004;33(2):73-81. doi: 10.1080/03009740310004667.
  PMID: 15163107
  citation: Tashjian RZ. Epidemiology, natural history, and indications for treatment of rotator cuff tears. Clin Sports Med. 2012 Oct;31(4):589-604. doi: 10.1016/j.csm.2012.07.001. Epub 2012 Aug 30.
  PMID: 23040548
  citation: Macfarlane GJ, Hunt IM, Silman AJ. Predictors of chronic shoulder pain: a population based prospective study. J Rheumatol. 1998 Aug;25(8):1612-5.
  PMID: 9712108
  citation: Litchfield R. Progressive strengthening exercises for subacromial impingement syndrome. Clin J Sport Med. 2013 Jan;23(1):86-7. doi: 10.1097/JSM.0b013e31827e9fb5.
  PMID: 23269329
  citation: Vaysman M, Alben M, Todd M, Ruotolo C. Pharmacologic Enhancement of Rotator Cuff Repair: A Narrative Review. Orthop Rev (Pavia). 2022 Sep 4;14(3):37782. doi: 10.52965/001c.37782. eCollection 2022.
  PMID: 36072503
  citation: Yuan T, Qian H, Yu X, Meng J, Lai CT, Jiang H, Zhao JN, Bao NR. Proteomic analysis reveals rotator cuff injury caused by oxidative stress. Ther Adv Chronic Dis. 2021 Mar 17;12:2040622320987057. doi: 10.1177/2040622320987057. eCollection 2021.
  PMID: 33796243
  citation: Metsios GS, Moe RH, Kitas GD. Exercise and inflammation. Best Pract Res Clin Rheumatol. 2020 Apr;34(2):101504. doi: 10.1016/j.berh.2020.101504. Epub 2020 Apr 2.
  PMID: 32249021
  citation: Delgado DA, Lambert BS, Boutris N, McCulloch PC, Robbins AB, Moreno MR, Harris JD. Validation of Digital Visual Analog Scale Pain Scoring With a Traditional Paper-based Visual Analog Scale in Adults. J Am Acad Orthop Surg Glob Res Rev. 2018 Mar 23;2(3):e088. doi: 10.5435/JAAOSGlobal-D-17-00088. eCollection 2018 Mar.
  PMID: 30211382
  citation: Celik D, Atalar AC, Demirhan M, Dirican A. Translation, cultural adaptation, validity and reliability of the Turkish ASES questionnaire. Knee Surg Sports Traumatol Arthrosc. 2013 Sep;21(9):2184-9. doi: 10.1007/s00167-012-2183-3. Epub 2012 Aug 30.
  PMID: 22932692
  citation: Beaton DE, Wright JG, Katz JN; Upper Extremity Collaborative Group. Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am. 2005 May;87(5):1038-46. doi: 10.2106/JBJS.D.02060.
  PMID: 15866967
  citation: Cinar-Medeni O, Ozengin N, Baltaci G, Duzgun I. Turkish version of the Rotator Cuff Quality of Life questionnaire in rotator cuff-impaired patients. Knee Surg Sports Traumatol Arthrosc. 2015 Feb;23(2):591-5. doi: 10.1007/s00167-014-3290-0. Epub 2014 Sep 11.
  PMID: 25209207
  citation: Kamper SJ, Maher CG, Mackay G. Global rating of change scales: a review of strengths and weaknesses and considerations for design. J Man Manip Ther. 2009;17(3):163-70. doi: 10.1179/jmt.2009.17.3.163.
  PMID: 20046623
  citation: Matthews TJ, Hand GC, Rees JL, Athanasou NA, Carr AJ. Pathology of the torn rotator cuff tendon. Reduction in potential for repair as tear size increases. J Bone Joint Surg Br. 2006 Apr;88(4):489-95. doi: 10.1302/0301-620X.88B4.16845.
  PMID: 16567784
  citation: Millar NL, Hueber AJ, Reilly JH, Xu Y, Fazzi UG, Murrell GA, McInnes IB. Inflammation is present in early human tendinopathy. Am J Sports Med. 2010 Oct;38(10):2085-91. doi: 10.1177/0363546510372613. Epub 2010 Jul 1.
  PMID: 20595553
  citation: Andersson G, Backman LJ, Scott A, Lorentzon R, Forsgren S, Danielson P. Substance P accelerates hypercellularity and angiogenesis in tendon tissue and enhances paratendinitis in response to Achilles tendon overuse in a tendinopathy model. Br J Sports Med. 2011 Oct;45(13):1017-22. doi: 10.1136/bjsm.2010.082750. Epub 2011 May 2.
  PMID: 21540192
  responsible party type: Principal Investigator
  investigator affiliation: Istanbul University - Cerrahpasa (IUC)
  investigator full name: Aysenur Erekdag
  investigator title: Principal Investigator
  mesh term: Shoulder Pain